User:Irismeister/Conventional medicine
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Conventional medicine is mainstream Western medicine, as it is practiced today as part of the health care system in the industrial states of the first world. Very few alternative medical practitioners are licensed to practice conventional medicine. Since many conventional medical practitioners often extend the scope of their practice to alternative procedures (sometimes for seeing more clients) the reverse is not true.
This article looks into the necessity of finding acceptable alternatives for purposes of serving the patient's best interest first, within the body of mainstream medicine. It also voices criticism concerning the human, individual and social issues involved in current medical practices, both conventional and alternative.
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Historical Divisions of Conventional Medicine
The hallmark of Conventional Medicine is triple: control, division and specialization. In the 19th century, Westerners began to consider serious comparisons between Western and non-Western medical practices. Today, participants in debates over medicine are divided: many advocates of alternative medicine idealize the original "shamans" as models; some people however see shamans as antecedents to conventional medicine. Other scholars, who are not involved in debates about the philosophical and practical aspects of medical practice, study shamanism from other points of view (e.g. as religious or political actors). Early students of shamanism as a religion include Mircea Eliade, Carlos Castañeda and Jean Clottes.
Since its beginning in the Late Ceramic Phase of Asian Neolithic, Chinese Medicine (中药, zhōngyào ) was a synthesis of approaches, finely tuned for the needs of an individual patient. Indeed, Chinese Medicine emphasizes - for instance in the classical treatise of the mythical Yellow Emperor, Huang Di Nei Jing Su Wei - the absolute necessity of an extremely suble, thorough and profound knowledge of the "individual inside each patient". Mixing a synergy of physical diagnosis based on clinical observation and taking the pulse (the semiology of which takes fourty volumes in another classical treatise) with therapies like moxibustion, vegetal or opotherapic extracts, and Acupuncture, Chinese Medicine offers a compelling paradigm:
It still is, after six thousand years of continuous cultural evolution, a medicine based on no specialty (but a unique approach to only one single patient) using all ways and means that might help that particular single patient. Simply put, for that particular culture of integrative medicine, the patient is more than a collection of parts, which are "addressed" by specialists as if they were subsystems (direction, suspension, locomotion) in an automobile. Western students of Chinese Medicine are often overwhelmed by a cultural approach offering different (sometimes even opposing) remedies, to patients apparently suffering from the same disease because they display the same symptoms and complain about the same suffering. Still other civilizations separated, and from their very beginning, the practice of medicine between "specialities":
Physicians in ancient Rome for instance dealt with two classes of human suffering - rheuma and trauma. Claudius Galenus, a Roman citizen of Greek nationality (like most of the practicing physicians of the time, who were Greek) instituted a theory of medicine which later on based the School of Salerno and many of the current divisions between "learned" physicians on one side, and "barbers and dentists" on the other. Molière derided both such classes of medical doctors, the second of which gained city rights only after the Renaissance. At the beginning of the 17th century, medical practice in England was divided into three distinct groups: the physicians, the surgeons, and the apothecaries. Physicians were part of the upper-class and usually held a university degree. Surgeons, in contrast, were typically apprenticed and hospital trained and often served the dual role of barber-surgeon. Apothecaries also learned their roles prescribing, making, and selling medicines, through apprenticeships and sometimes within hospitals.
After 1750 in Europe, the practice of medicine was growing increasingly according to a medication-centered paradigm. At that time, prescription of at least some specific medication was already the expected outcome of medical consultation. During this historical period medications were prescribed by both physicians and apothecaries. In Europe, the practice of surgery had started to raise its status during the Middle Ages, and notably after Ambroise Paré's invention of ligatures as hemostatic means clearly less barbaric than cauterization. When Hahnemann started responding to physicians and apothecaries who prescribed poisonous medication like calomel (mercury(I) chloride) and against barber-surgeons of the period who engaged in severe blood letting, he made a significant therapeutical advance. As a direct consequence, apothecaries, or pharmacists, could no longer prescribe most medications in Europe starting with the nineteenth century.
Prescription became a medical doctor's exclusive right, after a mandatory physical examination.
The history of conventional medicine revolves around the development of the external agent model of disease
Alternative medical practitioners claim that conventional medicine's success in treating disease caused by disease agents is coming to an end, almost as quickly as it started during the 1930s, as antibiotics, for instance, are becoming less and less effective. They assert that the disease model is a primitive model of disease. This model also explains why conventional medicine is unable to effectively deal with "lifestyle diseases" which allegedly are not caused by external disease agents.
The external agent model of disease is often referred to simply as the biomedical model of disease which generally looks for single, very specific causes for diseases, with correspondingly specific treatments. Like antibiotics for infections, "find the microbe and kill it" approaches are expected to be effective for many diseases in most people, under most conditions.
The conventional medical model assumes that all disease is necessarily caused by a structural anatomic or biochemical abnormality. The allopath's responsibility is therefore limited to finding the abnormality to be cured. But without an easily discovered abnormality, the biomedical model often proves to be ineffective. The alternative model does not require that a disease's cause be understood in simple terms. Many schools of thought offered constitutional, homeopathic, diathese, and "external agents only act via internal causes" theories and models of disease. Notably, the hippocratic principles of humors and dyscrasias are close to constitutional models of disease.
Therefore, what we call alternative models today are not necessarily alternative always, especially in pre-industrial times. In fact they are the original and mainstream models in the beginning of Western Medicine.
Conventional medicine is said to treat the disease, not the patient
When you treat the disease, either a high-tech diagnosis is made with the expensive tools of modern medical science or a diagnosis has been made, based upon a physical examination of the patient. The concept behind the treatment of disease is the anatomo-clinical method whereby specific diseases have corresponding specific lesions at various levels, which should completely explain hallmark manifestations of that disease.
When you treat the patient, the diagnosis of that patient's individual characteristics come forward. Taking the personal, family and antecedent medical history of the patient before you address the current chief complaint becomes mandatory. Complex and varied, if subtle constitutional types are described, in somatic, psychic, and homeopathic terms. It is not a surprize to characterize a patient as a Thuya" or "a Pulsatilla type", before you list the current complaints. The concept behind the treatment of the patient is to endow the patient to cope with current aggressions, and even to thrive in hostile environments, using the inner capacity of healing.
Alternative medical practitioners contend that they tap into reserves which are otherwise ignored, and do a better job because it's far more profound than fixing a few symptomatic problems. Indeed, adepts of conventional medical theories sometimes confirm that "the functional reserve" of many body systems is only rarely, if ever used. The brain for instance, is only the trivial example, with less than ten percent of its capacities involved in our activity on a daily basis.
Practitioners of alternative medicine are also said to treat the patient exclusively. Indeed, they do not necessarily identify any specific disease. In many alternative medical paradigms, practitioners are instructed to forget about pathology and even about symptoms! A case-study in alternative medicine does not ascertain what the patient has been doing wrong because not all illness is assumed to be the "fault" of the patient. Further, the natural doctor or naturopath will usually try to regulate the deeper aspects of life in their patients (for example, their diet, their addictions like smoking, and even their philosophical attitudes) before using any remedies, nutritional supplements or herbs.
Going in different directions and perhaps deeper into the human suffering than merely revealing "mechanisms" of disease, treating the patient and not the disease is also a paradigm of prevention. Diseases are only naturally avoided, if the patient is treated right. It is perhaps ironical that during the practice of conventional medicine, the most ferocious adepts of biomedical approaches admit that their attitude of letting the patient complain, spending more time with the patient, and physically examining to a greater extent all systems and functions (even those not related to the chief complaint) drastically increases their conventional medical success! All of these good old hippocratic habits are menaced in the long term, by the industrial approach to health and disease, when time becomes an issue in conventional medicine.
The complex biopsychosocial model of health encompassing the mind-body connection is only a conventional medical translation of a concept which for ages was only called, in one word, harmony.
In short, "treating the patient" emphasizes the ABC of archetypes, the behavioral and the constitutional issues of the patient.
Conventional medicine can be impersonal
There is an important distinction between individual care and personalized care in modern patient care.
More and more, modern therapeutical approaches are based on complex, common and step-by-step controlled clinical trials and sophisticated protocols. The onus in such approaches is to report a quantified, numerical and statistical result to the manufacturers and holders of intellectual property for those protocols, so that they might be scientifically, financially and effectively improved. However, there is a side effect in this general trend: human patients (who are not ideal, uniformed, inbread or even cloned experimental models) are only benefiting from personalization of a common scheme.
Although this personalization goes far enough for most industrial or consumer-centered purposes, it is less than individualized attention, and even dosage. In order to diagnose and treat patients, conventional medicine relies increasingly on new, sophisticated technologies centered mainly in hospitals. This can result in 'assembly line' medicine, not only leaving patients feeling unhappy with their care, but convincing them of the existence of obscure, impersonal forces which downright disregard their most basic health needs. Even if all of these were not true, the image of conventional medicine clearly suffers from impersonal bias.
Patients can hardly be expected to volunteer for advancement of medical sciences, and indeed, expect the most, the best and the latest for their suffering as such. No social or economical necessity can possibly convince patients to accept rationalization of their treatement according to a general scheme. Therefore, although it is less hi tech and sometimes even expensive, alternative medicine rallies more and more people, in a trend-setting movement.
Adepts, regulators and proponents of conventional medicine must therefore admit, and develop ways and means to integrate alternative approaches, if the patient's best interest is still to be served. Already patients "voting" with their purse, despite medical insurance laws, advocate concerns about conventional medicine unable to address their intense, deep but unclear suffering.
When all conventional medical resources are exhausted, especially in chronical degenerative, proliferative and inflammatory pathologies, and controversial "do not ressuscitate" or "do not feed" cruel prescriptions are issued, alternative medical approaches can still save life by merely addressing the individual inside the patient, with care and patience.
Critics or alternative medicine from a conventional medical point of view should not be unfair in comparing the overall results of so different approaches to health and disease, when they are not comparable. Perhaps both medical concepts, conventional and alternative, have their place and they can harmoniously coexist on a non-exclusive, mutually tolerant basis.
Both systems have in common the old adage that "the secret of personal patient care is to care for the patient personally.
Conventional medicine is expensive
Both the government and individuals must pay for expensive new medical technology. This is generally at the expense of other areas where possibly better quality of life could be obtained, including education, health promotion and social welfare.
However, alternative medicine is also expensive. The cost of living is also increasing everywhere. So the cost issues are better understood inside the cost-for-benefits mindset:
Conventional medicine is more and more an industry. Many actors and profits are involved in health systems of the post-modern industrial nations. The drug industry is one of the most constantly increasing industries in volume and in value, and seems to be recession-free. The latest and most expensive diagnostic tools, like the PET scanners, rapidly become the sine qua non (the norm) in oncology wards. No wonder that patients are expecting more and more for their investment in health, and the general trend in media teaches them to accept nothing less.
However, this trend cannot continue indefinitely: Projections demonstrate that at current growth parameters, Medicare will go completely broke by 2019. Already, the medical offer is diversified towards accepted and reimbursed Complementary and Alternative Medicine (CAM) in a conventional move required by the realities of the demand in the health market.
Criticism of expenses incurred by conventional medicine is therefore more aptly formulated together with criticism of cost issues in general and billing of CAM procedures.
Society must decide if the patient's best interest is still served first, when the current cost and power structures developed in conventional medicine necessarily remain conservative, over-regulated and corporatist.
The choice of medical systems is everybody's business, not only the prerogative of health care providers, regulators and scientists, especially when expenses can no longer be controlled.
Conventional medicine's primary mode of treatment is said to be prescription of medication
Historically, in Europe, the practice of surgery was separated from the practice of medicine while in the Americas, north and south, the separation is a little more muddled.
Speaking from the conventional medicine point of view, licensure was coined as a response against physicians and apothecaries who prescribed medications rather than against the surgeons. "Snake oil" and radioactive water were less likely to invade the health market, but a new trend evolved:
After 1750 in Europe, the practice of medicine was growing increasingly in a medication-centered manner. During the industrial revolution, prescription of medication became the expected outcome of medical consultation. Hence, the only method of treatment practiced by licensed physicians, that is still in use today, is the prescription of medication.
Today, a patient paying for a visit to a conventional medical practitioner could not possibly expect less than a solid, sometimes thick, always officially endorsed list of drugs, assorted by referrals to other conventional medical practioners. Obviously, such societal choices help maintain and increase both costs and the offer of medication. Ideally, "design" drugs are expected to be developed, so that from erectile dysfunction to seasonal affective disorders and other mood swings, almost anything might be fine tuned according to the medication paradigm.
However, the reality of health and disease and even the sheer magnitude of the pathological spectra is such, that all medication has side effects. Indeed, the front effect is only what remains when marketing-driven drug development chooses to ignore and silence the rest. Increasingly, collusion and conflicts of interest appear between drug developers and the drug regulating bodies, for economical or trivial purposes [reference 1]. As a consequence, reporting the incidence and prevalence of new side effects shows alarming trends. Well in excess of 100,000 deaths per year are due to side effects of medication in the USA only [reference 2].
Corporate media condition consumers and consumer habits, for health industry as much as for any other industry. The specific difference is that health is not an industry to start with, but an objective of the patient's best interest.
Such doctrine, which may involve more than prescription of industrial medication, puts the human being in front of the economical paradigms of the society.
Conventional medicine no longer addresses the patient's best interest, but increasingly, the logic of economics
Historically, medicine was administered on a request-and-serve basis, inside the unique, case-by-case and doctor-to-patient relationship. Modern and post-modern systems of health care necessarily introduce more complex, institutional relationships, based on technology, industry, and epidemiologic considerations, all of which cannot ignore the statistical approach. Favoring the statistical approach weakens the case for addressing the individual, personal and human needs. Conflicts of interest may ensue. For instance, patients may complain about undergoing schematic approaches, instead of caring, individual therapeutical attention. Modern medicine is accused of not being about patients as much as about increasing a nation's GDP. Indeed, the post-modern turnover of private insurance, and a nation's social security reimbursement money is comparable, year after year, to the GDP in the same nation. Only by delaying reimbursements for as low as one month and investing the extra cash flow on the international low-interest short term market, la Sécu - the French Social Security - makes, or could make a ten billion euro profit per year!
When financial considerations such as these ones are taken into account, the absolute economical necessity for continuing growth in health industry mandates increasing medical costs. They are clearly spiralling in a vicious, positive feed-back loop which cannot be maintained by either population growth or increased medical insurance rates. In conclusion, and as a side effect, the health industry, which is the first industry in all industrialized states, now favors something else than the patient's best interest. It is perhaps understandable that many patients feel compelled to criticize their doctors more and more, sometimes on fictitious reasons, and that doctors now practice defensive medicine [1] (http://www.abcnews.go.com/wire/US/ap20040305_2234.html) and preach overconsumption more than they peform time-honored preventive medicine acts. With such conflicts of interest rampant, and medical litigation becoming an industry in itself, the destiny of conventional medicine is now inexorably bound to the evolution of societies which invented it. Conventional medicine is on a diverging path from the original principles of hippocratic, alexandrine and knidic medicine which founded the health systems for all societies in the Western Civilization.
All of the above explain the current, and more and more obvious push towards Alternative Medicine. If less industrial an approach, or because of this, still addressing the individual inside a patient first is something that conventional medicine has to reinstate, if its tremendous advances are to be matched by something different than techno-animism and a great leap backwords.
References
- [1] Dennis Cauchon, " Analysis of financial conflicts at 159 FDA advisory committee meetings from Jan. 1, 1998, through June 30, 2000" USA Today, September 15, 2000, 11-17. The analysis found that more than half of the experts hired to advise the government on the safety and effectiveness of medicine had financial relationships with the pharmaceutical companies that will be helped or hurt by their decisions. The article is online in full here (http://www.mercola.com/2000/oct/1/fda_drug_approvals.htm).
- [2 ] Jason Lazarou, Bruce H. Pomeranz and Paul N. Corey, "Incidence of adverse drug reactions in hospitalized patients: A meta analysis of prospective studies," Journal of American Medical Association, April 15, 1998, 279(15): 1200-05. This study found more than 100,000 deaths per year and 2,000,000 severe side effects in U.S. hospitals alone.
External Links
- An excellent social satire link about evidence-based medicine and critiques of evidence-based medicine (http://bmj.bmjjournals.com/cgi/content/full/327/7429/1459)
- Databases Profiling Malpractice Plaintiffs for the Purpose of Withholding Medical Care to Them Are a Shame for Conventional Medicine (http://www.abcnews.go.com/wire/US/ap20040305_2234.html);