Complementary, alternative or integrative: one word carries most of the risk

Key takeaways

• NIH defines complementary care as used together with conventional medicine, alternative care as used in its place, and integrative care as the two brought together in a coordinated way¹.
• In a 2018 study of cancer patients, people whose records showed complementary medicine had about twice the risk of death, but the extra risk was no longer significant once researchers counted refused or delayed treatment¹¹.
• People who used only alternative treatments for four common cancers were about 2.5 times as likely to die over roughly five and a half years as similar patients in standard care¹⁰.
• NIH’s research office began with $2 million from Congress in 1991 and dropped “alternative” from its name in 2014³.
• Before you try anything new, ask one question: am I adding this, replacing something, or coordinating it with my care team?

In 2018, a team of cancer researchers combed a national database covering about 1.9 million people with breast, prostate, lung or colorectal cancer. They found 258 whose records showed complementary medicine¹¹.

At first, the result looked alarming. Those patients had about twice the risk of death during the study as similar patients¹¹.

Then the researchers looked at what else those patients did. They had turned down standard treatment far more often. About a third refused chemotherapy, compared with about 3% of similar patients¹¹.

Once the researchers accounted for refused or delayed treatment, the extra risk shrank and was no longer statistically significant¹¹. The danger didn’t seem to come from what patients added. It came from what they left out.

That is the difference between three words people often treat as one: complementary, alternative and integrative. Here is what each means, how NIH’s own vocabulary changed, and a decision table you can use.

Three words, three relationships with your medical care

The National Center for Complementary and Integrative Health (NCCIH), part of the National Institutes of Health (NIH), defines the terms by how an approach is used¹.

• Complementary: a non-mainstream approach used together with conventional medicine.
• Alternative: a non-mainstream approach used in place of conventional medicine.
• Integrative: conventional and complementary approaches brought together in a coordinated way.

Notice what these words describe. They aren’t labels for a remedy. They describe your plan.

Picture three people getting chemotherapy who all drink ginger tea for nausea. (This is a made-up example.)

The first tells her cancer team, which tracks it with the rest of her care: that’s integrative. The second drinks it and never mentions it: that’s complementary. The third drinks it and stops chemotherapy: that’s alternative. The tea is the same, but the risks are very different.

The words also depend on where you live. The World Health Organization’s African regional office describes “complementary” or “alternative” medicine as practices that aren’t part of a country’s own tradition or its mainstream medicine². By that logic, a practice can be traditional in one country and complementary in another.

How NIH’s vocabulary changed, from 1991 to today

NIH’s office for this field has changed names twice, and each change says something about the times.

Year	What happened	What it signaled
1991	Congress gave NIH $2 million for an office and an advisory panel to recommend research on “promising unconventional medical practices”3	Lawmakers wanted these practices tested
1993	The NIH Revitalization Act formally created the Office of Alternative Medicine3	“Alternative” was the umbrella word
1997	42.1% of adults used an alternative therapy, up from 33.8% in 1990; visits to these practitioners topped visits to all primary care doctors (published 1998)4	Use had gone mainstream
1998	Congress upgraded the office to the National Center for Complementary and Alternative Medicine3	“Complementary” joined the name
2014	Congress renamed it the National Center for Complementary and Integrative Health3	“Alternative” was dropped
2025	The White House’s budget request for fiscal 2026 proposed eliminating the center as part of reorganizing NIH into eight institutes6	Its future became a budget question
2026	Congress funded the center for fiscal 2026 at about $170 million, and the request for fiscal 2027 again proposed eliminating it7	Congress has the final say

Why drop “alternative”? In May 2014, center director Josephine Briggs proposed a new name. In its early years, she said, the center had paid for trials of disputed methods, homeopathy and remote healing among them, and those trials had grown rare. The work had shifted to questions like whether yoga eases pain when added to medication⁵.

Briggs also drew a sharp line. She separated complementary care from alternative medicine that people might choose in place of proven treatment, and she said she worried about patients picking something entirely unproven⁵.

Critics weren’t persuaded. Donald Marcus, an immunologist at Baylor College of Medicine, called the change cosmetic. Arthur Grollman, a pharmacologist at Stony Brook, said “integrative health” had a fuzzy definition⁵.

Congress settled the name in a December 2014 spending law³. The 2025 proposal to close the center did not take effect: NIH’s own budget tables show Congress gave it about $170 million for fiscal 2026, the same as the year before⁷. The fiscal 2027 request proposes closing it again, and that decision also rests with Congress⁷.

Alongside is the norm, but “Instead of” is less common, and hard to measure

NCCIH says most people who use non-mainstream approaches also use conventional health care¹. The surveys point the same way.

In a 2002 federal survey, the reason users gave most often was that combining an approach with conventional treatment would help⁸. Our article on why people turn to natural health covers the full list.

But “alongside” didn’t always mean “coordinated.” In 1997, only 38.5% of people using alternative therapies told their doctors, about the same share as in 1990⁴. That gap is the space where “integrative” care grew up.

How many people use something instead? It depends on the question.

A 2017 Pew Research Center survey found that 20% of U.S. adults said they had tried alternative medicine instead of conventional medicine. Another 29% had used it alongside conventional treatment, and half had never used it⁹.

Many of those “instead” choices may involve minor problems. One clue: among people who never take over-the-counter cold or flu medicine, 34% had used alternative medicine instead of conventional care⁹. That link is our inference, not Pew’s conclusion, since the survey summary doesn’t say which problems people treated.

For serious disease, choosing only alternative care appears to be uncommon. In a Yale study of four common cancers, researchers found about 280 such patients across a decade of records¹⁰. The lead author called that a large undercount, since some patients may never have told their doctors¹⁰.

When “instead of” turns dangerous: what the cancer data show

Those 280 patients are the clearest test of what “alternative” can cost. Yale researchers matched each of them with two similar patients who got standard treatment. The matches had the same cancer, diagnosis, age and race¹⁰.

Over about five and a half years, the alternative-only group was about 2.5 times as likely to die¹⁰. The gap varied by cancer:

• Breast cancer: almost six times as likely to die.
• Colon cancer: about four times.
• Lung cancer: about two times.
• Prostate cancer: no figure in the Yale summary. The researchers said slow-growing cancers like this one may need longer follow-up to show the full gap¹⁰.

The people who chose alternative-only care tended to have more education and higher incomes¹⁰. This doesn’t look like a simple story of people lacking access to medicine.

The same research team’s study from the top of this article adds detail. Compared with similar patients, people whose records showed complementary medicine refused surgery 7% of the time versus 0.1%, and radiation 53% versus 2.3%¹¹. They refused hormone therapy 33.7% of the time versus 2.8%¹¹. Five-year survival was 82.2% versus 86.6%¹¹.

Both studies are observational, meaning they track what happened rather than assigning treatments by chance. They show links, not proof of cause.

The 2018 complementary-medicine study drew pushback. An unsigned commentary in the Natural Medicine Journal, a publication for clinicians who use natural medicine, argued that the database’s code for unproven treatments given by nonmedical staff blurred complementary and alternative care¹². It also said 258 users out of about 1.9 million was implausibly few¹². Even so, the critique made the same core point: the study mostly measured what happens when people skip proven treatment¹².

NCCIH’s guidance lines up with both papers. No complementary approach has been shown to cure cancer or put it into remission, and delaying treatment lowers the chance of a cure¹⁴. Some supplements, including antioxidants, might interfere with chemotherapy, so talk with your cancer team first¹⁴.

What “integrative” means when medical schools use it

“Integrative” is the newest of the three words in NIH’s vocabulary, and the easiest to misuse.

In academic medicine, the word has a specific meaning. The Academic Consortium for Integrative Medicine & Health began in 1999, when eight academic medical institutions met at the Fetzer Institute in Kalamazoo, Michigan. It now has more than 80 members in the United States, Australia, Brazil, Canada and Mexico¹³.

Its definition opens by saying integrative care “reaffirms the importance of the relationship between practitioner and patient”¹³. The rest of the definition describes care that centers on the whole person, rests on evidence and draws on any suitable treatment, healthy habit or kind of health professional¹³.

Three ideas carry the weight: a relationship, evidence and coordination. A shop that sells supplements under an “integrative” sign, without talking to your doctor, doesn’t meet that bar. Our guide to telling real integrative care from a marketing label goes deeper.

When integrative care is done well, it often looks ordinary. In cancer care, NCCIH notes that acupuncture may ease nausea, and that yoga and mindfulness programs may help with fatigue and anxiety¹⁴. Offered as part of the treatment plan, those are integrative.

A decision table: which word describes your plan?

Use this table to name what you’re doing, then judge the stakes.

Your plan	Which word fits	Risk level	What to do next
Tai chi classes for balance, and your doctor knows	Complementary, close to integrative	Low	Keep going and mention it at checkups
A new herbal supplement on top of prescription drugs, and no clinician knows	Complementary, but uncoordinated	Moderate, because of possible interactions	Bring the bottle to your next visit
Acupuncture for chemotherapy nausea, arranged through your cancer center	Integrative	Low	Ask how the team will track whether it helps
Rest, fluids and herbal tea instead of cold medicine for a mild cold	Alternative, for a minor problem	Usually low	Call a clinician if you have trouble breathing or a high fever
Stopping blood pressure or diabetes medicine to try a “natural protocol”	Alternative, for a serious condition	High	Talk with your prescriber first and never stop on your own
A cleanse or supplement plan instead of surgery, chemotherapy or radiation for a treatable cancer	Alternative, for a life-threatening illness	Highest	Get a second opinion first, and ask about integrative oncology

Three questions predict where “instead of” turns risky:

1. How serious is the condition? A cold passes on its own. Untreated cancer, diabetes or high blood pressure does not.
2. How well does the proven treatment work? Skipping a treatment with a small benefit costs less than skipping one that often cures.
3. Can you get lost time back? Some conditions wait while you experiment. Others spread.

What the evidence shows, word by word

The same practice can earn a different rating depending on whether it adds to care or replaces it.

Claim	Evidence level	What the research shows
Tai chi, used alongside regular care, reduces falls in older adults	Strong evidence	A 2019 review found high-certainty evidence that it may cut the number of people who fall by about 20%15
Acupuncture, hypnosis, mindfulness, yoga or tai chi ease some cancer symptoms	Promising but early	Helpful for some symptoms, with evidence that varies by practice14
Adding complementary care, while completing standard cancer treatment, shortens survival	Not enough evidence	The extra risk was no longer significant once refused or delayed treatment was counted1112
Using only alternative treatment for breast, colon or lung cancer	Evidence says no, or unsafe	Much higher risk of death than in matched patients who got standard care10
Any complementary approach as a cancer cure	Evidence says no, or unsafe	None has been shown to cure cancer or cause remission14
Antioxidant supplements are safe to take during chemotherapy	Not enough evidence	They might interfere with treatment, so ask your cancer team first14

Where natural-health values fit

“Complementary” can sound like a lesser word for something you care about deeply. In practice, it carries natural-health values well.

It keeps you in charge of what you add. It honors prevention and gentle care. And it respects “first, do no harm,” which also means not giving up a treatment that works.

“Integrative” asks more of everyone. Clinicians have to listen to what you value. Practitioners have to share notes. You have to tell each of them everything you use.

“Alternative” is the one place where a values choice can turn into a gamble with your life. If you’re weighing it for a serious illness, get a second opinion and ask for a shared decision with your clinician.

If a product or practitioner promises to cure a serious disease, report it to the Federal Trade Commission at ReportFraud.ftc.gov. Report a bad reaction to a supplement to the FDA through MedWatch.

Questions readers ask

The bottom line

Complementary, alternative and integrative aren’t three kinds of remedies. They are three relationships between a remedy and your medical care. Adding is usually low-stakes. Coordinating is better. Replacing a proven treatment for a serious illness is where the measurable harm shows up.

The most useful habit is the simplest: before you start anything new, ask whether you’re adding, replacing or coordinating. Then tell your care team, whichever answer you give.

Related reading

• Natural health has no official definition, so we offer a working one
• What complementary care means, and why the word misleads
• How to tell real integrative care from a marketing label
• What happens when you don’t tell your doctor about supplements
• When a second opinion changes something, and how to get one

Sources

1. National Center for Complementary and Integrative Health. “Complementary, Alternative, or Integrative Health: What’s In a Name?” NIH, updated April 2021. nccih.nih.gov
2. World Health Organization, Regional Office for Africa. “Traditional Medicine.” WHO, accessed October 2026. afro.who.int
3. National Center for Complementary and Integrative Health. “Public Laws Establishing NCCIH.” NIH, accessed October 2026. nccih.nih.gov
4. Eisenberg DM, Davis RB, Ettner SL, et al. “Trends in Alternative Medicine Use in the United States, 1990–1997: Results of a Follow-up National Survey.” JAMA, 1998 (Harvard Medical School publication record). hcp.hms.harvard.edu
5. Reardon S. “NIH alternative-medicine centre proposes name change.” Nature news blog, May 16, 2014. blogs.nature.com
6. National Institutes of Health, Office of Budget. “Overview of FY 2026 Executive Summary.” NIH, 2025. officeofbudget.od.nih.gov
7. National Institutes of Health, Office of Budget. “Overview of FY 2027 Budget: Supplementary Tables” (Budget Request by IC summary table and Programs Proposed for Elimination). NIH, 2026. officeofbudget.od.nih.gov
8. Barnes PM, Powell-Griner E, McFann K, Nahin RL. “Complementary and Alternative Medicine Use Among Adults: United States, 2002.” Advance Data No. 343, National Center for Health Statistics, CDC, May 27, 2004. cdc.gov
9. Funk C, Kennedy B, Hefferon M. “Americans’ health care behaviors and use of conventional and alternative medicine.” Pew Research Center, February 2, 2017. pewresearch.org
10. Yale School of Medicine. “Finally, data about alternative medicine and cancer” (on Johnson SB, Park HS, Gross CP, Yu JB. “Use of Alternative Medicine for Cancer and Its Impact on Survival.” Journal of the National Cancer Institute, 2018, published online August 2017).
11. Johnson SB, Park HS, Gross CP, Yu JB. “Complementary Medicine, Refusal of Conventional Cancer Therapy, and Survival Among Patients With Curable Cancers.” JAMA Oncology, 2018;4(10):1375–1381. pubmed.ncbi.nlm.nih.gov
12. Natural Medicine Journal. “Does Complementary Medicine Increase Risk of Death in Cancer Patients?” Commentary, October 12, 2018.
13. Academic Consortium for Integrative Medicine & Health. “Mission and Vision.” Accessed October 2026. imconsortium.org
14. National Center for Complementary and Integrative Health. “Cancer and Complementary Health Approaches: What You Need To Know.” NIH, updated October 2021. nccih.nih.gov
15. National Center for Complementary and Integrative Health. “Tai Chi: What You Need To Know.” NIH, updated December 2023. nccih.nih.gov