Reductionist Vs Holistic Paradigm in Health
A review on how treatments have changed from mere cure of disease to maintenance of the whole body.
- Introduction to Disease Treatment
- Reductionist Approach
- Why Reductionist Approach is Important?
- Issues behind Reductionist Approach
- Holistic Approach
- Improvement in Holistic Approach over Reductionist Approach
- Issues behind Holistic Approach
Public health is both the science and art which deals with the protection and improvement of the health of the population as a whole. One of the major aspects of this sector is disease treatment. The perspective from which I am interested in analyzing disease treatment is the change in its paradigms which govern its strategy. Since 1978 Declaration by WHO, health became globally accepted as the fundamental right of human being and has been gaining significant concerns from the governments all around the world. For example, India’s first health policy came in 1983. Trade Related Aspects of Intellectual Property Rights (TRIPS) agreement also importance to the health has been given the top most priority. Treatment for the people already suffering from the disease has a significant priority in decision making aspects of health. Treatment philosophy is very dynamic changing between holistic and reductionist viewpoint. The shift between these two theories has been analyzed from the Kuhnian, Popperian or Lakatosian perspective in following essay.
Introduction to Disease Treatment
Health is fundamental for any nation’s progress in any sphere. In terms of resources for economic development, health is of highest importance as it determines the potential man-hours of productive work of an individual. It is generally determined by the mortality statistics and disease based mortality contribute significantly to the mortality figures (1). In order to reduce mortality and morbidity due to the disease, it is important to provide treatment for the diseases.
Several variables play the role in determining the treatment like treatment effectiveness, cost of the treatment, treatment response time, side effects, time taken to develop the treatment, risk of resistance development against the treatment, reproducibility of the treatments and sustainability of treatments. In order to achieve the best treatment, two competing philosophies reductionist approach and holistic approach have been in constant confrontation over the decades to establish their dominance. Any line of medicinal treatments like allopathic, ayurvedic, yoga, chinese traditional medicine, homeopathy, unani, siddha, integrative medicine make use of either of the one paradigms.
Till recently, reductionist approach has been the dominant paradigm in the medical field because it was scientific and methodical in approach, which makes it possible to obtain standardized and reproducible results with logical explanation behind those results. But as the exceptions in this theory increase, this approach is slowly loosing it dominance in favour of the holistic approach, which is emerging as the potential solution. Further, the availability of scientific advancements are allowing understanding this approach’s science and methodology.
The earliest reductionist philosopher was Thales, born around 636 BC at Miletus in Asia Minor. He hypothesized that the universe was made out of water—water being the fundamental substance of which all others were composed. It was re-introduced in around 300 years back by Descartes in 1637. It believes that world is made up of small pieces and could be understood by studying those small pieces. The earliest entry in the medicine can be traced back to the 19th century work of Bichat in Paris. (2) (3) This theory gained dominance in 20th century. (4) It believes in one to one relationship between cause and treatment and by going at more and more fundamental level one can find the better cause of the disease.
Why Reductionist Approach is Important?
This approach gained dominance over holistic treatment as it was the only theory based on scientific thinking, which allowed the people to understand the both the cause and treatment of disease. The ability to breakdown the cause to smallest possible fundamental unit provided easier and better way to understand the disease as it simplified the whole disease to just one aberration in the body. The treatment developed on this approach was more generalized, which allowed the production of the large quantity of medicines at the industrial scale, bringing down the cost and time. This helped in addressing the health needs for increasing population of the world. It is also easier to modify and monitor treatment safety, efficacy and response time as ingredients and its effect on the disease is known.
This approach provided an easier way to manage the whole treatment domain because it allowed better prediction of the process and results. This allowed it to become the part of industrialization, providing the growth booster for this sector.
Issues behind Reductionist Approach
This approach has gained lot of questions over the period of time. Use of multi-drug therapy and emergence of side effects of the drug and resistance of disease against drug cannot be explained by the reductionist theory alone. Since, according to that theory any intervention in the system is localized and will not interact with other parts of the system, which has not been the scenario in many cases. This indicates the the oversimplification of a process. Is reductionism causes mere reduction of something down to eliminate certain aspects from our description of it? 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. 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. (3)
The holistic approach to health recognises the interdependence of our various bodily systems and looks at the disease and patients as a whole. Though, this approach can be traced back to Aristotle in his Metaphysics (3), it has been in use in the traditional medical systems even before that (5). A key assumption of the holistic approach is that there are ‘emergent properties’ on the progression from a lower to higher hierarchical level— things that cannot be explained by examining the component parts themselves. It has been in practice before reductionist approach, but due to lack of scientific knowledge to understand the body as a whole made it difficult to understand this approach and to justify the results of the treatment. This acted as limitation for its acceptance in the scientific community which is driven by the scientific explanation of the each and every cause (3).
Improvement in Holistic Approach over Reductionist Approach
The main strength of the reductionist theory is that its approach is explicitly built on the concept of scientific thinking allowing it to explain the events. However, since the theory of science is not specific to just the fragmentation of events, but can be applied to any approach that can be provide explanation for the events. As a result, scientific advancements have allowed better understanding of this approach providing better explanations behind the issues of side-effects and resistance which could not be explained by reductionist approach. Further, the better understanding of holistic theory has lead to the emergence of the integrative treatment. In integrative treatment of holistic approach, instead of focussing on any single line of medical system, the focus is on treatment of the body by combining the best of all the treatment systems. The major advantages of this approach over the reductionist approach were:
• Lower cost and side-effects of the treatments.
• Treatments for most the problems have been already available in ancient literature so no research has to be done from the scratch.
• Availability of better scientific knowledge, scaling up of the medicines and alteration in the effectiveness and response time can be achieved.
• Shift in the other paradigms of the health sector like shift from biomedical paradigm to socio-cultural paradigms (6) has made people look for lot more local solutions, which can be provided by this approach.
• Multi-drug therapy has been an indicator that there is no single solution for the disease control and multiple solutions are needed to prevent disease resistance and side effects.
Issues behind Holistic Approach
There are certain issues which had been raised as the potential stumbling block like complexity of system understanding, lack of availability of standardized knowledge and availability of the raw materials for the drugs. Since, most of the issues are more physical in nature rather than conceptual, so the advancements in science and technology can deal with most of the issues.
In this two kinds of phenomenon can be found one is the paradigm shift and another is the paradigm evolution. There is a shift in the paradigm from the approach of breaking down the problem to the smallest fundamental unit in a system and in isolation with body (Reductionist Approach) to considering the problem as part of the body system and focussing on the whole body for the treatment (holistic approach). The process shift from reductionist to holistic theory appears to be based on falsification, as the factors which cannot be explained by the reductionist theory are explained by a totally different theory, i.e. holistic theory. Based on the current understanding it can be concluded that paradigm shift took a Popperian approach among the three approaches since, the holistic theory completely falsify the previous theory of reductionism and is based on a totally different principle. However, the way holistic approach has emerged is not the same as it was before the emergence of the reductionist theory, the application of this approach has undergone some incremental modifications and is broader in approach. Instead of focussing on any single line of treatment, it has broadened its approach to encompass all types of treatment systems indicating a Kuhnian approach.
1. Planning Commission of India (1951),” First Five Year Plan: Health”, New Delhi.
2. K, Sweeney and D, Kernick (2001), “Clinical evaluation: constructing a new model for post-normal medicine”, Journal of Evaluation in Clinical Practice, 8, 131-138.
3. MJ, Beresford (2010),”Medical reductionism: lessons from the great philosophers”, Q J Med, 103, 721-724.
4. AC, Ahn, M, Tewari, CS, Poon and RS, Phillips (2006), “The Limits of Reductionism in Medicine: Could Systems Biology Offer an Alternative?”, PLoS Med,6, 3, e208.
5. Wikipedia, “Ayurveda”, Wikipedia, Accessed on: 20 February 2012. http://en.wikipedia.org/wiki/Ayurveda.
6. AV, Patil, KV, Somasundaram and RC, Goyal (2002), “Current health scenario in Rural India”, Aust. J. Rural Health, 10, 129-135.