10 questions to school medicine

Background for the questions: The prerequisites for a humane medicine development has during the last centuries changed substantially. But the great success related to development of pharmacological interventions and preventions of microorganism related diseases seems to be blinding (see e.g. Kuhn below) scientific medicine answerable, perpetrators as well as general public while life style related diseases are now main medical problem and this requires something quite otherwise than pills. Old mainstream just go on driven by economical interests where individuals and societies are the losers.

A critical analysis and specification of requirement for how today humane medical problems should be dealt – at all levels (also theory, methodology) with the aim to provide effective biopsychosocial assessment and interventions of life style- and society related diseases (can be defined different but should include many cardiovascular-, cancer- and autoimmune diseases).

Below are a number of questions presented which I regard as necessary to work hard with. My background as musician, folk scholar, Ph D in psychology and professor in medical engineering formally but informally focusing on biopsychosocial medicine (but also many years of personal experienced of severe stress related problems, at worsened immobilized) gives me a different perspectives on present medical situation. I have still after 20 years in science difficulties to understand scientific medical reason for the dominating simplistic paradigm as well as related methodology, data treatment and ways to do many clinical assessment and interventions, that is, when it concerns non-micro organism related diseases/problems/symptoms and accidents.

The absence of a functional biopsychosocial knowledge platform must be motivated scientifically – and also explained how it just can go on the pharmacological road. Hardly could it be explained only by a “silent” marketing focused attitude impact (based on economical interests). Such a massive dupe of intellectual scientists and clinicians would not be possible. Or is it a modified version of Neal Postman’s argument below? Or? Or – am I wrong in my analysis? Something I would be grateful to learn if so!

Medicine is defined as “art of healing” and not pharmacological interventions, which unfortunately has become how the word medicine is used something, which also need to be subjected to analysis. This shows how powerful marketing can be. Biopsychosocial medicine uses pills as temporary support when it is needed, which often is not the case in life styles- and society related diseases. ASPIRE is an example on intervention package to be learn and individual tailored/implemented.

Questions:

1. Can a functional medicine development occurs without an effective, useful biopsychosocial medical knowledge platform (see Bernard´s argument below) as well as enough time together with patients to anchor relevant knowledge and motivation for effective cooperation?
2. Can effective treatment occurs if not individuals´ biopsychosocial processes thorough, systematic are analyzed (see Lazarus´ argument below), that is; relevant dysfunctions (generating the symptoms) are identified and expressed in intervention terms?
3. Can effective treatment occur if not biopsychosocial intervention processes are measured and followed to enable intervention modification and thereby increase the efficacy?
4. Can pharmacological interventions be regarded as no 1 for treatment of life style- and society related diseases/problems/symptoms? If not, why are other kinds of treatments called alternative or complementary – alternative, complement to what? Pharmacology?
5. Can effective intervention occur without patients are educated to become a competent, motivated resource in her/his own rehabilitation – “man as a health creator”?
6. Can nomotetic focused empirical studies be satisfactory for ideographic (individual focused) clinical work/interventions aimed for stress prevention or health promotion?
7. Can present medical and psychological education be regarded as adequate for a biopsychosocial policy, attitude and way to work with life style and society related diseases – concerning assessment, explanation to patients, patient education and other kind of interventions?
8. Can the today ways to analyze complex multifaceted data be regarded as sufficient – that is to deal with individual biopsychosocial processes over time?
9. Can it be claimed that there is not a gap between what medical research addresses and what everyday life (also clinical) needs?
10. Can it be claimed that the dominating focus on empirical studies is enough for a knowledge development within medicine or, as in I Kant´s argument (see below) – needs more theoretical work? Perhaps like in physics, theoretical physics? Is the absence of a biopsychosocial system integration and concrete useful knowledge development no problem for the medical development?

In my professor presentation I have addressed some of the questions above in ”Evolution and Health” (NB not English corrected). Here I also discuss IBED – Individual Biological Evidence based Documentation which is needed to be a (crucial) complement to evidence based medicine or practice in clinical and preventive work.

Quotations/arguments

Thomas Kuhn: “Paradigmatic thinking often lead man (as e g scientists) to exclude areas of research/relevance, including particular findings and/or theories/rational that does not easily fit into the paradigms of today. A paradigm is a set of believes about reality that seem self-evident and un-changeable. This is the more or less explicit platform where theories and hypotheses are generated-/extracted/emerging. Paradigms are needed for effective work but if regarded as “facts” and the scientific truth it can lead individuals (e g scientists) to defend their view-point against rational evidence or fight back new evidence while not fitting into the own paradigm” Kuhn 1957, The Structure of scientific Revolution p.??)

Neal Postman: “What Huxley teaches is that in the age of advanced technology, spiritual devastation is more likely to come from an enemy with a smiling face than from one whose countenance exudes suspicion and hate. In the Huxleyan prophecy, Big Brother does not watch us, by his choice. We watch him, by ours. There is no need for wardens or gates or Ministries of Truth. When a population becomes distracted by trivia, when cultural life is redefined as a perpetual round of entertainments, when serious public conversation becomes a form of baby-talk, when, in short, a people become an audience and their public business a vaudeville act, then a nation finds itself at risk; culture-death is a clear possibility ” .. Who is prepared to take arms against a sea of amusements? To whom do we complain, and when, and in what tone of voice, when serious discourse dissolves into giggles? What is the antidote to a culture’s being drained by laughter? (Postman, 1985, p 155-156) .. ”What afflicted the people in Brave New World was not that they were laughing instead of thinking, but that they did not know what they were laughing about and why they had stopped thinking” (p. 170).

Claude Bernard: “.. If we break up a living organism by isolating its different parts it is only for the sake of ease in analysis and by no means in order to conceive them separately. Indeed when we wish to ascribe to a physiological quality its values and true significance we must always refer it to this whole and draw our final conclusions only in relation to its effects in the whole” (Bernard, 1865) in A Despopoulos & Silbernagl (1991) Color Atlas of Physiology: N.Y.: Thieme.

Richard .S. Lazarus: ”Since appraisal, emotions, and coping patterns ebb and flow in a person’s changing commerce with the environment, a new type of assessment is needed that measures process and variation within individuals and across situations, as well as structure and stability” (Lazarus, Cohen, Folkman, Canner & Schaefer’s, 1980, p. 113) Lazarus, R. S., Cohen, J. B., Folkman, S, Canner, A. & Schaefer, C. (1980).

Emery, F.E, p.,8: ”Human organizations are living systems and should be analyzed accordingly. The fact that it faces us with the task of analyzing forbiddingly complex environmental interactions gives us no more of an excuse to isolate organizations conceptually than the proverbial drunk had when searching for his lost watch under the street lamp because there was plenty of light when he know he had lost it in the dark alley” Emery, F.E. (1969). Systems Thinking. Perguin Books Ltd, Harmondsowrth, Middlesex; England, page 8
… ” .. the members of the organization must be so committed to the end-state that they will respond to emergencies calling for greater efforts. The basic regulation of one system is this self-regulation – regulations that arises from the nature of the constituent parts of the system. One corollary is that it is only within such framework that regulatory mechanisms, such as cost controls, can make an effective contribution. In creating these mechanisms it is essential to ensure that they did not run counter to, or undermine the requirements for self-regulation, and to remember that mechanisms which are appropriate in one phase of a system´s existence may, with a change in location with respect to the mission, becomes inappropriate” What also should be discussed is dysfunctional self-regulation which is the ”normal” case when a subject has been ”hypertensioning” for a long time leading to adjustment to a dysfunctional steady state has be maintained and thereby becoming habitual. Such dysfunctional steady states take time to gradually normalize. When a patient is “habituating” a systolic blood pressure of 180 mm Hg and then direct normalizes it to 140 mm Hg it will be subjected to compensation/adjustment to reach the dysfunctional steady state (BvS clinical experiences). This requires time – in terms of many correct small steps lead to large ones – over time.

Below quotations from von Bertalanfyy. L. (1968) General Systems Theory. Braziller. N.Y.
P.51: “Conventional education in physics, biology, psychology or social sciences treat them as separate domains, the general trend being that increasingly smaller subdomains become separate sciences, and this process is repeated to the point where each speciality becomes a triflingly small field, unconnected with the rest. In contrast, the educational demands of training “Scientific Generalists” and of the developing interdisciplinary “basic principles” are those general systems theory tries to fill in”

P. 192-193: … a new model or image of man seems to be emerging. We may briefly characterize it as the model of man as active personality system. .. This implies a holistic oriented psychology. It is used to be a general trend of psychology to reduce mental happenings and behaviours into a bundle of sensations, drives, innate and learned reactions or whatever ultimate elements are theoretically superimposed. In contrast, the system concept tries to bring the psychophysiological organism as a whole into the focus of scientific endeavour. This a new “model of man” appears necessary … “with” emphasis on the creative side of human beings, on the important individual differences, on aspects that are non-utilitarian and beyond the biological values of subsistence and survival – this is implied in the model of active organism. These notions are basic in the re-orientation of psychology …. Man is not a passive receiver of stimuli coming from an external world, but in a very concrete sense creates his universe. ”

Immanuel Kant (in my interpretation):”Data is empty without a theory and a theory is blind without data”

A biopsychosocial medicine overview is in

http://www.psych.uncc.edu/nsgordon/Health%20Psych%20PDFs/Suls_2004.pdf