Perspectives on Integrative Medicine

Short Communication

Robust Evidence in Integrative Medicine: Innovations, Challenges, and Future Directions: Ye-Seul Lee, Myeong Soo Lee, David Moher, In-Hyuk Ha, Jian-Ping Liu, Terje Alræk, Stephen Birch, Tae-Hun Kim, Yoon Jae Lee, Juan V.A. Franco, Jeremy Y. Ng, Holger Cramer; Perspect Integr Med. 2024;3(3):162-167. Published online October 23, 2024; DOI: https://doi.org/10.56986/pim.2024.10.005

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Graphical Abstract Abstract PDF: Integrative Medicine (IM), which includes therapies such as acupuncture, herbal medicine, yoga, and meditation, is gaining attention for managing chronic pain conditions. However, concerns about the quality of evidence supporting the use of these interventions persist. The 5th Annual Jaseng Academic conference 2024, in Seoul, South Korea, themed "Robust Evidence in Integrative Medicine: Innovations, Challenges, and Future Directions," addressed these concerns by focusing on advancements in study design, evidence synthesis, and open science practices. This conference proceeding summarizes key insights from the conference, emphasizing the role of pragmatic randomized controlled trials (pRCTs) in evaluating real-world effectiveness, and addressing the complexities involved in IM research such as sham controls. The integration of IM therapies into comprehensive pain management strategies (particularly in Korea), supported by government-backed research and policy initiatives was also discussed. Advancements in methodologies were addressed, such as bibliometric analysis, evidence mapping, and the development of clinical practice guidelines (CPGs) for integrative therapies. These methodologies offer valuable insights but face challenges due to the heterogeneity of IM interventions, and potential synergistic or antagonistic effects when combined with conventional medicine. Finally, the potential of open science to enhance transparency, reporting, and reproducibility in IM was explored, emphasizing the increased role of adherence to reporting guidelines (CONSORT and PRISMA). The future of IM research is built upon the continued efforts of refined study designs, rigorous evidence synthesis, and the integration of open science principles, for a robust and more credible evidence base.

Original Articles

Evidence Map of Acupuncture: Where We Stand and Where We Should Go: Tae-Hun Kim, Jung Won Kang; Perspect Integr Med. 2024;3(2):106-113. Published online June 21, 2024; DOI: https://doi.org/10.56986/pim.2024.06.006

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Graphical Abstract Abstract PDF Supplementary Material

Background
Evidence mapping presents the current status of evidence on a specific field. The "Evidence Map of Acupuncture" published in 2014 gave an overall picture of the evidence on acupuncture treatments for various conditions/diseases. In this study, evidence in 2024 for the effect of acupuncture was reassessed.
Methods
The systematic reviews (SRs) on acupuncture for the 43 conditions/diseases where evidence was previously unclear or potentially effective in the "Evidence Map of Acupuncture" 2014 were searched in the PubMed and the Cochrane Library, and included SRs up to February, 2024. The Grading of Recommendations, Assessment, Development, and Evaluations assessment in the included SRs was used for assessing the confidence level in the evidence of each condition.
Results
When compared with the results of the "Evidence Map of Acupuncture" 2014, the average number of randomized controlled trials included in a SR increased from 11 to 19.5 by 2024. However, the confidence level showed an overall decrease. The reasons for unclear evidence were mainly methodological limitations such as poor research design, small sample size and small number of studies, and the results of the 2024 reassessment did not show a significant difference in the reasons compared with the "Evidence Map of Acupuncture" 2014.
Discussion
To improve clinical evidence for acupuncture, simple repetition and increasing the number of new randomized controlled trials does not seem to be effective. To reduce redundancy, large scaled studies should be conducted, and a new critical appraisal tool for acupuncture is needed to avoid unfair evaluation of risk of bias in acupuncture research.

Citations

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Robust Evidence in Integrative Medicine: Innovations, Challenges, and Future Directions
Ye-Seul Lee, Myeong Soo Lee, David Moher, In-Hyuk Ha, Jian-Ping Liu, Terje Alræk, Stephen Birch, Tae-Hun Kim, Yoon Jae Lee, Juan V.A. Franco, Jeremy Y. Ng, Holger Cramer
Perspectives on Integrative Medicine.2024; 3(3): 162. CrossRef

The Status of Nationwide Implementation of Integrative Medicine Programs by Japanese Local Government from a “Social Model” Viewpoint: Hui-Yu Chung, Masaki Moroi, Yasutaka Hojo, Fu-Shih Chen, Keiko Yukawa, Yoshiharu Motoo, Ichiro Arai; Perspect Integr Med. 2024;3(2):98-105. Published online June 21, 2024; DOI: https://doi.org/10.56986/pim.2024.06.005

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Graphical Abstract Abstract PDF

Background
The world's demographics are transitioning, prompting governments globally to adopt diverse health promotion and disease prevention programs to enhance people's quality of life. While several integrative medicine (IM) programs, including traditional or alternative medicine, may be in place, the level of implementation nationwide is unknown. This research represents the first nationwide study in Japan, conducted in 2018 before local government health programs were cancelled due to the COVID-19 pandemic. The study examines the use of IM by local government in Japan and its safety and effectiveness as a “social model.”
Methods
IM programs for disease prevention and health promotion of all 1,944 Japanese local governments in 2018, were retrieved the using the Web Archive Project of the National Diet Library, which is a maintained website repository for all Japanese local government including IM and health programs.
Results
A total of 1,739 IM programs were implemented in 537 local governments (27.6% among all Japanese local governments). These included programs for Yoga (1,242; 71.4% of the projects), Qigong (211; 12.1%), and Aromatherapy (145; 8.3%). Among the providers of the programs, only 16 (0.9%) were national medical-related license holders. The purpose of disease prevention or health promotion was not described with scientific basis (safety and effectiveness).
Conclusion
Japanese local government conduct health-promoting IM programs, but untrained providers administer many of them. There needs to be more evidence to support the alleged health promotion objectives. Local governments require better support and evidence-based planning to rectify this situation.

Citations

Citations to this article as recorded by

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Takanobu Takata, Shinya Inoue, Kenshiro Kunii, Togen Masauji, Junji Moriya, Yoshiharu Motoo, Katsuhito Miyazawa
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Review Article

Current Status and Challenges of the Evidence for Cupping Therapy in Clinical Practice Guidelines in Korea: Seungwon Shin; Perspect Integr Med. 2024;3(2):74-85. Published online June 21, 2024; DOI: https://doi.org/10.56986/pim.2024.06.003

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Graphical Abstract Abstract PDF Supplementary Material: Clinical practice guidelines (CPGs) published in Korea were reviewed to evaluate up-to-date evidence and the recommendations for cupping therapy (CT) to inform clinicians and researchers for future studies. There were 14 CPGs (allergic rhinitis, ankle sprain, cervical pain, chronic low back pain, cold hands and feet, facial nerve palsy, Hwabyung, knee osteoarthritis, lumbar herniated intervertebral disk, migraine, osteoporosis, postoperative syndrome, shoulder pain, and traffic accident injury) with 29 recommendations for CT determined from “low” to “moderate” rated evidence. The levels of evidence were mostly downgraded due to the risk of bias and imprecision. The majority of recommendations for CT were graded as B or C. This comprehensive analysis underscores the imperative need for robust clinical research, including randomized controlled trials and observational studies using real-world data to enhance the quality of the evidence for CT. In addition, recommendations providing definite phases or scope of the target conditions/diseases and treatment regimens should be employed. This work lays a foundational step towards integrating CT into evidence-based clinical practice, emphasizing strategic directions for future research to bridge the gap between evidence and practice.

Editorial

Best Evidence for Best Care: Nicola Robinson; Perspect Integr Med. 2023;2(3):139-141. Published online October 23, 2023; DOI: https://doi.org/10.56986/pim.2023.10.001

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