Humanist Perspectives: issue 153: The Art and Science of Medicine

the world around us
The Art & Science of Medicine
by Theo Meijer

illustration by Todd Stewart

illustration by Todd Stewart

In the nineties Dean Ornish, MD, president of the Preventive Medicine Research Institute in California, conducted a series of studies to see if a comprehensive program of intensive lifestyle changes can have a positive impact on the progression of coronary heart disease. He was concerned that the arsenal of conventional medicine, consisting of bypass surgery, angioplasty and other similar procedures, was merely treating symptoms without any effort to go deeper and to determine possible underlying causes of arterial blockages.

A group of 28 patients following his treatment program for one year showed a measurable reversal of coronary blockages. A control group of 20 patients followed a more conventional diet and did not receive exercise programs, group support, counselling or instruction in stress reduction. The study found that Ornish’s 28 patients suffered half the rate of heart attacks without drugs or surgery. On the average, the patients in the control group got worse instead of better. Conditions of the arteries were measured independently with angiography.

The Ornish program consists of exercise, yoga, meditation, stress reduction and lifestyle changes. Patients are encouraged to confront emotional aspects of their healing as well as physical concerns like diet and high cholesterol. There are a number of reasons for why these remarkable results are not widely known.

For one, the American Heart Association remained sceptical of Ornish’s approach, questioning whether most Americans could actually maintain the drastic dietary and lifestyle changes necessary for his program. This is a common problem in medical practice. Changing behaviour, even when there is good reason to do so, is always difficult.

Another reason, though, is more troubling. In his 1990 book Reversing Heart Disease Dr Ornish comments: “If I perform bypass surgery on a patient, the insurance company will pay at least $30,000. If I perform a balloon angioplasty on a patient, the insurance company will pay at least $7,500. If I spend the same amount of time teaching a heart patient about nutrition and stress management techniques, the insurance company will pay no more than $150. If I spend that time teaching a well person how to stay healthy, the insurance company will not pay at all.”

If I perform bypass surgery on a patient, the insurance company will pay at least $30,000 … If I spend the same amount of time teaching a heart patient about nutrition and stress management techniques, the insurance company will pay no more than $150.

Fifteen years later these discrepancies will have increased significantly.

The insurance system in the United States encourages the use of drugs and surgery rather than focusing on health education and disease prevention. The billing system in Canada is similarly problematic.

While sceptics often dismiss alternative medicine as merely a billion dollar industry based on greed, it is not unreasonable to keep in mind that the love of money plays an important role in conventional medicine as well. In many cases patients treated without surgery seem to enjoy the same survival rates as those who undergo open-heart surgery. Physicians may be too hasty to prescribe surgery immediately upon the appearance of angina or chest pain. Clinical studies seem to indicate that certain treatments and behaviours, generally considered among complimentary and alternative therapies, can be effective.

Another important aspect of conventional medicine is the ever increasing emphasis on prescribed drugs. In a recent article in the Literary Review of Canada, Charles Godfrey points out that the most profitable business sector operating today is the pharmaceutical industry, grossing US $37 billion worldwide in 2001. In that year so-called Big Pharma enjoyed returns of around 18.5% compared to a median 2.3% for the rest of industry, according to an analysis of Fortune 500 data. In Canada this represents 16.2% of health care costs!

An increasing problem is the industry’s financing of research facilities at major universities. Publication of research results is often influenced by donors – unfavourable research results have been and will be stifled, to the detriment of Canadian consumers.

To some extent the Patent Medicine Prices Review Board, with its mandate to ensure that drug prices will not be excessive, has protected consumers in Canada. Nevertheless, the odds are that we will be paying more for drugs as the result of a convoluted economic process that has little to do with sick Canadians and is heavily influenced by the USA.

In his article elsewhere in this magazine, psychologist and Humanist in Canada columnist James Alcock advances ten reasons why alternative medicine enjoys increasing popularity. One of those is that a visit to a modern physician is generally a very brief one and typically terminates with a prescription for drugs or a referral for tests. Alternative practitioners on the other hand appear to understand your problem and appear to be interested in you and your life and rarely pass you on to someone else.

Alcock mentions that Greek physician Galen already recognized in the second century CE that it is therapeutic for a troubled person talk to an empathic listener!

Furthermore, there seems to be merit in techniques such as reframing, which challenges us to change the way we look at things in order to feel better about them. The key is to recognize that there are many ways to interpret the same situation and to learn to get rid of negative thoughts or feelings that can result in stresses. Spend more time focusing on the positive things in our lives and less time thinking negatively.

Positive thinking also aims to avoid negative thoughts or a sense of powerlessness, dejection and failure. Instead focus on our strengths and determine whether we have control over the situation. If we do, let’s go ahead and take care of it! If it is entirely beyond our control, worrying will not make any difference, so let the situation resolve itself.

As a life-long sceptic by inclination and conviction I am most certainly neither an apologist for alternative medicine nor a detractor of scientific modern medicine. However, I do suggest that sceptics too often overlook the reality that modern medicine is an art as well as a science and deserves critical scrutiny while some of the ideas underlying alternative activities may have merit, even though supported mostly by anecdotal evidence and possibly due to placebo effects.

Medical practice, if it is to be of the greatest possible benefit to the people it serves, must be balanced with imagination and humanity. This is something that most practitioners of alternative medicine know, and something that deserves more attention from those who practice modern scientific medicine.

Theo Meijer is a retired educator and a life-long modern Humanist. He was president of the BC Humanist Association for over three years from 1996 to 1999 and has since been involved with the Victoria Humanists.

Illustrator Todd Stewart is the former Art Director of Ascent magazine. He is now a freelance designer and illustrator living in Montreal.