Reductionism vs wholism in medical research

Reading medical journals is generally a frustrating experience for me, as most articles emanate from the reductionist paradigm, defined by T. Colin Campbell in his masterwork, Whole, as the belief “that everything in the world can be understood if you understand all its component parts” (p. 47). Campbell contrasts this with wholism, the belief “that the whole can be greater than the sum of its parts” (p. 47).

The triumph of reductionism in medical research and practice leads to the perspective that disease is simply a series of biochemical processes, which can be interfered with by developing drugs that target aspects of those biochemical processes.

The concept of ‘health’ (which derives from the Greek world holos, meaning ‘whole’, is completely foreign to the reductionist perspective. Drugs treat disease; they don’t (and can’t) restore health, because health is not merely the absence of symptoms of disease – it’s a condition of the whole, living body, which arises naturally and inevitably when all the various dimensions of the human ‘owner’ of that body – physical, psychological, social and spiritual – are functioning at their optimal level.

In contrast to the reductionist perspective, a wholistic perspective on disease seeks to understand how this particular disease developed in this particular person at this particular time, and how their particular body is attempting to restore itself to a state of health by manifesting symptoms. Once these particularities are understood, a wholistic treatment plan can be tailored for the individual, incorporating diet, lifestyle and psychosocial factors which act synergistically to restore health.

The January 9, 2018 edition of the Journal of the American Medical Association (JAMA) – unintentionally, I’m sure – contained a fascinating juxtaposition between the reductionist and wholistic viewpoints.

On the reductionist end of the spectrum, an article and accompanying editorial conveyed the sad news that the latest ‘magic bullet’ for Alzheimer’s disease, idalopirdine, had failed miserably in 3 clinical trials, without any apparent understanding of how utterly predictable this failure was, given that Alzheimer’s disease is a complex chronic disease process primarily influenced by diet, lifestyle and socioeconomic factors (such as education level).

After pointing out that “medications approved for the treatment of Alzheimer disease provide little symptomatic benefit”, the author of the editorial, David Bennett M.D., opined that “the rationale for the agent [idalopirdine] was sound” because “the brains of patients with Alzheimer disease show pathological abnormalities in multiple neurotransmitter systems”, and this particular drug “has the potential to augment multiple neurotransmitter systems to improve cognition.”

But then reality set in. As with the other 400+ drugs that have been clinically trialled in Alzheimers patients, the intellectual bankruptcy of the reductionist perspective informing the development of idalopirdine revealed itself yet again. On the whole, patients given a placebo (inert substance with no therapeutic value) actually did better than those given the drug. Given that another drug with a similar mechanism of action, inteperdine, also failed to demonstrate any benefit in clinical trials, it looks like the end of the road for this particular class of drug.

Dr Bennett lamented that “the lack of progress in the treatment and prevention of Alzheimer disease is frustrating for patients, families, physicians, researchers, industry, funders and policy makers”. No doubt. But what’s even more frustrating to me is the refusal to learn the obvious lessons from this lack of progress: reductionism doesn’t work. Instead of acknowledging the bleeding obvious, Bennett urges close study of the reasons for failure of the drugs trialled so far… so that we can come up with better, more targeted drugs. Where have we heard that before?

How anyone – let alone a highly-educated person – could have expected a drug to exert a clinically meaningful effect on a complex clinical syndrome that is the cumulative result of factors such as undereducation, decades of poor dietary and lifestyle choices and lack of intellectual stimulation is completely beyond me. As mentioned in my article summarising the research of Drs Ayesha and Dean Sherzai, we need to grow up, stop looking for magic bullets to save us from our bad habits, and take an integrated approach to prevention and treatment of cognitive decline, incorporating a wholefood plant-based diet, regular exercise, meditation, restful sleep and cognitive stimulation.

Fortunately, just when I was on the verge of concluding that doctors must be the most well-educated stupid people on the planet, another editorial gave me some hope that there are signs of intelligent life in the profession after all. JAMA senior editor Philip Greenland, M.D. took a clear-headed swing at the media outcry over new clinical practice guidelines for the prevention, detection, evaluation, and management of high blood pressure in adults, pointing out that those who criticised the guidelines for “making too many individuals in the United States ‘sick’ or labeling them with a disease” were missing the obvious point that these people are sick, whether or not they have obvious signs of it as yet, and that the culprit is their diet and lifestyle.

As Dr Greenland baldly stated,

“The US way of life is the problem, not the guidelines.”

(And don’t fool yourself, we in Australia are stumbling down the same path to destruction as our American friends.)

Ah, what a breath of fresh air to read such common sense in a medical journal!

Greenland referred to a 2003 study which “showed that 90% of more of people with myocardial infarction [heart attack] had been exposed to unfavourable levels of major cardiovascular risk factors before the onset of CHD [coronary heart disease].” Importantly, “unfavourable levels did not mean clinically high, rather simply levels above population ideal levels (systolic blood pressure > 120 mmHg, diastolic blood pressure > 80 mmHg, smoking cigarettes, total cholesterol > 200 mg/dl [5.2 mmol/L], or diabetes).”

In other words, people didn’t have to be diagnosed with any particular illness to be at risk of suffering a heart attack. They just had to have what is often considered “normal-for-age” levels of risk factors such as blood pressure.

And on the other hand, individuals who did not have any of these risk factors had a “90% lower lifetime risk of coronary heart disease compared with the rest of the population”. Significantly, favourable lifestyle factors dramatically reduce the risk of CHD even in people with an unfavourable genetic risk profile.

I agree with Greenland’s contention that “individuals must take more responsibility for their health behaviors”.

However, this admonition needs to be set in context. The medical profession has become the handmaiden of the pharmaceutical industry, enthusiastically spruiking its message that people can eat whatever they feel like, drink to excess, be physically inactive, ignore their needs for sleep and meaningful social interaction… and then, when their poor lifestyle choices eventually but inevitably make them ill, the doctor will dispense some magic pills to cure them, like the priest offering dispensation for one’s sins.

Doctors need to stop acting as enablers for their patients’ poor lifestyle habits, and instead treating them as intelligent adults who are capable of understanding that today’s behaviour choices shape tomorrow’s health outcomes.

The reality is that the critics of the new US blood pressure guidelines are right to worry about what doctors will actually do in response to them. The vast majority of those who take the guidelines seriously will whip out their prescription pads rather than talking to their patients about the danger that they’re placing themselves in by following the diet and lifestyle practices that have elevated their blood pressure, and coaching them to change their habits.

So it’s going to be up to you, the consumer, to educate yourself about the risks and benefits of medical treatment for high blood pressure, and to get informed about what you can do to improve your cardiovascular health.

To this end, I’m now offering my clients an extremely well-tested method for assessing arterial health, which gives you a heads-up on your cardiovascular risk a good ten years before the age at which blood pressure typically rises, by measuring arterial stiffness. The SphygmoCor device was developed at the University of New South Wales, and is now in use all over the world. It’s a quick, completely safe and non-invasive test which equips you to take control of your health destiny. Contact me to book a SphymoCor assessment.

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2 Comments

  • Peter Strous

    Reply Reply January 15, 2018

    Re: “The medical profession has become the handmaiden of the pharmaceutical industry”
    – Doctors in MEDICINE are doctors in the products of the pharmaceutical industry (medicines). What we really need are doctors in HEALTH.

    Re: Reductionism = “that everything in the world can be understood if you understand all its component parts”
    – Looking at detail only, how will we even know that you have observed ALL ITS COMPONENTS?
    – In proper science we need to look at the WHOLE picture (all observations) before trying to create an understanding, a hypothesis. Otherwise we are “cherry picking”, aren’t we? Intentionally or out of stupidity of course.
    – Looking at the basis of health being a healthy diet, a doctor not knowing this basic fact cannot be called a “health professional”.

    Great article Robyn! Thanks.

    • Robyn Chuter

      Reply Reply January 15, 2018

      Absolutely true, Peter! It’s sheer arrogance to think that we could ever even identify all the component parts in our complex human bodies, let alone understand how they all work, let alone-let alone comprehend how they all work together, let alone-let alone-let alone grasp how our nutrition, exercise, thinking patterns and other behaviours affect each of these parts and the interactions between them!
      The beautiful truth of health is that it’s our natural state, and barring exceptional circumstances, all we have to do to enjoy it is get out of the way of our body’s native intelligence and let it operate.

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