CAM

The first question you have to ask about ‘alternative’ is: alternative to what? Proponents of alternative medicine will describe the practice of doctors in the National Health Service, both in primary and tertiary care, as ‘orthodox’, ‘mainstream’, ‘Western’, ‘reductionist’, and so on. In return, the practitioners of conventional medicine view ‘alternative/unconventional’ medicine as a series of comprehensive health belief systems, superficially with little in common, yet sharing beliefs in metaphysical concepts of balance and similarities which date back to Galenic doctrine from the second century CE, or oriental mysticism 2,000 years older.

So in this parallel universe of alternative medicine, treatments are based on metaphysical concepts, rather than orthodox physiology and biochemistry. Yet it has to be accepted that each view of the other is to some extent pejorative, and if we are to establish a dialogue between the champions on either side of this conceptual divide we must show mutual trust and mutual respect. Perhaps for the time being we might blur these distinctions by using the word ‘unproven’, which can apply equally well to therapeutic interventions on each side. Of course, the issue of the definition of ‘proof’ then raises problems that I will address in a moment.

Next we must consider the definition of ‘complementary’. The Oxford English Dictionary defines the word as ‘that which completes or makes perfect, or that which when added completes a whole’. In other words, while modern medical science struggles to cure patients, complementary medicine helps patients to feel better, and who knows, by feeling better the act of healing itself may be complemented. Some complementary approaches may be placebos, and the touch of the ‘healer’ or the hand of the massage therapist could be guided by strange belief systems that are alien to modern science. Yet providing that the intention is to support the clinician in his endeavours rather than compete in the relativistic marketplace of ideas, one might set aside these concerns.

Finally ‘holism’, a slippery word whose ownership is competed for by both sides of the therapeutic divide. The word holism was coined by General Jan Smuts in 1926. He used it to describe the tendency in nature to produce wholes from the ordered grouping of units (holons). Chambers’ Twentieth-Century Dictionary describes holism in a precise and economic way: ‘Complete and self-contained systems from the atom and the cell by evolution to the most complex forms of life and mind.’ It can be perceived, then, that the concept of holism is complex and exquisite, and as an open system lends itself to study and experimentation. As such it should be a concept that unites us rather than a continuing source of dispute.

To do justice to General Jan Smuts’ definition of the word holism, we have to start at the molecular level, and then from these basic building blocks attempt to reconstruct the complex organism that is the human subject living in harmony within the complex structure of a modern democratic nation state.

The basic building block of life has to be a sequence of DNA that codes for a specific protein. These DNA sequences or genes are organised within chromosomes forming the human genome. The chromosomes are packed within the nucleus with a degree of miniaturisation, which is awe-inspiring. The nucleus is a holon looking inwards at the genome and outwards at the cytoplasm of the cell. The cell is a holon that looks inwards at the proteins, which guarantee its structure and function contained within its plasma membrane, and at the energy transduction pathways contained within the mitochondria, which produce the fuel for life. As a holon, the cell looks outwards at neighbouring cells of a self-similar type which may group together as glandular elements, but the cellular holon also enjoys cross talk with cells of a different developmental origin.

These glandular elements group together as a functioning organ which is holistic in looking inwards at the exquisite functional integrity of itself, and outwards to act in concert with the other organs of the body. This concert is orchestrated at the next level in the holistic hierarchy through the neuro-endocrine and immunological control mediated via the hypothalamic pituitary axis, the thyroid gland, the adrenal gland, the endocrine glands of sexual identity, and the lympho-reticular system that can distinguish self from non-self. Even this notion of selfness is primitive compared with the next level up the hierarchy, where the person exists in a conscious state somewhere within the cerebral cortex, with the mind, the great-unexplored frontier, which will be the scientific challenge for doctors in this new millennium.

It could even be argued that complementary medicine is practised at the highest level in the hierarchy that governs the human organism. Providing the ‘complementary’ practitioner concentrates on making the patient feel better and spiritually at ease, then his or her position is secure in the modern world. We would also urge proponents of alternative and complementary medicine to appreciate that the holistic system is an open system that lends itself to the experimental method. There is much research that is urgently required to investigate the psychosomatic aspects of disease, and the spiritual dimension to healing.