In the false dilemma post, we raised the issue that in medicine, the treatments of chronic diseases often boil down to medical interventions alone, such as the prolonged use of drugs or surgeries. In addition, we also divulge our preference for treatment options that specifically require behavioural modifications or lifestyle changes.
But then, why go through all these hurdles when some potentially helpful treatments are evidently available? Well, this is a perfectly legitimate objection — one that motivates us to write up this 4-part series justifying our approach.
As it turns out, we have come to realize over the years that the medical false dilemma — which fortunately is being exposed and brought to spotlight by functional medicine practitioners — is merely the tip of the iceberg. The remaining iceberg, which we shall explore extensively throughout this series, is only in the process of slowly emerging bit by bit — some of which have yet to see the light of day.
In general, it’s fairly easily, from a patient’s standpoint, to differentiate between healthy signs and strange symptoms that hinder our well-being. More often than not, doing so only requires a bit of careful observation, common sense and experience.
But how do we define health in such a way that can withstand scientific precision and rigor, without, for example, resorting to hearsay? Well, one seemingly-elegant solution is to appeal to the notion of biomarker. According to Wikipedia:
“A biomarker, or biological marker, generally refers to a measurable indicator of some biological state or condition. The term occasionally also refers to a substance whose presence indicates the existence of living organisms.
Biomarkers are often measured and evaluated to examine normal biological processes, pathogenic processes, or pharmacologic responses to a therapeutic intervention.”
While the approach of assessing health through biomarkers seems to work well on the surface, it quickly led to several unforeseen consequences as the time goes by. For one, it encourages the mentality of equating health with biomarkers that are suspected to be associated with health — associations that are subject to substantial revisions over time; associations that carry a risk of being ultimately disproved.
Despite these risks, the biomarker approach would continue to dominate our discourse, while slowly forming the basis of our health policies and recommendations. This would then lead to the widespread presumption that health can be medically maintained, by explicitly tweaking a list of biomarkers and making them fall within the threshold of alleged normality — A dominant medical philosophy known by us as biomarkerism.
In essence, a biomarkerist seeks to fine-tune our biomarkers through medical means.
In fact, nowhere do we see biomarkerism at work more clearly than in the development of drugs. While it’s true that occasionally, the effectiveness of certain medications are discovered serendipitously, it still holds that in general, during the drug development phases, there is a tendency to exclusively aim for “normalizing” the targeted biomarkers, while ignoring at the same time other salient signs the subjects might be experiencing.
What’s worse, it appears time after time that the pharmaceuticals would do almost anything to ensure that a drug under trial attain the wanted effects — or are reported to exert the wanted effects — without much elaboration on the drug’s potential toxicity, or how it affects the rest of our body.
Sure, there are certainly scenarios in which regulating out-of-bound biomarkers becomes a matter of life and death, but that is very different from claiming that medically-driven biomarker maintenance is sufficient for health. In fact, we would even claim that there are far more scenarios where the medical regulations of biomarkers are not only irrelevant, but harmful as well:
Controlling the alleged risk factors of a disease can sometimes prove to be worse than the disease itself.
- The practice of bariatric surgery to control weight gain
- The rampant use of cholesterol-lowering drugs to reduce the risk of cardiovascular diseases
- The casual application of antacid to neutralize stomach pH level
- The regular use of type II diabetes medications to control blood glucose level
Since our current focus rests on the general patterns of medical practices, we will leave some of these topics for the future posts. In the meantime, however, one can think these issues as follows:
What if obesity, elevated cholesterol level, acidic stomach and high blood glucose level are merely symptoms of some larger health issues? What if we have developed an entire medical machinery, only to realize later that we have been focusing on the wrong things all along?
The identification and classification of nutrients has undoubtedly played a crucial role in shaping our understanding about their decomposition, absorption and interaction with other molecules and hormones. In fact, the advance in nutrition science has been carried forward to such a degree that nowadays, it is customary to attribute the health benefits of a food to its nutritional contents.
And then…before we know it, people would start to associate health (or diseases) with certain nutrients. Nutritionism, the idea that the health impact of a food can be sufficient explained in terms of its most salient nutritional components, would quickly become implicitly accepted as the dominant medical philosophy governing our diet and food choices.
In the form pejoratively popularized by Michael Pollan, nutritionism refers to the much-stronger thesis that it is the nutritional composition of a food that determines its health value.
While seemingly innocent at first sight, this way of thinking has several far-reaching implications, with the first one being that it now becomes theoretically possible to make any kind of food healthy, simply by adding a list of nutrients that the current science deems beneficial.
For example. one can now justify the consumption of industrial eggs, simply by appealing to their high protein and omega-3 fatty acids content, without even worrying about the unsanitary conditions under which the chickens were raised. Similarly, by solely adding a plethora of synthetic micronutrients, the bread industry and heart foundations can now dub industrial whole grain breads as healthy, despite the fact that they were manufactured from denatured and genetically-modified wheat. In brief, while nutritionism-driven policies and recommendations are a cause for celebration for the food industry, their impacts on the consumers can be devastating, as these practices create loopholes whereby mass intoxication and nutrient deprivation become permissible.
In many cases, ascribing a single value to a nutrient constitutes a form of false stereotyping.
The second equally serious implication of nutritionism is that people would start to think of a nutrient as either good or bad (as exemplified by our general perception on saturated and unsaturated fat, or on omega-3 and omega-6 fatty acids), without acknowledging that each one of them could play a distinct role in maintaining our health, and that the effects of a nutrient can vary greatly depending on the biochemical context it finds itself in. To make the matter even worse, the alleged benefits of a nutrient tends to be debunked as the research continues, while other times, a nutrient is further classified into subcategories, making the situation increasing intractable…
Look for nourishment — not nutrients
However, all is not lost, and we think there is a way out of this confusion: by realizing that consuming naturally-occurring food, in minimally-processed form, provides inherent nourishment to the body, one can stop gambling their health with food whose full effects science has yet to determine. In fact, even with just a bit of self-education and well-informed choices, we can stop outsourcing our diet to questionable food corporations whose motives could be in direct conflict with our own.
Medical Reductionism — A Fatal Philosophical and Methodological Flaw
If there is anything biomarkerism and nutritionism have in common, it’s the fact that they invariably reduce the concept of health to its various components. In our terminology, this is equivalent to saying that both of them are instances of a wider philosophy known as medical reductionism.
In the context of knowledge acquisition, reductionists generally claim that the study of a system can be achieved exclusively by analyzing each individual component separately.
While biomarkerism and nutritionism are not the only forms of medical reductionism, they do constitute a significant portion of the larger philosophy, that is chiefly responsible for spinning the health care system from a disease prevention/eradication model, to one that put the emphasis on symptom maintenance and nutrient control.
This shift in organizational structure, accompanied by a corresponding shift in mentality, along with other motives, would then further distract us from ever tackling the root causes of diseases. Results? A troublesome rise of chronic illnesses in the recent decades — coronary heart disease, hypertension, type II diabetes, stroke, rheumatoid arthritis, multiple sclerosis, obesity, dementia — you name it.
Many of the above chronic illnesses are linked to systemic chronic inflammation in the body, which could be traced back to faulty diet and modern lifestyle.
Of course, we are not the only one to recognize this lurking trend, and there is certainly much more to be said about medical reductionism. For example, in an article published in the journal QJM, Dr. Mark Beresford discusses how medical reductionism could promote narrow-focus reasoning:
“There becomes a point where the reduction becomes disassociated from the phenomenon it is trying to explain and exclusively reductionist research strategies can be systematically biased and overlook salient biological features. Again this is evident in medicine—although many ‘targeted’ agents are now used in the clinic, it is fair to say that in most cases the benefits to patients have been relatively modest, despite sound theoretical principles and laboratory data.”
To understand better what Dr. Beresford is trying to refer to, let’s consider the following thought experiment:
Suppose that Dr. Beresford has been experiencing systemic inflammation throughout his body, which also has been taking a toll on his mental health. After a bit of reluctance, he decides to pay a visit to a conventional neurologist for his headaches, who prescribes him with aspirins and painkillers. He then proceeds to a conventional cardiologist for his chest pains, who later gives him Lipitor to lower his LDL level. He then goes to his dentist for his regular check-up, and discovers that he has several cavities and is told to come back for the dental fillings. And when all is over, he pays a visit to a conventional gastroenterologist for his irritable bowel syndrome, who then advises him to take antispasmodic medications regularly.
However, despite Dr. Beresford’s efforts to manage his own health issues, he still feels a lack of tangible systemic health improvements over the years. Frustrated and discouraged, he goes on to experiment with eliminating refined carbohydrates from his diet, and within two months, almost all of his previous symptoms are gone!
With instances of medical reductionism as such, a verse from The Blind men and a Elephant invariably comes to mind: 😉
“And so these men of Indostan
Disputed loud and long,
Each in his own opinion
Exceeding stiff and strong,
Though each was partly in the right,
And all were in the wrong!”
In Part II of this series, we will discuss a different kind of flaw that afflicts mainstream Western medicine — The kind that simultaneously impacts multiple branches of our establishment at various levels of hierarchy.
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