I met a woman recently who had been insured by Anthem for twelve years. Within three weeks of her diagnosis of a brain tumor, Anthem notified her that they would no longer cover her. Can you imagine having to deal with the news that you have a brain tumor then have your health insurance yanked out from under your feet? This happened to her in 2010. Luckily, she’s survived her brain tumor and now Obamacare has made such reprehensible behavior by health insurance corporations illegal. Obamacare patches up a few things but Conventional medicine still has a terminal illness. If not for the dedication and humanity of most of the people working within that sick system, it would have collapsed long ago. Doctors, nurses, pharmacists and the like are carrying the burden of the healthcare system on their backs, but they are burning out at an ever increasing rate. We can’t keep propping up Medicine while medical corporations continue to run amok.
I don’t need to elaborate the symptoms of Medicine’s illness, we know them all too well: the run-away costs that are breaking the financial back of the industrialized world; going to your conventional doctor for treatment is now the third leading cause of death in the US; we spend the most per capita on our healthcare yet we rank around 40th on most measures of health, such as infant mortality and such; millions of people are uninsured…the list goes on.
We all know the symptoms of the disease. People are proposing solutions that attempt to treat the symptoms. No one is talking about the cause. Changing the way we pay for healthcare will not cure the system: that just treats some of the symptoms. When I look at the healthcare crisis, I see two causes: 1) the corporatization of healthcare and 2) the science upon which medicine is based. In this blog, I want to address the latter and come back to the former.
Clinical Medicine is not a science. It is a discipline based upon a science. Doctors are fond of saying that the practice of Medicine is both an art and a science. They are flattering themselves: the clinical practice of Medicine is engineering. The practice of medicine is not science. When that anesthesiologist is putting you to sleep, you hope the science has been done and that he’s not experimenting on you. And art is…well, how do you define art? Engineering can be defined as the artful application of scientific principles toward the solution of problems. And that is definitely what most doctors want to do with their patients if the System would just let them (see previous blog posts).
The problems that Medicine is trying to solve are those of human disease and suffering and the creation and maintenance of health. Medicine needs to be based upon a science that is appropriate to the task. The science upon which Conventional medicine is based is too limited to encompass all of human experience. Yet we have good data to support the idea that all of human experience impacts health. We need a medicine that is based upon a broader science, one that can explore all of human experience, not just the physical, biochemical level or our experience.
Integral Medicine is based upon such a science.
The purpose of science is to understand Nature (so that we can ultimately bend her to our will.) Over time, the discipline of science has developed a strategy, called the Scientific Method, which is arguably the best method we have for sifting out the truth from a lot of different possibilities. The Scientific Method is not perfect, for it is performed by human beings. But, when followed properly, it is self-correcting. Interestingly, a method of inquiry akin to the Scientific Method is one of the seven classical pathways to enlightenment.
The Scientific Method has several defined steps that we are all supposed to learn in High School science classes. The first step is to pick some part of Nature you want to study, for example, an ant hill. The next step is not mentioned much but is more or less assumed: look through the published literature and see what others have already learned about ant hills. The next step is to observe an ant hill and collect some raw data. Then you look at the data and try to make some sense out of it. You propose a theory that tries to explain as much of the data as possible. Here is where it gets interesting.
Since we don’t know Nature, we need to propose a model of Nature, or at least of that aspect of Nature that we’re studying (scientists are still working on a Unified Theory of everything). The model, by definition, needs to be a simplification of Nature. In order to make that simplification, we must make some assumptions, usually called “simplifying assumptions”, about our system of study. Every scientific discipline has its model. Conventional Medicine, for example, has its medical model.
Ideally, your theory fits within the current prevailing model for that scientific discipline. On rare occasions down through history, Science has had to make major modifications to foundational assumptions underlying the predominant model and a Scientific Revolution ensues. (http://www.amazon.com/Structure-Scientific-Revolutions-Thomas-Kuhn/dp/0226458083) But this is rare. The bulk of scientific work entails discovering new and useful details that help to “flesh out” the prevailing model.
So let’s assume that your theory about your ant hill fits within the prevailing model of life currently held by most biologists. The next step, then, would be to pose a question and make a prediction: “If I dropped some bread crumbs here, this is what I expect the ants to do.” This is called developing an hypothesis. (If this is triggering PTSD from your high school science class, I apologize. I’m laying a foundation to get to my point.) Once you construct your hypothesis, you design an experiment to test your hypothesis. In your experiment, you have to try to anticipate and adequately control possible confounding variables, that is, other things that might happen that would make interpreting your results more difficult or less reliable. For example, every time you dropped bread crumbs, you want them to be the same kind of bread crumbs.
Then you actually perform your experiment, collect the observations and see how they compare with what you predicted. You also compare your results with others who have performed the same or similar experiments to see how your results stack up to theirs. The more experiments you do that match the prediction you made based upon your theory, the more you start to have confidence that your theory actually captures and represents some important or vital aspect of Nature.
In medicine, the aspect of Nature that we’re exploring is you. Some people would use scientific information about you to bend you to their will (http://www.huffingtonpost.com/warren-adler/keeping-the-sheep-dogs-at_b_950151.html) but in Medicine we like to think that we’re high-minded enough to use science not to bend you to our will but to help you improve your health, which, hopefully, is bending yourself to your own will. In Medicine, the data that we need our model to explain is all of human experience. How is that so? Well, try to think of one experience you’ve had that has absolutely no impact whatsoever on your health. Pretty hard to do, I expect. Everything in your life influences your health. Everything in your life is fair game when it comes to looking for the root causes of your health problems. We need a medical science and a medical model that can take all this kind of information into account.
In The Structure of Scientific Revolution, Kuhn elaborates on several symptoms a particular branch of science will exhibit when the pressure for a scientific revolution is building. Conventional medicine exhibits all of them. There is a great body of human experience that lies outside, that is, cannot be adequately explained by conventional medicine. A large number of alternative models of healing and health are being put forward. More and more practitioners are becoming aware of the limitations of conventional medicine (lagging somewhat behind the awareness of the general population.) The predominant underlying assumption upon which the conventional medical model is based says that you are but a skin-bag of biochemical reactions and all diseases are an imbalance of those chemical reactions, injuries or natural aging. If we but knew what those reactions were, we could pour in other chemicals and you could then be the person you want to be or we could sew you back up, wire you together or replace worn-out parts.
More than Biochemistry
You are indeed a skin-bag of biochemistry. But is that all you are? Are you a victim of your genes and environment, merely reacting to and from them all the time, or do you have consciousness, identity, creativity, volition, free will? Do you have meaning in your life? Do you see meaning in some of the events around you? How can there ever be spontaneous creativity if we’re all locked into a physical deterministic chain of cause and effect? I think it is high time we make a new medical model.
Kuhn also elaborated some of the characteristics that the new paradigm replacing the old ought to have. It needs to first adequately explain all the data and observations covered by the old model and it ought to also be able to explain and incorporate most of the observations that were out-lying to the old model. It also ought to be amenable to the process of science fleshing it out. Integral Medicine is based upon such a science. It is able to take into account and make sense out of most human experiences that lie outside of the current medical model, such as mind-body connections, placebo effect, spontaneous healing, shamanism and such.
The framework of Integral Medicine has five parts:
- The Integral Worldview
- Broad science
- An expanded model of a human being
- A definition of health
- The education metaphor
Let’s explore this framework in Part 2.
Copyright 2012 Steven M. Hall, MD