514 Historical Summit on Integrative Medicine Furthermore, when we seek ‘evidence’, we should not only evaluate evidence obtained from randomized double-blind trials, but we should also evaluate evidence from outcome studies, cost-effectiveness studies, and when possible and appropriate, basic science trials. We need to remember that we today accept most surgical practices even though the vast majority of them have not been proven to be effective based on double-blind placebo-controlled trials. Few people consider surgery to be ‘unscientific’ just because it is not viable to conduct placebo-controlled trials. And yet, many physicians, scientists and health policy analysts assume certain that some alternative treatment methods are unscientific because they too cannot be evaluated in placebo- controlled trials (how does one give a placebo meditation or a placebo yoga posture?). Likewise, many treatments that ‘integrative practi- tioners’ use comprise a ‘package of treatments’ that include various dietary changes, vitamin and mineral supplements, herbal remedies, homeopathic medicines, yoga practice, stress management methods and so on. Evaluations of the outcomes of such packages of treat- ment are truly necessary. At this summit, there were several professors of genetics and other basic sciences who discussed the most recent scientific discoveries in their fields. However, I was a bit surprised at the casual reference to ‘genetic causes’ of illness and to new (and old) infective agents that ‘cause’ this or that disease. My concern here is that because language is so important, it is necessary that we draw from systems biology and systems thinking to realize that it is more accurate to say that these influences are ‘co-factors’ to diseases, not causes of them. The concept of causality tends to be linear, when, in fact, cause is rarely so simple. The susceptibility of the host always influences whether infective agent leads to disease or not, and as Dean Ornish and others have now noted, even genetic status of an individual can be altered. Finally, we must be more humble in how we all make use of the words and concepts of ‘scientific medicine’. An IOM special report, ‘Informing the Future: Critical Issues in Health’ (published in 2007), noted that one-third of Americans today take five or more medications. And yet, even if all of these drugs have been proven ‘scienti- fically’ to work, each drug was tested individually, not in combination with one or two, let alone five, drugs. Furthermore, most of the studies conducted have not been on children or the elderly, and yet, the high quan- tities of drugs are prescribed them. Still further discon- certing is that most medication is tested for very short periods of time, even though many drugs are used over years or decades. While such evaluations are complex and difficult to conduct, these issues simply mean that we must remain humble in our sense of which drugs work, when, and for whom. A report from the IOM on this summit is expected to be published in late 2009. Because President Barack Obama has placed health care reform as a major priority of his administration, the timeliness of this summit is significant, though it is uncertain what role integrative health thinking and practices will become a part of Obama’s initiatives. Obama did, however, give us some insight into his present thinking when, in May 2009, he responded to a question about acupuncture’s role in his health care reform plans, Obama said, ‘[m]y attitude is that we should—we should do what works. So I think it is pretty well documented through scientific studies that acupuncture, for example, can be very helpful in relieving certain things like migraines and other ailments—or are at least as effective as more intrusive interventions. I will let the science guide me’ (4). Important Online Links To see agenda and presentation slides of the IOM Summit, to watch the web cast of the summit, and to access the commissioned papers that were available prior to the start of the summit, please visit: http:// www.iom.edu/?ID=52555 The US Senate hearing on integrative medicine by the Committee on Health, Education, Labor and Pensions in which testimony was provided by Dr Andrew Weil, Dr Mehmet Oz, Dr Dean Ornish and Dr Mark Hyman, can be watched at http://help.senate.gov/ Hearings/2009_02_26/2009_02_26.html References 1. Pelletier K. The Economics. Institute of Medicine Summit on Integrative Medicine and the Health of the Public. February 25–27, 2009. Retrieved from: http://www.iom.edu/CMS/28312/ 52555/59924/63468.aspx (last accessed 19 August 2009). 2. World Health Organization Assess the World’s Health System. Press Release WHO/44 21 June 2000. Retrieved from: http://www .photius.com/rankings/who_world_health_ranks.html (last accessed 19 August 2009). 3. Ornish D, Lin J. Daubenmier J, et al. Increased telomerase activity and comprehensive lifestyle changes: a pilot study. Lancet Oncol 2008;9:1048–57. 4. Obama Positive Toward Acupuncture. Acupuncture Today 2009;10. Retrieved from: http://www.acupuncturetoday.com/mpacms/at/ article.php?id=31983 (last accessed 19 August 2009). Received March 11, 2009; accepted August 3, 2009