Integrative practitioners commit to spending more time and more
energy assisting transition, and benefits are seen in terms of
transitions to positive, healthier lifestyles. The route to conversion
away from self-destructive, industry-driven behaviours - fats and sugars
are cheap to add to food but increase addictive, food-driven behaviour -
can be complex and riven with emotional, physical and economic constraints
that far exceed the time and skills of many 'mainstream' medics.
Humans, being what they are, find their route to this solution
through numerous portals; some may find a GP or private doctor with the
time and motivation to counsel them accordingly, but most do not. Coming
into contact with a caring healthcare practitioner - an alternative,
functional or integrative practitioner, who spends time and engages with
the individual to reach mutually agreed decisions - can and does have
profound effects on that person's current and future health status.
To deny this option because RCTs continue to throw up spectacular
failures and few successes when applied to separated aspects of the
alternative armoury, rather than the collective experience is to deny the
powerful effects that this interaction and mutual care generates on mood
and personal belief. These benefits are dismissed as placebo by the
skeptic's, yet the same placebo-esque strategies are employed by their
colleagues on a daily basis, where time and intellect demand fast and
often abrupt communications.
Medicine is not simply the delivery of technique, it also requires
the art of support and development through a cooperative relationship
between the participants and employing different disciplines adds
substantive healing benefit to the recipient. These benefits should be
harnessed and employed as part of the therapeutic tool kit.
Unfortunately, RCTs continue to throw up spectacular failures and few
successes when applied to separated aspects of the alternative armoury,
rather than the collective experience. But to deny patients the entire
option of alternative healthcare is to deny the powerful effects that this
interaction and mutual care generates on mood and personal belief. These
benefits are dismissed as placebo by the skeptics, yet the same placebo-
esque strategies are employed by their colleagues on a daily basis, where
time and intellect demand fast and often abrupt communications. Medicine
is not simply the delivery of technique; it also requires the art of
support and development through a cooperative relationship between the
participants. Employing different disciplines adds substantive healing
benefit to the recipient. These benefits should be harnessed and employed
as part of the therapeutic toolkit.
Snyderman and Hood's proposal is that medicine - they refer to it as
prospective medicine - should become focussed on improving the functional
health of the individual. To achieve this, it requires practitioners to
employ the following four criteria:
* personalised
* predictive
* preventive
* participatory
This new medicine is then focused on systems biology rather than disease.
By altering this approach, it redefines chronic disease as a functional
alteration in the physiological network that, in turn, requires a systems
approach to clinical intervention to improve both safety and effectiveness
of therapy. , ,
Many mainstream medical colleges and scientific journals are exploring
facets of alternative medicine previously, and in some cases currently,
dismissed as quackery, and finding evidence of measurable effect. The
prestigious Nature Immunology journal earlier this year included a review
article that included the following text:
"Rather than developing new anti-inflammatory drugs, it might be more
cost-effective to devote more effort to new approaches, such as monitoring
the human intestinal microbiota and manipulating it if required through
the use of probiotics and/or prebiotics (nondigestible food ingredients
that stimulate the growth and/or activity of bacteria)."
This may be simple to comprehend to the trained practitioner, but is
likely to be non translatable to the untrained, or unqualified lifestyle
change promoter.
Chronic inflammation, at least at the molecular level, is a sine qua
non of most chronic diseases. Strategies outside of conventional dietetics
and drugs are making promising inroads into the management and resolution
of these conditions, often effectively employing principles and naturally
derived agents derided by the skeptics.
Inevitably, polarisation of opinions will reflect character,
experience and education. All sides can, at times, feel they have won a
battle but lost the war, while in most cases stridency is rarely
appreciated except by the converted. The incontrovertible truth is that
the public and the professions are voting with their feet, are happy to
wait for the evidence that satisfies the critics, and are employing the
techniques and treatments that satisfy them now.
To encourage and support a cross-discipline dialogue, to share the
best from both sides, does not do the honourable professions of medicine
and research a disservice; it positively supports the role that we play in
the management of our patients' expectations and desires. No system is
perfect, but today's predominantly reductionist approach to healthcare has
one glaring error: it does not allow for easy overview. As a result, a
sort of biological polyglot with a long-range perspective has fallen by
the wayside, bogged down with data and delivery. Yet being able to
figuratively embrace the patient and share in their needs, while
rationalising and sharing the intervention with them, requires unique
skill sets. If I hope for anything of note from the College of Medicine,
it is that the 'students' will be encouraged to step back sufficiently
from their deep analysis to see what, in many cases, is simply missed in
daily clinical care.
And that is the Holy Trinity of patient-centred outcomes:
satisfaction, functionality and cost. These aims are well met by
alternative/integrated medicine practitioners. What else do patients care
about?
[1]Braunwald E. Shattuck lecture-- cardiovascular medicine at the
turn of the millennium: triumphs, concerns, and opportunities. N Engl J
Med 1997;337:1360 -1369.
[2]Corwin RL, Grigson PS. Symposium overview--Food addiction: fact or
fiction? J Nutr. 2009 Mar;139(3):617-9. Epub 2009 Jan 28.
[3]Weston AD, Hood L. Systems biology, proteomics, and the future of
health care: toward predictive, preventative, and personalized medicine. J
Proteome Res. 2004;3(2):179-196.
[4]Snyderman R Langheier J. Prospective health care: the second
transformation of medicine. Genome Biol. 2006;7(2):104.
[5]Hood L, Heath JR, Phelps ME, Lin B. Systems biology and new
technologies enable predictive and preventative medicine. Science.
2004;306(5696):640-643.
[6]Tilburt JC, Curlin FA, Kaptchuk TJ, Clarridge B, Bolcic-Jankovic
D, Emanuel EJ, Miller FG. Alternative medicine research in clinical
practice: a US national survey. Arch Intern Med. 2009 Apr 13;169(7):670-7.
Rapid Response:
The College of Medicine
I continue my thoughts -
Integrative practitioners commit to spending more time and more
energy assisting transition, and benefits are seen in terms of
transitions to positive, healthier lifestyles. The route to conversion
away from self-destructive, industry-driven behaviours - fats and sugars
are cheap to add to food but increase addictive, food-driven behaviour -
can be complex and riven with emotional, physical and economic constraints
that far exceed the time and skills of many 'mainstream' medics.
Humans, being what they are, find their route to this solution
through numerous portals; some may find a GP or private doctor with the
time and motivation to counsel them accordingly, but most do not. Coming
into contact with a caring healthcare practitioner - an alternative,
functional or integrative practitioner, who spends time and engages with
the individual to reach mutually agreed decisions - can and does have
profound effects on that person's current and future health status.
To deny this option because RCTs continue to throw up spectacular
failures and few successes when applied to separated aspects of the
alternative armoury, rather than the collective experience is to deny the
powerful effects that this interaction and mutual care generates on mood
and personal belief. These benefits are dismissed as placebo by the
skeptic's, yet the same placebo-esque strategies are employed by their
colleagues on a daily basis, where time and intellect demand fast and
often abrupt communications.
Medicine is not simply the delivery of technique, it also requires
the art of support and development through a cooperative relationship
between the participants and employing different disciplines adds
substantive healing benefit to the recipient. These benefits should be
harnessed and employed as part of the therapeutic tool kit.
Unfortunately, RCTs continue to throw up spectacular failures and few
successes when applied to separated aspects of the alternative armoury,
rather than the collective experience. But to deny patients the entire
option of alternative healthcare is to deny the powerful effects that this
interaction and mutual care generates on mood and personal belief. These
benefits are dismissed as placebo by the skeptics, yet the same placebo-
esque strategies are employed by their colleagues on a daily basis, where
time and intellect demand fast and often abrupt communications. Medicine
is not simply the delivery of technique; it also requires the art of
support and development through a cooperative relationship between the
participants. Employing different disciplines adds substantive healing
benefit to the recipient. These benefits should be harnessed and employed
as part of the therapeutic toolkit.
Snyderman and Hood's proposal is that medicine - they refer to it as
prospective medicine - should become focussed on improving the functional
health of the individual. To achieve this, it requires practitioners to
employ the following four criteria:
* personalised
* predictive
* preventive
* participatory
This new medicine is then focused on systems biology rather than disease.
By altering this approach, it redefines chronic disease as a functional
alteration in the physiological network that, in turn, requires a systems
approach to clinical intervention to improve both safety and effectiveness
of therapy. , ,
Many mainstream medical colleges and scientific journals are exploring
facets of alternative medicine previously, and in some cases currently,
dismissed as quackery, and finding evidence of measurable effect. The
prestigious Nature Immunology journal earlier this year included a review
article that included the following text:
"Rather than developing new anti-inflammatory drugs, it might be more
cost-effective to devote more effort to new approaches, such as monitoring
the human intestinal microbiota and manipulating it if required through
the use of probiotics and/or prebiotics (nondigestible food ingredients
that stimulate the growth and/or activity of bacteria)."
This may be simple to comprehend to the trained practitioner, but is
likely to be non translatable to the untrained, or unqualified lifestyle
change promoter.
Chronic inflammation, at least at the molecular level, is a sine qua
non of most chronic diseases. Strategies outside of conventional dietetics
and drugs are making promising inroads into the management and resolution
of these conditions, often effectively employing principles and naturally
derived agents derided by the skeptics.
Inevitably, polarisation of opinions will reflect character,
experience and education. All sides can, at times, feel they have won a
battle but lost the war, while in most cases stridency is rarely
appreciated except by the converted. The incontrovertible truth is that
the public and the professions are voting with their feet, are happy to
wait for the evidence that satisfies the critics, and are employing the
techniques and treatments that satisfy them now.
To encourage and support a cross-discipline dialogue, to share the
best from both sides, does not do the honourable professions of medicine
and research a disservice; it positively supports the role that we play in
the management of our patients' expectations and desires. No system is
perfect, but today's predominantly reductionist approach to healthcare has
one glaring error: it does not allow for easy overview. As a result, a
sort of biological polyglot with a long-range perspective has fallen by
the wayside, bogged down with data and delivery. Yet being able to
figuratively embrace the patient and share in their needs, while
rationalising and sharing the intervention with them, requires unique
skill sets. If I hope for anything of note from the College of Medicine,
it is that the 'students' will be encouraged to step back sufficiently
from their deep analysis to see what, in many cases, is simply missed in
daily clinical care.
And that is the Holy Trinity of patient-centred outcomes:
satisfaction, functionality and cost. These aims are well met by
alternative/integrated medicine practitioners. What else do patients care
about?
[1]Braunwald E. Shattuck lecture-- cardiovascular medicine at the
turn of the millennium: triumphs, concerns, and opportunities. N Engl J
Med 1997;337:1360 -1369.
[2]Corwin RL, Grigson PS. Symposium overview--Food addiction: fact or
fiction? J Nutr. 2009 Mar;139(3):617-9. Epub 2009 Jan 28.
[3]Weston AD, Hood L. Systems biology, proteomics, and the future of
health care: toward predictive, preventative, and personalized medicine. J
Proteome Res. 2004;3(2):179-196.
[4]Snyderman R Langheier J. Prospective health care: the second
transformation of medicine. Genome Biol. 2006;7(2):104.
[5]Hood L, Heath JR, Phelps ME, Lin B. Systems biology and new
technologies enable predictive and preventative medicine. Science.
2004;306(5696):640-643.
[6]Tilburt JC, Curlin FA, Kaptchuk TJ, Clarridge B, Bolcic-Jankovic
D, Emanuel EJ, Miller FG. Alternative medicine research in clinical
practice: a US national survey. Arch Intern Med. 2009 Apr 13;169(7):670-7.
Competing interests: No competing interests