Differentiating Healthcare Paradigms
If we look back throughout all but the most recent years of human history, there has been a distinct lack of knowledge and science around how the body works, and therefore relatively limited knowledge on how best to supports its health during disease and injury.
Nevertheless, over the ages a slow but consistent push has gradually yielded ever greater insights into how we work, what makes us sick, and what makes us well.
This noble pursuit has evolved into what we may now call ‘modern’ medicine.
However it should be noted that each generation invariably regards THEIR medicine as the ‘modern’ kind, (and therefore largely superior to the past).
Although, we might do well to remember that this has always been an ongoing process, one that has not been without its detours and misguided notions, and one that is certainly never completely finished (lest future generations remember us in the same way that we so readily deride the understandings, efforts and practices of our forebears).
Therefore it is normal and natural that even in our current time, there is continued contention about what are the most appropriate means of achieving the goals of human health.
It would be an oversimplification to say that anything that works has already been incorporated into modern medicine.
After all the term ‘modern’ medicine, when used alone, simply denotes a point in time.
We need more specific terms for describing the subtly differing paradigms that underpin the various modalities and specialties throughout all of medicine today.
The dictionary broadly defines the word ‘medicine’ as:
n. The science and art dealing with the maintenance of health and the prevention, alleviation, or cure of disease
n. A substance or preparation used in treating disease
However it remains to be clarified what precisely defines ‘disease’, and which are the optimum ‘substances’ and techniques to be employed to resolve that disease in any given situation.
This is where the many differing paradigms and approaches, each with their own labels, and ways of seeing human health and well-being, may have something to contribute.
Here is a brief summary of common types of medicine as they are described today:
e.g.
- Traditional Medicine: Based on the historical cultural practices.
- Homeopathic Medicine: Based on principles of energy having ability to induce healing responses in the body.
- Herbal Medicine: Involves the use of botanical extracts and plant compounds as complex natural pharmaceutical preparations.
- Nutritional Medicine: Involves the use of diet and nutrients as therapeutic agents for the avoidance and amelioration of disease.
However whilst all of these might be considered forms of ‘medicine’, none of these would be called ‘medical’.
So we need to further clarify what exactly modern western conventional medical medicine actually is.
Modern Conventional Medicine
The dictionary defines ‘medical’ as:
adj. of, relating to, or concerned with physicians or the practice of medicine
In most western nations, such as Australia, the term ‘medical’ is a legally protected title (i.e. it would be unlawful for anyone not registered as a medical physician to use the term in reference to any of their products, services or personal title).
This is because modern conventional medicine has come to refer to the default form of medicine used in western societies (and is therefore also sometimes called ‘mainstream medicine‘).
However there are some issues with many of these common terms.
For example, the term ‘Conventional Medicine’ simply refers to the fact that it has a certain amount of universal adoption and agreement, and therefore operates according to conventions. However conventions may be updated and changed.
Therefore this term has relatively poor descriptive powder, since all forms of medicine throughout history could have been regarded as the ‘conventional’ medicine of their day (and the same could be said for the terms ‘modern’ medicine and ‘mainstream’ medicine).
The term ‘Western Medicine’ (being simply applicable to a certain region or heritage) could also be considered equally arbitrary.
One of the shining achievements of modern science is the development of systems to seek truth (i.e. the scientific method), via evidence (rather than via mere opinion, superstition, or the persistence of conventions alone).
Therefore on the one hand the use of conventions may help provide a means of adhering to evidence-based practices (avoiding falling prey to other common aspects of human nature that have often departed from truth throughout history), however an overly regimented deference to conventions can also actually create a barrier to innovation and the evolution of any scientific field.
The need for strong universal agreement and reliance on conventions is an understandable artifact of the systemetised healthcare systems we have built in the modern age (so that many individuals and institutions across a wide variety of times and places can all be organised to uphold similar standards of practice).
Some have used the term ‘Allopathic Medicine‘ to refer to modern conventional medicine. However apart from often being used as somewhat of a pejorative term, it also constitutes a relatively poor descriptor, since it was originally coined by early Homeopaths in the early 19th century to differentiate how the mainstream medicine of their day used ‘opposites’ (hence the word ‘Allo’) in their attempts to resolve the imbalances of disease (e.g. if you have too much of something, then it makes sense to withhold that thing, or administer more of its opposing counterpart to balance it out), in contrast to the precepts of Homeopathy which involved the use of ‘similars’ (hence the word ‘Homeo’), which meant giving MORE of the same thing that is imbalancing the body (albeit in a benign form) to stimulate the body to better counteract its effects itself).
Therefore by this definition, the allopathic logic of avoiding what you are excessive in, and giving more of what might oppose or balance it out, is deeply embedded within almost all other forms of medicine (including many traditional, natural, and even nutritional forms of medicine). Therefore the term Allopathic Medicine could be applied to almost all fields of medicine that are not Homeopathy. For these reasons as well as others, Allopathic Medicine is certainly not the most appropriate term to use to describe modern conventional medicine.
Medical Medicine?
Therefore given all of the above, perhaps one of the most legally accurate, and also unambiguous terms (if seemingly redundant) for the current primary care form of medicine would be ‘Medical’ Medicine.
For these reasons, and for the purposes of simplicity, clarity, and disambiguation, the term Medical Medicine will be used throughout the rest of this content.
However beyond the clarification of basic labels and terms, it may be more useful to explore the actual perspectives, precepts and practices involved in various forms of modern medicine, and how they differ.
How does Medical Medicine define ‘Disease’?
Medical Medicine tends to define disease by its symptoms, often assigning labels (diagnoses) to the observable features that cause danger, discomfort, or disability to the patient.
This means that many different patients, who all have the same symptoms, will often get the same diagnoses.
One of the challenges of any systemetised healthcare system is a difficulty in retaining a high level of personalisation.
‘Disease’ in this context serves as a categorisation, used for grouping individuals, to assist with selecting their most appropriate treatment or care.
What treatment strategies does Medical Medicine employ?
Any agent or action that will resolve, hide or suppress those symptoms.
This may include the use of chemical agents that are often foreign to the body, to suppress or augment the physical processes in the body responsible for the symptoms (e.g. pharmaceuticals), or otherwise invasive physical interventions to the body (e.g. surgery to remove the problematic tissues).
How does Medical Medicine define ‘Health’?
Given the above understanding of disease, Medical Medicine tends to regard relative health as an absence of symptoms.
Fundamental Precepts of Medical Medicine
- Based on population norms.
(Determines the most desirable body parameters, and the suitability of treatments, based on averages of the largest possible group of individuals)
- Tends to focus on different aspects and parts of the person as isolated.
(Separating into singular specialties, and treating issues found there alone)
Strengths:
This approach is highly beneficial and appropriate in critical and acute situations where immediate and invasive modification of the body’s chemical or physical state (via chemicals or surgery), in order to save their life.
This model lends itself to minimal hesitation (emergency), maximised efficiency (shortest amount of practitioner time required), and maximised regulatory control (standards of practice are very easy to define and enforce).
This allows for a highly systematised and hierarchical organisational structure that suits governmental administration.
Weaknesses:
Does not always acknowledge individual differences.
Does not always address the true causes of disease.
Has a high potential risk for undesirable side-effects and unintended harm.
Can be resistant to necessary change.
Functional Medicine
How is Functional Medicine Different?
As the name suggests, Functional Medicine involves determining how the body is functioning, to seek opportunities to resolve any disturbances to optimum health.
i.e. Assessing and addressing the internal and external factors affecting personal function.
Functional Medicine is evidence-based, western in its cultural and geographic origin, and distinctly modern (in its very recent emergence by name).
For this reason Functional Medicine can also be regarded as a form of modern western medicine.
But due to the growing developments in scientific understanding, public awareness and education, changes in political healthcare structures and economic factors, as well as a increasing crises of chronic degenerative disease in western populations (as opposed to the more time acute and critical forms of morbidity from previous eras), the science and principles of Functional Medicine are set to continue growing in their prevalence and incorporation into the mainstream healthcare model of western societies (being increasingly adopted by medical practitioners, out of necessity as much as awareness).
It should be made clear that while there is certainly some overlap, the purposes and applications of Functional Medicine and Medical Medicine are technically different.
How does Functional Medicine define ‘Disease’?
Functional Medicine defines disease as a departure from the naturally optimum functioning of the body.
(In the truest sense of the word, a state of dis-ease is any lack of harmony in physiological systems)
These disturbances may not be manifesting as detectable symptoms yet, and therefore Functional Medicine tends not to rely on the same classification methods as medical diagnoses. Although Functional Medicine will certainly assist with the investigation of underlying mechanisms responsible for any overt disease as diagnosed by medical medicine.
Seeking the upstream causes for any dysfunction provides opportunities for resolving the actual reasons for any existing risks or symptoms, and guides treatment recommendations based on highly personalised insights.
As Carl Jung observed: “Every individual is an exception to the rule”.
This means that many different patients, who all have the same symptoms, will often get relatively different determinations and treatment recommendations.
What treatment strategies does Functional Medicine employ?
Any agent or action that will resolve, modify or counterbalance any identified impediments to optimum body function and health.
This may include the use of various chemical agents that are natural to the body (e.g. specific forms and doses of nutrients and nutraceuticals) and therefore capable of modifying cellular function and body metabolism, as well various behavioral, lifestyle, environment and mindset related changes (to support harmonisation of any disruptive influences on health).
Such as dietary change, nutrient supplementation, lifestyle modification (such as exercise, sleep patterns, etc.), change in personal environment and surroundings, mindset exercises and educational insights, etc.
How does Functional Medicine define ‘Health’?
Functional Medicine tends to define health as an appropriate level of vibrant well-being and functional capacity (for the personal situation and life-stage), rather than the mere absence of overt symptoms or disease diagnoses.
Fundamental Precepts of Functional Medicine
- Based on personal norms.
(Determines the most desirable body parameters, and the suitability of treatments, based on personal indicators, metrics and case history – independent of large population norms)
- Tends to regard all aspects and parts of the person as interconnected.
(Maintaining a broad awareness of numerous inter-related factors and systems comprising the whole individual and their health status)
Strengths:
This approach is more appropriate to assess and address the many chronic health conditions and risks that exist over time in modern western populations
Acknowledges and accounts for individual personal differences.
Seeks to address the true cause of disease as well as prevention.
Particularly useful in persistent and complex health situations involving multiple systems and factors.
Has a low risk of adverse side-effects or harm.
Is highly adaptive to update and change (as new science and evidence emerges).
Weaknesses:
Is not necessarily appropriate for many acute and critical health situations (where immediate medical primary care is more appropriate).
This model requires extensive practitioner and patient time (less time efficient) – (although may yield results that save time and costs over the long term).
More challenging to systematise and develop universal standards of care for.
Integrative Medicine
The term ‘Integrative Medicine‘ constitutes the marriage of both functional and medical type paradigms in the implementation of modern western healthcare.
To leverage on the strengths of both (and mitigate some of each of their weaknesses) to provide a more comprehensive healthcare model that allows for a more diverse range of options for selecting the most appropriate type of care for different situations (e.g. critical vs chronic type disease needs).
The shared terminology and mutual understanding of Integrative Medicine provides a unifying framework for multiple healthcare professionals to all work together in the pursuit of the health and well-being of an individual (rather than any one modality or approach being expected to manage all situations and aspects of an individual’s needs or care).
This cooperation and collaboration may involve:
- A multi-modality clinic (with healthcare professionals of various qualifications and approaches all under one roof).
or
- Cross-referrals between distant and unrelated practitioners with a mutual understanding and regard for each other’s various areas of expertise.
Such cooperation and collaboration requires humility on the part of each practitioner, and a focus on the best interests of the patient, rather than the superiority of one approach over another in all situations.
Sometimes a certain degree of integration is occurring when health professionals simply adopt certain practices, principles and precepts common to another modality (knowingly or unknowingly).
A subtle example of medical professionals utilising functional principles in the way they prescribe various medications may be demonstrated when patients make statements such as:
“I have an autoimmune disease, and I take malaria pills”
“I take heart medication for my anxiety”
“I take a 1950s antidepressant for my nausea”
“I take an anti-allergy medication to make me sleep”
“I take the birth control pill for my acne”
“He’s on ADHD medication for his low blood pressure”
Apart from the intriguing fascination that many may have with these apparent contradictions or juxtapositions, it illustrates how perceptions (of both the patient and the practitioner) play a significant role in all fields of medicine.
Beyond the use of pharmaceuticals (which are exclusive to the medical approach), the universal necessity of nutrition, and its unquestionable scientific relevance to health, perhaps means that nutrition provides the key common ground for numerous health professionals and modalities to intersect (in their collective care of a given patient).
This centrality of nutrition makes nutrition-related treatments key in any integrative care setting (e.g. where a Medical Doctor and Functional Medicine practitioner might share mutual regard for this most fundamental aspect and need of their patient).
The continued harmonisation of such perceptions and understandings between healthcare modalities is likely to continue, as the science and necessity for them also continues to grow in the modern healthcare environment.
Summary
Functional Medicine seeks to assist the body with its natural processes, and asks WHY any dysfunction or disharmony exists, to look for the right therapeutic interventions to restore that harmony (at the core level that it appears to stem from), so that a more true resolution to any issues can bring about a relief in any symptoms (albeit usually at the slower time and pace required to achieve this), and in the process has the potential to prevent various future issues from also emerging as a result.
The Functional Medicine approach requires that practitioners, whatever their level of skill or specialty, always look at the body (and person) as a whole, given that any thorough exploration of the human body and its mechanisms invariably reveals that no single function exists entirely separate from (or unaffected) by every other (directly or indirectly).
The Functional Medicine approach also requires the patient will be willing to take responsibility for their own health and well-being.
Functional Medicine does not replace the need for appropriate medical diagnosis and treatment.
If necessary, Functional Medicine practitioners will sometimes provide referrals to medical professionals (to rule out more urgent or serious conditions or pathology).
Functional Medicine principles can usually be utilised along with any concurrent medical treatments.