Thursday, June 28, 2007

Growing Evidence For The Decline of Bio-Medicine's Obsession with Reductionism

In January of last year (2006) I wrote a piece on this blog suggesting that contemporary bio-medicine was failing in part because it did not recognize the limits of a reductionistic model.In that blog which I called "American Medicine's Denial of the Anatomical Existence of the Neck (scroll down to January 11)"I cited Descartes(1596-1650) fundamental error of splitting mind and soul from body, the rise of "Holistic Medicine" since the late 1960s (actually I still like that term-"Holistic" despite the term's many competitors), my own promotion of what I called a Bio-Psycho-Social-Spiritual (BPSS) model of health care, and the rise of neuroscience and all of its profound implications such as human perception,human choice and intentionality and their impact on human health outcomes, which would render "the medical revolutions" of the human genome project and stem cell research (inflated promises) almost childlike.

Also in 1985 I published a statement I called "Reductionism's Last Hurrah" in my field of Occupational and Environmental Medicine (OEM) stating that the complexity factor alone renders scientific analysis of all exposures unfathomable.

Well since my January essay two important events occurred in my professional life that confirmed my belief that the excesses of a reductionistic model were causing contemporary bio-medicine to fail.

The first was a remarkable paper which was sent to me entitled "Beyond Reductionism-Reinventing The Sacred" by Stuart A. Kauffman,Professor at the University of Calgary, with shared academic appointments between biological sciences, physics and astronomy.(Wow- Talk about a "Neo-Renaissance Man"!).In this remarkable paper Kauffman,(formally from the University of Pennsylvania-my own home state), frames a new scientific world view of emergence and ceaseless creativity, which, he notes, is "awesome in what has come to pass in reality, and God enough for me and many, where God is the creativity of the universe, yielding a global ethics of respect for all life, the planet, awe, wonder and spirituality cut free from a transcendent God." I promise you, this is an essay -published by "EDGE"- worth reading many times.

The other event (less spiritual than the stunning Kuaffman essay but none the less important) in my life was listening to the Keynote Address at the 2007 American Occupational Health Conference(AOHC), my own medical specialty's most important annual conference, this year held during the first week in May in New Orleans, Louisiana. Professor Laura Punnett (Sc.D) from the Department of Work Environment,University of Massachusetts,Lowell- an institution with a long history of outstanding research on the subject of human work with a strong tradition of social conscience and progressive values, delivered the landmark address. I could almost not believe the words I was listening to or the data presented on the slides. It was as if I had waited 30 years to hear this keynote address at a major traditional US allopathic medical specialty conference. For more on Dr. Laura Punnett click here.

In the address Dr. Punnett literally challenged our specialty of Occupational Medicine(OM) to adopt a new research and practice paradigm. While the address revolved around inequitable distribution of workplace risks as it relates to workplace related musculoskeletal disorders-the latter being the largest current challenge in Occupational Medicine-more importantly Dr.Punnett presented a compelling case for socio-economic (SES) variables (e.g- poverty,education, power etc) not being viewed as confounding variables in studying disease and conducting academic research but rather as what she calls effect modifiers. Thus, with this recommended study design protocol change that Punnett recommends, SES variables, for example, become far more important factors than bio-medical researchers would heretofore consider. Dr. Punnett also stressed the importance of what the US National Institute of Occupational Safety and Health (NIOSH) calls Organization of Work (OOW) on which I have personally worked. Punnett refers to an inclusive (Holistic?) Multi-level Exposure Paradigm for Occupational Health which must include ALL of these factors including SES, gendered position, work organization and both physical and psycho-social exposures. I pinched myself for the first time at my conference and applauded the conference planners for inviting Dr. Punnett to be our keynoter.

I guess I consider myself a scientific "cyclist"(not bicycles) but rather I believe scientific and medical practice paradigms are historically cyclical. The ancient healers were holistic for example.The full flourishing of contemporary western reductionism without question produced miraculous results from which we have all benefited. But I submit respectfully the model has been taken to excess and has "run it's course".

Also I do not believe that reductionism is inherently wrong or incorrect. But this I am sure of.In any culture-in any time-REDUCTIONISM IS INCOMPLETE.

So welcome to the new age of holistic medicine (Hospice/Palliative Medicine is an excellent interdisciplinary model).This is the new medical world we will live in for the foreseeable future. It is not anti-science but leverages the best that contemporary reductionistic bio-medicine has to offer thus allowing bio-medicine to achieve its full potential.

Please - Let's here from you.

And Be Well,

Dr. Rick Lippin

Wednesday, June 20, 2007

The Power of Art- Moore's Movie SICKO Will Change Our Nation

Call me non-intellectual but I've always believed that the power and intensity of a single piece of Art, properly timed, on rare occasions can transform a nation.

Examples include Harriet Beecher Stowe's novel Uncle Tom's Cabin and it's impact on slavery, Upton Sinclair's muckraking novel The Jungle on slaughterhouse conditions which lead to tighter standards on food and worker safety and the TV special called Harvest of Shame which educated the nation on unjust working conditions of migrant farm workers.(thanks Professor Joe Palermo for the references).Twe more contemporary examples of this phenomenon are the photographic image of planet earth from space which I believe jolted us into global conciousness and "former president elect" Al Gore's oscar winning movie An Inconvenient Truth which undoubtedly advanced worldwide awareness of the treat of global warming. Certainly you-our readers- could think of yet more examples. Post them as comments to this blog.

Michael Moore's movie about our nations severely broken US Health Care System-entitled SICKO-is such a piece of Art.

Due to open broadly in the US next Friday on June 29 this film and activities and "buzz" surrounding the movie will further stimulate an already great hunger for bold and radical change in our US Health Care System. (See my blog immediately below entitled "1993-1994 is NOT 2009-2010"

Amy Goodman, who hosts a nationally syndicated news radio program called Democracy Now, calls what Moore is doing more than just a movie. She calls it a movement. See her piece in AlterNet. She is indeed correct. For more on this movement go to Moore's web sites including a YouTube group or checkout SICKO'S the movie's official website.The websites and Michael Moore invite you to tell your own horror stories about US Health Care.I've told a few myself.

Marilyn Clement, National Coordinator for Healthcare Now ,the nations leading advocacy group for "Single Payer-Medicare for All" has also encouraged citizens to rally around the openning of SICKO. They are even trying to raise $ so people of very limited financial means can view the movie for free!

Another one of my long held beliefs is that there are three essential ingredients to a successful socio-political movement. They are,in order of importance-

- Timing
- Timing
- Timing


Moore's timing on releasing SICKO this month is impeccable and is a testimony to his political intuition or even genius?

This is his best Moore movie yet and this will reinforce the reality that health care reform will indeed be the domestic issue that will elect the next US president.You can take that one to the bank. "Trust me -I'm a doctor":)

If the current White House is stupid enough to even touch Moore for his trip to Cuba they will transform Moore into a martyr which will only generate yet more "buzz" for SICKO and surrounding activities.

Take a break this summer. Go to the movies and see SICKO. It will be good for your own personal health -and the health of our nation.

You will be witnessing first hand the power that art and art alone posseses to capture the hearts and passions of a nation on an issue of profound importance.

Capturing of only our minds, also extremely important, is a job best left to others.

Be Well,

Dr. Rick Lippin
Also founder -International Arts-Medicine Association (IAMA-1985)