Achieving Sustainable Medicine: The Changing Landscape of Nature, Culture, and Healthcare
We are moving past the threshold of doubt about the coming environmental crisis. The luxury of previous procrastination allowed easy waiting for politicians while scientists debated our future and corporations controlled the world and profited from societal denial.
We are witnessing no less than a change in worldview; a paradigm shift of perception about to be translated into practice. As far as the future of medicine goes, this is the time between lightning and thunder. We’ve seen the flash and are waiting for the rumble signaling the coming rain. Like the moisture from a welcome rain, what we do now will nourish the seeds we planted. But we’ve held off for too long. Instead of rain, there will be floods.
Crisis Fosters Opportunity
The Chinese saying, wéijī cùchéng jīhuì: “crisis fosters opportunity” is fitting for the present times and the global crisis that we have created. The crisis is evident, but the opportunities are uncertain.
According to Thomas S. Kuhn, author of The Structure of Scientific Revolutions, in a paradigm shift, a new worldview replaces its predecessor only after a time of crisis created by persistent failure in the application of the existing model.
We are in such a time of repeated failure, and a profound crisis of values is taking place in nearly every aspect of society. Medicine is no exception.
This crisis is like a horizon event where the known — the past and immediate present — blend into the unknown. A framework is emerging of new fully integrated and sustainable medicine consistent with the evolving needs of culture and society.
However, Kuhn wrote in the 1960s and 70s. He was not writing about paradigm shifts in the post-industrial world. In postmodern capitalistic societies, Kuhn’s theory gets twisted. A crisis became an opportunity for profit. By the late twentieth and early twenty-first centuries, medicine became a delivery system of a value-driven business model. Hospitals and large medical corporations hired executives from Amazon and other retail giants to shape the consumer-patient strategy. We still care for the sick, but now they are consumers of modern healthcare drugs, products, therapies, and services.
Illnesses of the past were mainly due to infectious diseases. Wounds festered. People contracted polio. Smallpox disfigured and killed. Pandemic influenza wiped out those in their prime. Bubonic plague laid nations to waste. The discovery of penicillin in 1941 ended most of this type of suffering. For a while. The vaccination campaign to end smallpox started in Africa in 1967. The last case in the Americas was in 1971. In May 1980, the WHO General Assembly pronounced smallpox eradicated as a human infection.
Antibiotics and became big business. Now, antibiotic overuse has overturned the balance of nature. Bacterial evolution does not stand still. It turns out that any use of antibiotics contributes to microbial resistance. Overuse makes the problem worse. Human deaths due to antibiotic resistant infections are predicted to surpass those of those of cancer. By 2050, the World Health Organization estimates the cost of treating antibiotic resistance to reduce world GDP by more than 100 trillion dollars.
Vaccines mainly target viruses. Antivirals are more difficult to discover and develop than antibiotics. After smallpox, vaccination campaigns like for polio and measles were so successful that the field of virology nearly became extinct. Then along came HIV, the virus associated with AIDS. Then chronic Hepatitis C Virus (HCV). Then Ebola.
Will we return to the dark ages of medicine when we lived in fear of plagues and infections?
The antibiotic crisis resistance stimulated scientists to find more effective antibiotics, to find vaccines to prevent infections, and to improve how patients with infections are managed. Advances in genetics, genomics, and computer generated disease vector mapping may speed up diagnosis and intervention. Novel antimicrobial strategies will emerge. A few effective antivirals are in use for HCV. And, alternative therapies including botanical extracts and nutritional strategies help integrate treatment strategies and serve as adjuvants to drug therapy.
Integration Requires Cooperation
Integration rather than diluting medicine humanizes it, enhances it, and makes it more functional and fundamentally more appropriate to a world vision of a sustainable economy and planetary culture. In the long term, it may even help to reduce costs, limit side effects and iatrogenic diseases, and improve clinical outcome as well as the quality of life for patients.
In a world out of ecological balance, we desperately need a new system of medicine that is sustainable, sane, and harmonious with all life on earth. After all, health is not merely a matter of the elimination of disease, the absence of pain, or alleviation of symptoms, but a condition of being that is energetic, complete, whole, and alive.
No society can endure for long without a system of medicine that understands and meets the needs of its citizens, and that maintains the well-being of the individual at optimal levels.
A new system of medicine is not only necessary but is essential to the future of the planet with far-reaching implications such as the protection of tropical biodiversity, the expansion of organic farming of food crops, and wider use of wild-gathered and farmed herbal medicines. Such a system of medicine should look towards long-term solutions, as well as symptomatic relief. These solutions must be culturally significant, be acceptable according to the beliefs and philosophy of the patient and harmonious with that person’s community and culture. They must also be sustainable and environmentally sound.
The philosophy and practice of a new medicine must be consistent with the new biology of systems theory, advanced by Fritjof Capra author of The Web of Life, and the deep ecology model founded by Arne Naess. It must have as its ultimate goal the restoration of balance within the individual and harmony between the person and the environment, as well as the treatment and cure of disease. It must be inclusive rather than exclusive, and not only have diagnosis and treatment based on pathology but function as well.
Modern medicine, as practiced during the second half of the twentieth century, is based for the most part on continual accelerated technological advances combined with market-driven economic principles supported by scientific studies. For the patient, this translates as those that cannot pay for care, receive none, or are dependent on minimal services provided by relief agencies or government sponsored programs. Those that have money obtain the most technologically advanced services yet fail to experience a cure, becoming dependent on multiple drug combinations to keep them functioning, while amidst affluence, their quality of life deteriorates.
In essence, due to this “for profit” mentality, we have a “sick care system” rather than a health care system.
It is akin to the same thinking that decides where to drill for oil on Alaska’s north slope, where to cut the most exotic hardwoods in Costa Rica’s supposedly protected rainforests, and how to extract the greatest amount of fish from the Peruvian banks. A pharmaceutical and medical system based on high-profit margins renders the maximum services to a population of ever increasing sick people who have expensive health insurance to pay for their treatment. The cost of care rises. Profits increase. The cost of insurance spirals upward. The number of iatrogenic incidences increases exponentially.
Such a system that looks for one disease, one cure fails to comprehend chronic and multiple systems diseases. The degenerative dysfunction and frailty of aging is treated by warehousing the elderly in nursing facilities. Part of the same consciousness that believes in bombing an enemy into oblivion will not solve the problem of social injustice and fatalism that spawn terrorism. The current maximum profit driven medical model of patients as consumers, while ignoring human and environmental consequences, will not solve the chronic disease epidemics of cancer and cardiovascular illness.
The Evolutionary Philosophy for a Sustainable Medicine
The underlying philosophy of modern medicine rests on a mechanistic view of the natural world; one in which humanity, or even an individual man, dominates all aspects of the more feminine amorphous world of earthy biological phenomena. However, this Euro-centrist, materialistic, male-oriented narrow scientific worldview is shifting, if ever so tentatively, as David Korten writes, “from the metaphor of the machine to the metaphor of the self-organizing living organism.”
In his 1990 Nobel lecture, Octovio Paz said, “We are witnessing the twilight of the future, and we are experiencing a crisis of the essential ideas and beliefs that have guided mankind for over two centuries.”
The opportunity implied in progress has two faces: evolution and revolution. Evolution is the progressive improvement, though not necessarily linear, of living things, ideas, and phenomena. Revolution is a radical change and at times departure from a norm that is overly resistant to evolution. Naturally-occurring change is silent, an undercurrent. At the same time, revolutionary changes occur to challenge and dissolve existing obstacles that arise in the evolutionary path and to keep the attained momentum moving forward. Both of these faces are present in the current climate of modern medicine.
Historically, progress in medicine occurs slowly through an evolutionary process of science and empiricism over a period of several decades or longer with the occasional interruption by an accidental and brilliant heretic. For the outcome of the current crisis in modern medicine, where unexpected challenges arise daily, to eventually attain a common ground between traditional and alternative practices, several evolutionary and revolutionary ideas and practices need to occur.
A deeper understanding of how healing occurs is required. The compassionate treatment of the patient and not just disease intervention is necessary. A broader understanding of how individual patients and groups of people become vulnerable to environmentally induced illnesses is needed to understand the development of chronic diseases. The integration of appropriate conservative therapies such as acupuncture will shift the burden of healthcare from dramatic intervention to safe and effective natural therapies. We need a dramatic reduction in iatrogenic diseases and a closer evaluation of the response to treatment and prevention of reoccurrence. Every new procedure, drug, treatment, and therapy must adhere to the Hippocratic maxim of “physician do no harm.”
Therefore, for fundamental change to occur in the current medical model, it will have to be rooted in a more complex theory of nature. Diseases may be seen as imbalances rather than a ruthless enemy, and birth and death as the bookends of life not as a medical problem to be solved with technology. There will be no “war on cancer.” The social view by which medicine is practiced will have to shift from a for-profit system to a system that predominately serves society and the individual patient; from a limited national view to a global perspective and from an expensive form to one of reasonable cost utilizing sustainable modalities.
Physicist David Bohm said, “postmodern physics begins with the whole.”
This was also true with the alternative medicine movement that began as “holistic medicine” in the 1960’s and early 70’s. Indeed, this concept of holism may be the most significant contribution of alternative medicine: the idea that all things are in their underlying nature connected and evolving towards a purpose, though we may not always know what that is.
How people cope with illness, aging, birth, and death, and how diseases get treated will fundamentally and dramatically need to change for this new vision to be successful.
To accomplish this, several changes in how medicine is practiced need occur:
- A Deeper Understanding of Human Nature and the Nature of Healing: Though the nature and biology of humans have been essentially the same for tens of thousands of years, there is still much to know about how we think and behave. Adapting modern psychotherapeutic techniques combined with the meditative eastern philosophical models is an example. Integrative therapy could be available to all individuals to improve the understanding of human nature in the home, school, and society as a whole. Also, the study of human science should extend to the area of bioenergetic phenomena. Quantum healing, as presented by Deepak Chopra, MD, is not only an exciting new field but contains the seeds of a further dimension of healing and regeneration. Scientific research into spiritual healing is already underway and will prove to be an interesting adjunct to recovery and rejuvenation.
- Integrated Medical Education: A re-structuring of medical school education towards better hands-on clinical skills for the general practitioner and the movement away from medical schools as elite institutions, including the creation of a new integrated medical degree for general practitioners and the establishment of rural “barefoot doctor” programs, including midwifery, delivering a minimal standard of care to all individuals in improvised rural and inner city areas. A universal requirement for one year of humanitarian service in any part of the world would be required. Physicians of this medicine will be a benediction to those they serve, and not only will they serve as highly paid technicians but also as shamans and healers.
- Early Recognition & Preventative Medicine: An aggressive preventive medicine and education program involving diet and exercise for arthritis, diabetes, heart disease, and cancer is extremely necessary for the developed countries. Preventive medicine should also extend to pre-conceptual care, as it does today for pre and post-natal care. Another area of importance is an understanding of the processes and diseases of aging and their prevention rather than today’s exclusive dependence on expensive intervention. Honorable and humane death and dying should be understood as part of a life well lived, and not as a failure of medicine and science. Self-care, under proper educational guidelines, should be encouraged and a proactive partnership between doctor and patient fostered.
- Ecological Medicine: New means and methods of evaluation need to be developed for “green” therapies, such as herbal medicine, phytonutrients, bioregulatory therapies, and homeopathy. Evidenced based medicine becomes the key word as opposed to the old school of excessive emphasis on scientific medicine that was often poor science. In a climate of more pro-active patients and easy access to information, issues of public safety arise and more precise regulation of over-the-counter herbal and nutritional supplements may need to be implemented to protect consumers from unscrupulous suppliers. Establishment of a “green medicine” for the use of natural botanical, animal, and sea products to include organic agriculture, sustainable gathering, and increased ethnobotanical field research; and the widespread use of acupuncture for the treatment and management of pain conditions such as arthritis and neuralgia.
- Appropriate Sustainable Technologies: The development of appropriate sustainable technologies that have a low impact on resources but a high return in clinical usefulness should be given priority over expensive high-profit medications and procedures. These include the utilization of modern methods of assessing the safety and efficacy of natural products and to make those that are safe and effective immediately available to all as over-the-counter medications.
- Environmental Health: An extensive program for the evaluation of environmental health risks and the study of increasing immuno-compromised conditions caused by continuous toxic exposure is a vital aspect of this new medicine. Aggressive programs are needed to protect newborns, infants, and others particularly vulnerable to chemical pollution. Clinical ecology and environmental medicine are of great importance, and we would be well served if physicians were encouraged to go into these specialties.
- Research: The NIH’s National Center for Complementary and Integrative Health (formerly the National Center for Complementary and Alternative Medicine) has a budget for 2017 of $130.5 million. This is substantial since there was nearly no funding in 1992. Still, considerable additional funding needs to be made available for the ideas listed above. Private sources could contribute substantially to research and development.
- Infectious Disease and Public Health: One of the most important areas is in the investigation of viral illnesses, such as AIDS and hepatitis C, and the development of preventative and effective treatment measures. Other global infectious disease epidemics include malaria and tuberculosis, Dengue fever, Zika virus, Ebola, SARS require aggressive research. We need a better understand of debilitating new illnesses like chronic fatigue syndrome (CFS) associated with HHV-6 and EBV viruses, and murine retroviruses that can cause cancer.
- New Standards of Care: A consensus of how to practice this new model will have to be reached but only after a further exploration into both systems of medicine, alternative and conventional. This may include a drastic reduction in the use and dependency on expensive pharmaceutical drugs, which will, in turn, reduce iatrogenic side effects and their consequences. Of great importance will be the avoidance of the overuse of antibiotics, while funding an accelerated research program on antimicrobial alternatives. Alternative therapies will also have to be carefully evaluated using the same disciple and methods as used in conventional medicine. However, there should not be two standards, but fair and equal standards for both systems.
- Delivery System: Without a delivery system for this new medicine that makes it universally available, all the best research, new medications, and preventive medicine measures will be useless. Adapting current successful models while advocating innovation new methods must be encouraged and implemented. Encouraging doctors and nurses to work closer to home, in their immediate communities, and developing a system of smaller university teaching clinics for hands-on training would not only serve the students but patients as well. Also, the use of internet technologies and interactive EHRs will play an important role in healthcare in developed countries allowing patients who have become consumers of medical services to access to technical information, virtual consultations, and online pharmacies.
A Shared Vision for a New Medicine
William Irwin Thompson said, “Now you cannot simply be Sartre in Paris or Heidegger in the Black Forest, thinking big thoughts about being and nothingness, for no single person, no single city, and no single language or discipline is adequate to bring forth the pattern that connects cognitive domains in a global geometry of behavior that is the distributive lattice of the new planetary culture.”
In this age, it is not one great scientist, or philosopher, or prophet who will guide us, but creative and concerned ordinary individuals: the organic farmer in the field looking into the morning sky for inspiration, the astute clinician with a case load of patients whose observations become the basis for future research, the poet and musician who provide therapeutic sound, the visionary and writer who rewrite the patient’s story from victim to victor; the team of young academics or researchers who together find solutions to former problems, and the far-thinking businessman, along with others who dare to cry out, who dare to change, and who collectively work to create this new culture of which medicine is a significant part.
When a vision is shared, a synthesis takes place by which shape and form are given to what was once an idea or a dream in the mind of only a single person. Each dream creates a larger dream. To give creative life to the emerging shape and form of the greater vision, one must have a determined will to see it manifested in the complex world of people, events, opinions, and things, and the energy to see it through to the end.
In an address to the New York Open Center in 1998, Rudolph Ballentine, M.D. said, “The personal healing experience is the prototype for the planetary one.”
Based upon a humanized technology that serves the individual patient, society, the health of future generations, and the planet upon which we live, a new medicine is arising in response to deeper transformational changes and has the potential to benefit us all, where medicine once again serves life and not death. However, diseases appear to change, human physiology and the nature of the human character remains essentially the same.
Sustainable medicine begins with a new vision of human values: of how we regard and care for each other and all things alive and non-organic in our world, and not just how we distribute goods and make money. Postmodern humanity will define itself based on these new principles.
We now have enough medical technology and knowledge for every physician to assist in accomplishing this vision. Like a piano with a set number of black and white keys, we can compose an infinite number of beautiful musical compositions.
As Walt Whitman said in, I Sing the Body Electric, “The Universe is a procession with measured and beautiful motion.”
A longer version of this letter was originally presented as a lecture by the author at the international conference, Ethics & The Culture of Development: Building a Sustainable Economy, in Havana, Cuba, June, 1998, and later published in Memoria-Resumen: Ethica y Cultura del Desarrollo, Construyendo una Economía Sostenible (in Spanish), by the Centro Felix Varela, La Habana, Cuba.
J. E. Williams is a doctor of Oriental and Naturopathic medicine with more than 35 years of practice and teaching. He has written poetry, photographed Andean shamans and New Mexican wildflowers. He is internationally recognized as an expert on integrative medicine. He has authored several academic papers and is the author of Viral Immunity, Beating the Flu, Prolonging Health, The Andean Codex, and other books.