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


Blogger Cervantes said...

The first challenge for anybody who chooses to work in the fields of medicine or public health is to define "health." What is the goal of our endeavor? Yet we seldom bother to reflect on that question, or discuss it. I definitely don't think it's part of the medical school curriculum.

5:41 AM  
Blogger Blake said...


You are so wise to return to this basic question of defining health

I've always liked the WHO definition which is a dream which remains elusive in ALL nations

Rick Lippin

7:23 PM  
Anonymous SpiderWoman said...

Have you read Edward C. Whitmont's, Psyche and Substance? Absolutely brilliant. He's an MD who moved to homeopathy and studied under Jung. He beautifully and elegantly discusses issues of deep psychology, health, metaphorical nonlinear thinking, and quantum physics, tying them all into a whole that, for the first time, truly made sense to me.

I come from a hard science background and thought that, though most of what I'd already seen in the allopathic medical world was corrupt, it was the only rational approach to health. Then, I was given the worst iatrogenic illness one can get, arachnoiditis. Hopeless. Untreatable. Fatal. And painful beyond anything imaginable.

But when I'd reached the point where death was around the corner, I was asked to try homeopathy, and though it seemed ridiculous to me, there was nothing left to lose, so I tried. It turned my life around. I'm here to tell the tale - and also to rethink the nature of reality.

I'm about to start a new career as a homeopath. Frankly, the attitude I see there is pretty absurd in most cases - wanting to have one's cake and eat it, too. Claiming that homeopathy is science, which it isn't, and also that science is junk because it changes what it considers to be true, which is nonsense, as that's its one true strength. On the other hand, there are those who try to make homeopathy into a religious experience. It's not that, either.

But, it does work. So a new paradigm is needed for it. Not only in terms of trying to explain it, but also in terms of applying it. All medicine - allopathic and its competitors - needs to move into a new world and a new paradigm. Both work within their own terms, if they're well applied.

Sadly, neither is usually done well.

12:46 PM  
Blogger Blake said...

Thanks Spiderwoman

You are wise

Also I personally believe in the efficacy of homeopathy but I don't know why it works?

Best Wishes in your new career as a homeopath.

Rick Lippin

2:33 PM  
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9:16 PM  

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