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| EDITORIAL |
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| Year : 2013 | Volume
: 1
| Issue : 1 | Page : 1-3 |
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"Perestroika" in 21 st century medicine: Opening the border between traditional and western medicine for 'The healing revolution'
Bhaskara P Shelley
Department of Neurology, Yenepoya Medical College, Mangalore, Karnataka, India
| Date of Web Publication | 21-Jun-2013 |
Correspondence Address:
Bhaskara P Shelley
Department of Neurology, Yenepoya Medical College, Mangalore - 575 018, Karnataka
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/2321-4848.113545
How to cite this article:
Shelley BP. "Perestroika" in 21 st century medicine: Opening the border between traditional and western medicine for 'The healing revolution'. Arch Med Health Sci 2013;1:1-3 |
How to cite this URL:
Shelley BP. "Perestroika" in 21 st century medicine: Opening the border between traditional and western medicine for 'The healing revolution'. Arch Med Health Sci [serial online] 2013 [cited 2023 Mar 30];1:1-3. Available from: https://www.amhsjournal.org/text.asp?2013/1/1/1/113545 |
"Doing what's right isn't the problem. It's knowing what's right." Lyndon B Johnson
Western medicine has entered a crisis of de-humanization, plagued by a somatic approach of compartmentalized organ-system-based knowledge providing high-tech mechanistic 'medical care,' rather than 'healthcare' delivery. Is it edging towards a 'health-scare industry' rather than a sanctum of brain-mind-body 'whole-istic' care? From the frying pan to the fire, western medicine does not envision an integration of the brain, mind, soul, and body for a healing encounter. The concept of organ-based diseases has become a major threat to holistic and integrative systems of medicine. It is ironical to note there is a growing preference for traditional medicine (TM) or complementary and alternative systems of medicine (CAM), even in affluent countries that have free access to western medicine, the lack of humanism, holism, and compassionate medicine being the main cause. Furthermore, the western health care system alone is not able to meet the health need of the entire population of the world. There exists a paradox in India i.e. the poor, rural, 'Bharat-The soul of India,' and the affluent 'Modern India.' Western medicine is prohibitively expensive not only for India's 'Bharat' but also for developing nations. Although western medicine will offer newer therapies and advanced technologies for 'fighting' illness, an essential question that worries underdeveloped and transition nations is whether they can effectively finance the implementation of medical advances and technology transfer. Therefore, from a healthcare perspective, I reiterate the need for critical engagement between western medicine and its neglected allies (TM and CAM). This will amalgamate the 'best of the best' of the western medicine yet integrate the ancient wisdom of traditional systems ensuring an economically sustainable, cost-effective, and accessible health care to India's 'Bharat' and other developing nations.
From the wisdom echoed by Plato 'The greatest mistake in the treatment of diseases is that there are physicians for the body and physicians for the soul, although the two cannot be separated,' it prompts us to revisit the foundations of 'salutogenesis' in health. [1] "How is health created?" 'How do people manage to maintain and develop their health, what creates health, and what factors make this positive process happen?' The answer lies in the two brilliant quotes: "It is a wise man's part, rather to avoid sickness, than to wish for medicines." Thomas More (1475 to 1535), Utopia and, another by Sir William Osler "One of the first duties of the physician is to educate the masses not to take medicine." The Western approach dichotomizes the health from the disease, whereas the traditional approach contemplate health as a balanced state versus disease as an unbalanced state.
21 st century medicine may be akin to the 'Leaning tower of Pisa,' more skewed towards a curative, and 'pathogenesis model.' The 'pathogenesis/dis-ease' model is centered on 'waging swift war,' fighting and combating illness, whereas the 'salutogenesis/health-ease' model has the core essence of promoting health, more of a "peace-keeping" perspective. A change in thinking from the 'pathogenesis/dis-ease' model to a 'salutogenesis/health-ease' model is quintessential. Health needs to be conceptualized as a dynamic continuum between "health-ease" and "dis-ease," where the creation of health is assumed to be a process of interaction between the internal and external resources of individuals and their environment. The next transformation of 'future medicine' should be a paradigm shift positively defined and measured as something other than the 'absence of diseases,' replace the Cartesian thinking, and perceive as an integrated function of biology, environment and behavior; and measured as a product of physical, mental, social, and spiritual variables.
Uniting western and traditional medicine will promote a rapprochement between religion, spirituality, medical practice (body-mind-spirit wholism), and salutogenesis-mediated healing health outcomes. Anthroposophical medicine is one such system centered on a holistic approach of "salutogenesis" that is well-established in Germany, Switzerland, Sweden, the Netherlands, Great Britain, Italy, the USA, and Brazil under the aegis of The International Federation of Anthroposophical Medical Associations. I wonder if such healthcare policies will be met with resistance since these ideologies stray away from the mainstream western scientific orthodoxy, in addition to having a narrower economic objective and efficiency. However, I stress that we should evolve through diversity and not take side with the dominant western system of medicine to evolve salutogenic approaches for healing health outcomes. Healing and treatment are not synonymous as reflected by the Chinese proverb "The superior doctor prevents illness; the mediocre doctor attends to impending sickness; the inferior doctor treats actual symptoms."
I emphasize the need for 'scientification' of TM, CAM; spirituality-mind-body medicine; energy therapies (Reiki, therapeutic touch, magnet therapy); AYUSH; maha panchabhuthas; body movement-based therapies (Mind-body interactions) -dance, music, art therapies; acupuncture; mindfulness-based stress reduction' meditation; and Yoga in the salutogenic approaches to health issues. In this respect, neuroscience has begun to dissect the complex mechanisms, by which the brain can influence peripheral biology, thereby providing the beginnings of a mechanistic understanding of how the mind may influence bodily systems via psychoneuroimmunology (neuro- endocrine- immunology network) or through placebo effects. Functional MRI, PET, SPECT, MEG, and voxel-based brain MRI have shown functional and structural alterations in various regions of the brain. In a similar vein, a number of rigorous research studies have found positive associations between increased spirituality and better health outcomes. Many of the TM/CAM approaches does have its roots in 'placebo effect,' and thus, mainstream medicine disregards this as unscientific or not evidence based. [2] Recent research has verified placebo-associated improvement (PAI) by demonstrating neurophysiologic and neurochemistry changes involving expectancy, conditioning, anticipation, and reward mechanisms in specific regions of the brain. PET studies have demonstrated functional brain changes that undermine placebo-associated improvement (PAI) in depression, Parkinson's disease, and pain syndromes. Furthermore, a plausible role of a genetic predictor related to COMT functional val158met gene polymorphism has been speculated to underlie the placebo effect in Irritable bowel syndrome. Development in placebo research and scientific experimentation will hold promise for bridging the long-standing gap between the scientific and humanistic orientations of western medicine and rejuvenate evidence-based patient care potential to significantly enhance patient healing outcomes. I believe such research would pave a way to better harness the positive parts of the placebo effects to use as part of medical therapy for mind-body self-healing processes.
India is a 'demographic billionaire' and two thoughts race through my mind, namely the concept of 'mental capital' [3] and the silent epidemic of dementia and other neurologic disabilities in India. Human work force, globalization and socioeconomic endeavors in this planet ultimately depend upon the well-being of citizens' cognitive resources i.e. 'mental wealth' or mental capital. Countries must learn how to capitalize on their citizens' cognitive resources if they are to prosper, both economically and socially. It is absolutely essential to realize that 'mental wealth' can only be attainable by preservation of brain function, promoting brain health, cognitive and emotional health, promoting cognitive resilience, and cognitive reserve, all of which stress the salutogenenic approaches to brain health. Does western medicine promise to prevent or cure dementia? Opinion is that it is very unlikely that in the near future, a new efficacious treatment for Alzheimer will become available. And even if that would happen in the near future, it is unrealistic to expect such a treatment to become widely available for the majority of the people in developing countries. Since dementia neuropathophysiology starts 20-30 years before its clinical expression, our current curative approach is, therefore, similar to the idiom "Closing the stable door after the horse has bolted out." Salutogenic approaches (healthy brain ageing strategies) through cognitively stimulating activities, creative engagement, exercise and physical activities, leisure activities, social engagement, healthy brain diet and nutrition, lifestyle behavioral, and midlife vascular risk modification have been demonstrated to have health-enhancing effects and longevity-enhancing properties. I am reminded of two quotes "You do not heal old age, you protect it, you promote it, you extend it" (Sir James Sterling Ross) and "It is not what life takes away from you that count. It's what you make of what is left with you" (Hubert Humphert) epitomizes the salutogenic theory of positive brain health promotion.
The best medical intervention is not segregation. Instead, it is the time for experimentation to integrate, and unite the two philosophies of the western and traditional systems of medicine that will usher in the 'healing revolution.' This would go a long way to uniting science, spirituality, and humanism for the benefit of mankind in the third millennium. Therefore, as we prepare to move into the next century, pluralistic and complimentary approaches centered on holistic, salutogenic approaches coupled with preventive public health strategies, and pre-emptive medicine will be the challenges of 21 st century Medicine. This new integrative system of Meta-medicine would provide us with the comprehensive understanding of the root cause underlining the organ-brain-psyche-social perspective to the biological process of human illness, and thereby empower the natural healing mechanisms. Till date, the scientific evidence on TM/CAM is underdeveloped, and rigorous research needs to be designed to study the different systems of medical practices in India. I would stress the need for more high quality randomized controlled trials (RCTs) to address the fundamental issues of efficacy, safety, and cost-benefit of traditional and/or alternative medicine to improve our weak scientific understanding before we can achieve 'integrated medicine.' In addition, traditional/CAM should be included in the curriculum of all Indian medical college of the Western system. Encouraging the indigenous medical systems should not be viewed as a potential threat to the existing Western medicine-oriented health care. One needs to study the attitudes of western medical practitioners towards the integration of western and traditional medical practices in India. The Indian government should foster national priorities for integrating traditional/CAM and western systems of medical practices for tackling the healthcare inequalities.
I believe, India being a pluralistic society, we need to evolve an integrative system of 'whole-istic' medicine customized to the national health priorities, not only in 'combating illness,' but also for the 'peace-keeping' process of health promotion and health maintenance. India has the rich heritage of one of the best systems of healthcare in Ayurveda, [4] the mother of medicine and also of all life sciences in India. The western system of Medicine in India seemed to have neglected the medical wealth contained in the Ayurvedic literature. The endeavors of Ayush Indian Council of Medical Research (ICMR); Working Group on Access to Health Systems in Ayush (Ayurveda, Yoga and Naturopathy, Unani, Siddha, Homoeopathy); Golden Triangle Partnership (GTP) having collaboration with Department of Ayush, ICMR, and CSIR (or National Health Policy for Traditional medicine) directed towards disease conditions of national/global importance are pioneering efforts to evolve such an integrative system in India. It is of paramount importance that we think beyond boundaries to promote such collaborations worldwide too.
"Sarve Janaah Sukhino Bhavantu." Let us physicians resolve and build bridges uniting the 'pathogenesis-salutogenesis' dichotomy of human afflictions paving way for a holistic meta-medicine system of health care epitomizing patient-centered care and positive healing outcomes for the human race and mental health capital rather than curative obsessions. The future lies in emphasizing health promotion, preventive and pre-emptive health strategies. "See me, Feel me, Touch me, and Heal me" summarizes the holistic healing revolution that blossoms from pluralistic approaches recognizing the need for co-operation between western and TM/CAM philosophies of medical practice!
"At the heart of science is an essential balance between two seemingly contradictory attitudes-openness to new ideas, no matter how bizarre or counterintuitive they may be, and the most ruthless skeptical scrutiny of all ideas, old and new. This is how deep truths are winnowed from deep nonsense" Carl Sagan.
| References | |  |
| 1. | Becker CM, Glascoff MA, Felts WM. Salutogenesis 30 Years Later: Where do we go from here? Int Electron J Health Educ 2010;13:25-32 
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| 2. | Kaptchuk TJ. The placebo effect in alternative medicine: Can the performance of a healing ritual have clinical significance? Ann Intern Med 2002;136:817-25.
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| 3. | Beddington J, Cooper CL, Filed J, Goswami U, Huppert FA, Jones HS, et al. The mental wealth of nations. Nature 2008;455:1057-60.
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| 4. | Valiathan MS, Thatte U. Ayurveda: The time to experiment. Int J Ayurveda Res 2010;1:3.
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