When food production technology made this possible, wheat flour processors began to eliminate the tough exterior (bran) and nutrient-rich core (germ) of the kernel in order to reach only the large, starchy part (the endosperm). The bread that is made from this process is white and fluffy, and it makes great PB & Js, and it takes forever to grow mold, but is almost completely lacking in nutritional value.
Nutritionists eventually pointed out, prompting commercial bakers to try to strengthen their bread by adding back key nutrients that were removed by processing. It did not work. While white bread made from refined flour is still available, nutritionists recommend whole grains as a healthier alternative.
Resistance to this reductionist approach to nutrition can perhaps best be grasped with the idea that the sum represents the totality of its parts: If inputs are missing, the end result will also be neglected.
Each person is also a sum of parts, and the reductionist approach to health care is essential when it comes to advancing many aspects of medicine and health care.
“Historically, the invention of the microscope, the definition of Koch’s four postulates for infectious diseases, the deciphering of the human genome, and even intelligent computers are prime examples of the dramatic benefits of biomedical reductionism,” said Dr. George Lundberg.
However, these successes may have convinced many in both the medical community and society at large that reductionism is a necessary, if not sufficient, approach. The numbers say otherwise.
“Classic medical interventions only contribute about 10 percent to reducing premature deaths compared to other elements such as genetic predisposition, social factors and individual health behavior,” continues Lundberg. “Most contemporary medical researchers have concluded that the chronic degenerative diseases of modern Western humans have multiple origins and are therefore unsuitable for the single-agent-single-outcome model.”
Paging Dr. House. It turns out that your particular form of genius isn’t that useful often.
And nowhere is the single-agent-single-outcome model arguably less effective than in behavioral health and chronic disease management. What many in medicine and healthcare are now realizing is that a vicious cycle of alternating physical and mental ailments is the norm in both chronic illness and long-term mental health problems.
“Depression and chronic physical illness are interrelated: many chronic illnesses not only cause higher rates of depression, but depression has also been shown to anticipate some chronic physical illness,” says Professor David Goldberg of the London Institute of Psychiatry.
It’s an unsurprisingly intuitive conclusion. A man with depression lacks the desire to eat well, exercise, and often practice the necessary daily hygiene. As his untreated depression deepens, so does his physical health. A woman with chronic, untreated pain feels like it will never end and her life is over. Faced with a seemingly unmanageable challenge, she falls into a funk that eventually metastasizes into a full-blown depression.
A reductionist approach to these scenarios could be to encourage more exercise or prescribe antidepressants. While both are necessary, neither will likely be enough.
Why hasn’t a more holistic approach to patient care become the norm? In short, because it’s expensive. Chronic illnesses are generally the most expensive component of health care.
According to a study by the New England Journal of Medicine, patients with three or more chronic conditions (43 percent of Medicare beneficiaries) account for more than 80 percent of Medicare health care costs.
Holistic support works for this expensive, highly endangered group.
The NEJM articles conclude that “an intervention that includes proactive follow-up care by nurses in close collaboration with physicians, integrating medical and mental illness management, and using individualized treatment regimens based on treatment principles, and both the medical outcomes as well as depression improves in depressed patients with diabetes, coronary artery disease, or both. “
Of course, the regimen included in the NEJM study is expensive – perhaps even more than what is currently considered holistic care.
However, it takes a certain kind of twisted logic to argue that rationing care entries will keep costs low – by reducing only the most obvious health concerns – when this approach invariably leads to readmissions, more office visits, more disability payments, and more missed more days of leads work.
Indeed, a stripped-down approach to accounting – silos of financial implications for the continuity of life – hides the fact that certain health costs are not the only measure of how chronic illness affects both individual life satisfaction and overall societal efficiency.
So the key is to make holistic health both the norm and affordable. How can that be done? By creating initiatives to achieve a number of key objectives:
Create incentives for basic services: Over the past two decades, the number of primary care providers (PCPs) available to patients in the United States has decreased by approximately 2 percent. That might not sound like a lot, but the decline comes when the population has increased naturally, meaning fewer patients have PCP. As healthcare shifts to pay for performance rather than service, the PCP is the natural quarterback of patient care. The country needs many more PCPs, not fewer, and the federal government has the option to use lending incentives and other tools to move medical students in those directions.
Hug technology: Holistic support probably only became possible with the digital age. Chronic disease management requires frequent measurement of patient vital signs, which is very expensive without wearables and similar digital age technologies. Now patients can regularly provide data without clinical intervention, this data can be automatically uploaded to an electronic health record, and EHR can notify the clinician when the results are alarming.
Make Bad Decisions Expensive: Perhaps just because smoking has become so socially unacceptable, the cost of cigarettes can be so high ($ 7.16 per pack in Chicago with all taxes) without causing significant protest. However, the data is clear that higher costs mean fewer smokers. The same types of behavioral economics programs can apply to fast food, soda, etc. Yes, people will be upset and complaining about the nanny condition, but without trying to change behavior, we may want to change the name to United States of Diabetes.
Reward smart choices: Healthy people use health and insurance services less often, which lowers costs. Moron. Utah-based Intermountain Healthcare combined technology and incentives (avoiding diabetes) and engaged nearly 1,500 pre-diabetes employees in a program run by Omada Health that lost a total of 9,162 pounds. Omada billed Intermountain based on success, and without going into specific numbers, Intermountain thought the cost of the program compared to the cost of treating diabetes was a wise investment.
These four balls are, of course, probably just the most obvious suggestions. They do not explain the complexities of the American healthcare system, which has to do with payment models, the profit motive, or what to do with uninsured, homeless, and devastatingly mentally ill people.
However, the advantages of holistic thinking in the case of insufficient reductionism apply both to individual care and to the entire health system. For example, public health takes a holistic approach to communities by examining how housing, transport and education affect general health. Where this approach is done well, the benefits are obvious.
Reductionist isolation is always necessary when identifying particular genes or determining which natural elements are effective in treating disease. However, it is wise to always bring the right tools for the job.