Biomedical model vs. alternative/holistic approaches

[Suzanne]

Hi. This is a question for med school students. I applied to UBC this year and didn't get in, though I got an interview (so hopefully I have a chance). I'm trying to decide whether to apply again. I have a degree in science and have done research in several labs, and I've also taken a significant number of courses in the humanities. I really like the idea of a profession that combines science with working closely with people, towards health. My one concern, and the reason I'm debating whether to apply again, is that I think the reductionist/biomedical model is problematic. I'm not against science or anything, I just think the standard scientific paradigm is flawed. I'm really interested in yoga and meditation. And I'm also really interested in the placebo effect - i.e. why don't we study the placebo effect to see if we can enhance our own ability to heal. I'm not opposed to the traditional methods of medicine, I just think we need a more holistic view. I know a lot of medical doctors are interested in this as well. I'm just wondering what it's like in medical school. Like, do you spend the whole time memorizing biochemistry, etc. And are people (students, professors) are generally open to alternative approaches to medicine?

 

Thanks for any feedback.

Suzanne.

[Jochi1543]

I think the reason we don't use placebos very often is ethics. How would you feel if your doctor prescribed you something, you shelled out $100 or more for it, and then later found out it was a sugar pill? I wouldn't be seeing him or her again, that's for sure - and would sue them out of work if my condition got worse.

 

We talk about alternative approaches in class. The issue there is that they are not very well-studied. Some things have been looked at clinically or at least in the lab, and some doctors are more open than others in suggesting those. The concern is always about unknown med interactions or contamination, as the supplement and herbal industry is not that well-regulated. I think there's a place for it, but I'd be uncomfortable recommending something unless I KNEW it'd be helpful and safe. I'd hate to say "why don't you try this" and then have the patient end up with some bizarre side effect and ask me "Why did you do this to me?" and think I'm some sort of quack. But some alternative therapies are quite harmless and often beneficial in some situations, like acupuncture or music or animal therapy. But I don't think that an hour of listening to a violin concerto = 12 rounds of chemotherapy.

 

We don't spend much time on biochemical minutiae. We are taught the basic mechanism of drug action (e.g. difference between ACE inhibitors and angiotensin receptor blockers), but we don't have to memorize protein conformations or anything ridiculous like that. Things like side effects and effectiveness are way more important.

[Sev]

The biomedical model is outdated. Modern medicine is focused on the biopsychosocial model, which posits that biological, psychological, and social factors interact to influence human health. The biopsychosocial model is quite holistic in the sense that the concept of a "mind-body connection" is strongly emphasized.

 

Take a look in any health psychology textbook and you'll see that medicine involves more than just a reductionist approach.

[Pantaloons]

Yes yes yes, we've all seen the movie Patch Adams.

It's 2011, and I don't think many (any?) medical school curricula still operate purely on the "reductionist/biomedical model" in Canada.

 

I'm not getting into your concerns about a "standard scientific paradigm" or your definition of "holism".

 

Psycho-social aspects of medicine are definitely discussed in lectures and in small groups. Remember, though, that modern medicine tries to be evidence based. So psycho-social management may involve exposure therapy, hospice activities, and exercise/recreational therapy, but NOT Q-ray bracelets, demagnetized water, or homeopathic water.

 

Let's not pretend that the caricature still exists of a medical school teaching science and ignoring the patient. We're beyond that and that's old news.

[A-Stark]

I hate Patch Adams. The movie anyway. It's sanctimonious sentimentalized garbage executed with the most nauseatingly saccharine performance of Robin Williams' career. And it ends with a courtroom scene - no, wait, it ends following an impassioned monologue from the title character with the entrance of a coterie of bald cancer kids, just in case we didn't get the sentimentality of the rest of the movie.

 

Barf.

 

Anyway, I think you're setting up a false dichotomy. Certainly the "biopsychosocial" model is key to something like current psychiatric practice, and there is ample space for yoga and meditation and similar "mindfulness" activities as adjunctive therapies. However, where I must take issue with these "holistic" approaches is when they take the place of validated treatments for serious conditions. To mention psychiatry again (since I'm nearly done that rotation), failing to treat schizophrenia adequately can result in lasting cognitive and social dysfunction. Yoga might help a bit, but stretching and breathing exercises are not adequate for serious medical or psychiatric illness. I don't mean to pick on yoga - I go to hot yoga frequently myself - but I disagree that it involves any kind of "holistic" approach that actually addresses serious illness.

 

And what does "holistic" mean, anyway?