Evolution from quackery to integration to functional
In the USA, of course osteopathy has for many years had an equivalence in law with orthodox (allopathic) medicine, while naturopaths practice as first line physicians in (I believe) 14 States, with legislation pending in many more.
When I was training, in the late 1950s, however the picture was so very different from today’s tolerance and acceptance. In 1964 journalist/author/historian Brian Inglis (see photo) changed the disparaging language with his famous book (and phrase) Fringe Medicine. This term brought with it a sense of being closer to acceptance….not at the heart of mainstream, but on the periphery …. somehow, almost kosher. Many years later I met Brian, and recall being tongue-tied when trying to express my admiration for his principled stand against the established order…… most embarassing!
Memory doesn’t help me with when the next linguistic change came, but I think it must have been in the early ’70s that the phrase alternative medicine crept into common usage. Alternative suggested different from, another choice, and was acceptable to many health care professionals practicing outside of mainstream. This was just a few years before the time (1982) that the Prince of Wales made his famous speech, on the occasion of the 150th anniversary of the founding of the British Medical Association, referring to ‘today’s alternative becoming tomorrow’s convention‘….or some such phrase?
Around that time the word holistic entered common usage, soon of course to be supplanted by complementary.
An article in the New York Times in 1985 (January 9th) entitled, ‘More Britons Trying Holistic Medicine‘, reflected how descriptive words were becoming jumbled, with the writer Barnaby Feder, using holistic, alternative and complementary, more or less interchangeably:
“The driving force behind the change has been the medical profession’s reluctance to embrace an ”holistic” view of health, as a condition reflecting interaction among a patient’s background, environment and state of mind, and the disease or injury. As critics see so- called conventional medicine, it looks narrowly at a patient’s condition in a way that usually leads to surgery or powerful drug treatments, while alternative medicines lead to less drastic therapies. The holistic philosophy is important in several forms of alternative medicine“
Holistic was certainly a buzz word back then, and still is, to the extent that it has almost lost its’ true meaning. It was coined in 1926 by a South African statesman, Jan Smuts in his book Holism and Evolution, signifying a way of understanding systems, other than in a reductionist manner.
Smuts described: “The tendency in nature to form wholes that are greater than the sum of the parts, through creative evolution.“
Holism derives from ὅλος (holos), a Greek word meaning all, entire, total, and represents the idea that all the properties of a given system (biological, chemical, social, economic, mental, linguistic, etc.) cannot be determined or explained by the sum of its component parts alone. Instead, the system as a whole determines, in an important way, how the parts behave. According to Wikipedia the general principle of holism was concisely summarized by Aristotle in Metaphysics: “The whole is more than the sum of its parts.“
This term resonated, and still does – despite it being much abused and overused, as – for me – it described what I did (or attempted to do) therapeutically, matching the original concepts of osteopathic and naturopathic medicine.
Complementary on the other hand brought with it a sense of being tacked onto something bigger and better (conventional medicine). Complementary in the minds of many British DOs and NDs was disparaging, too close for comfort to supplementary. This was a negative evolution….having been quacks, and then fringe, and then for a while, gloriously alternative, we suddenly found ourselves bathed in Aritotle’s holistic golden glow….. and now we were merely added extras, complementary…… most uncomplimentary!
We were said to be complementary, and yet many of us felt holistically alternative …. and so CAM was born.
This phrase – CAM – (standing for Complementary AND Alternative Medicine) bridged the intellectual divide – politically if not intellectually.…..and then., after a few years, in the 1990s, suddenly we were integrated!
So, what is integrated medicine?
Is it when a mainstream physician refers a patient to a CAM therapist/practitioner?
Or is it when a mainstream physician undertakes a few weekends (or longer) studying nutrition, or acupuncture, or homeopathy, or manipulation, or herbal usage, and then introduces these methods to his/her patients?
Or is it when Medical Schools offer a few token hours on these topics, in the early years of the training of the next generation of physicians?
Or is it – as it should be – orthodox/allopathic training, changing from its base to its core, to reflect a real understanding of how health is lost, and how it might be regained – and retained, by application of methods that respect self-regulation and homeostasis. By removing obstacles to recovery, rather than trying to make changes (pharmacologically or by other means) on behalf of the body and its’ systems? By accepting that most health problems are due to a failure of adaptation, and that therapeutic choices can usually be narrowed down to just three possibilities :
- Reduce or remove adaptive demands on the systems of the body
- Enhance the functionality of the systems of the body so that they can handle the biochemical, biomechanical and psychosocial adaptive demands to which they are responding – or failing to respond
- Treat symptoms – hopefully without adding excessively to the individual’s possibly exhausted adaptive capacities **
Until the happy day when all doctors are teachers, and they approximate these ideals, we need to make do with a model in which people, from different professional backgrounds and disciplines (Medical doctors, Osteopaths, Chiropractors, Naturopaths, Physiotherapists, Psychologists, Nurses, Massage therapists, Nutritionists, Herbalists, Acupuncturists etc etc) try to draw from each other the best their disciplines have to offer, working together in teams to discuss their beliefs and experience in health care, to watch each other work, to analyse outcomes, and to begin to forge a true integration?
Now that would be an alternative worth working towards.
Gladly, it is slowly happening, in small pockets of endeavour, and when time allows I’ll expand on this theme.
Until then you could do no better than to read a blog produced by John Weeks in the USA. To receive this email him at firstname.lastname@example.org or go to:
Or, you might want to start exploring the next evolution in this terminology saga – Functional Medicine.
To get a flavour of what this is about download a pdf brochure of the next International Functional Medicine Symposium, in late May, in Carlsbad, California on the topic of the Many Faces of Pain.
** Note: The theme of adaptation will form the focus of the next blog posting