Thursday, 17 January 2013

The merits of Prince Charles' approach to health and wellbeing

Prince Charles has been at it again. This time he has written an article published in the current Journal of the Royal Society of Medicine (JRSM) in which he advocates an "integrated approach to medicine and health."

Prince Charles defines an 'integrated approach' as being "an approach to care of the patient which includes mind, body and spirit and which maximizes the potential of conventional, lifestyle and complementary approaches in the process of healing."

Whilst I might disagree with him on some of the detail, and we certainly wouldn't agree on some alternative medicines such as homoeopathy, nevertheless I am in complete agreement with the core thrust of his argument.

A distinguishing feature of modern medicine is that it is 'evidence based'. This is as it should be. Patient trust requires that medical practise and treatments are based on knowledge and some kind of fundamental and tested principles. But for too long medical science has been driven by a reductionist approach.  It has tended to view the human body as an aggregate of mechanisms rather than an integrative process, and whilst this reductionism has sought answers and causality at the molecular level, medicine has tended to follow suit. Researchers working in the minutiae of their disciplines rarely cross boundaries, and increasingly they seek answers at the level of the gene.

And the word 'level' is a problem too because it expresses an idea of layered causality. The top layers are 'caused' by activity in the layer below them; a layered hierarchy where the 'ultimate' cause of what happens at the 'top' layer is to be found at the bottom layer. It is a 'bottom up' approach; genes, cells, tissues, organs and organ systems, and the final layer, the body.

It expresses itself in medicine too. In medicine we tend to look for cause and effect in clearly layered terms. Many effects we regard as 'symptoms'. Better to treat the cause rather than the symptoms, although it is often symptoms which not only cause discomfort but can also be lethal. It is as if there is an 'ultimate' cause, a 'faulty gene'. If we find that then we can treat it with targeted drugs.  Indeed some suggest that this will be the ultimate revolution in developing new treatments. The human genome project is based on just this idea of layered, hierarchical and 'bottom up' gene-centred causality. But not only has the gene centred view influenced biology and biomedicine; it has also influenced social sciences, society and politics.

Modern politics tends to view society as, at best, an aggregate of self-motivated or self-interested individuals. It reached its peak in Mrs Thatcher as prime minister musing that there was 'no such thing as society'. It rather misses the point; and it misses the point precisely because it doesn't look for it. The gene-centred view rather sees humans, and any other organism, as vehicles at the behest of genes; a view advocated by Richard Dawkins in his The Selfish Gene.

This view has been beautifully turned on its head by the distinguished biomedical scientist Denis Noble in his book The Music of Life;  and the 'central dogma' has been challenged in a recent lecture, 'Rocking the foundations of biology',  which can be viewed on Voices from Oxford. Denis Noble is no off the rails scientist. He is president of the International Union of Physiological Sciences and distinguished in his field of modelling how the heart works.

What Prince Charles advocates is patient-centred healing. We have indeed often lost sight of the process of healing and the personal aspects that can enhance it. This is not to dismiss the pharmacology but to consider what process within and without the body  make such treatments work better. Prince Charles puts it thus:

"One senior professional said to me that what seems to go missing all too easily is the art of thoroughly understanding the patient's narrative. He said that we need to equip our health professionals with skills (and a desire) to listen and honour what is being said, and – importantly – what is not said to them."

I doubt many medical professionals would disagree. The problem is finding the resources and time. Modern medicine shouldn't be about simply finding magic bullets. We would be very disappointed. They are very rare.  We need a different set of research questions and new goals, and one that considers how our social and environmental being affects our body, heart and mind. We need each other and we need to understand why and how.

Developmental science is teaching us that many manifestations of disease in later life have origins in the nutritional environment particularly during development. Health, well-being and equality matter in determining the epidemiology of disease. Inequality is a broader cause of disease than any 'faulty gene'. 

Holistic, yes; but it isn't mad.


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