The aims of science-based medicine, evidence-based medicine, and integrative medicine

The clinical aims of science-based medicine (SBM) are to prevent and cure diseases and to alleviate symptoms. SBM also aims to comfort and care for the sick.

Evidence-based medicine (EBM), SBM, and IM have the same clinical aims, but they have different scientific aims.

EBM is interested in Does it work? types of question about clinical interventions, and asks:

•  Does it work in carefully selected patients, in well defined settings, and with optimal monitoring and support?
• Does it work in the usual mix of patients, in usual care settings, and with usual monitoring and support?
• Is it worth it (cost effective)? 

SBM is interested also interested in How does it work? types of question, and answers them by building and testing conceptual and quantitative models with:

• Inputs - for example, a treatment intervention and the way it is delivered
• Internal processes - for example, the effects of the intervention are on physiological and biochemical processes 
• Outputs - for example, the clinical outcomes: benefits and harms 

For EBM the model is a black box. It is irrelevant what is inside the black box.

IM is interested in answers, rather than questions. Answers that support the use of CAM are remembered. Answers that do not support the use of CAM are either forgotten, or more research called for to close the evidence gap(1). This difference in attitudes explains why SBM and EBM ensure that conventional medicine continuously improves: treatments that do not work are discarded. In contrast, CAM modalities do not improve, although the changes in packaging and technology may give the impression of improvements (for example electroacupuncture).

SBM gets good rating scores for the first set of clinical aims (preventing and curing diseases and symptoms), and poor rating scores for the second set of aims (caring and comforting the sick). Which is why integrative medicine (IM) is able to integrate complementary and alternative medcine (CAM) into conventional healthcare.

Reference
(1) MacPherson H, Peters D, Zollman C. Closing the evidence gap in integrative medicine. BMJ. 2009 Sep 1;339:b3335.