MD, PhD, FMedSci, FSB, FRCP, FRCPEd

One of the most common claims of alternative practitioners is that they take a holistic approach to health care. And it is this claim which attracts many consumers. It also makes conventional medicine look bad, reductionist and inhuman, as it implies that mainstream medicine is non-holistic.

The claim can be easily disclosed to be a straw man, because all good medicine was, is and always will be holistic. Moreover, the claim amounts to a falsehood, because much of alternative medicine is everything but holistic. I will try to explain what I mean using the recent example of acupuncture for neck pain, but I could have used almost any other alternative treatment and any other human complaint/condition/disease:

  • chiropractic for back pain;
  • homeopathy for asthma;
  • energy healing for depression;
  • aromatherapy for jet lag;
  • etc. etc.

The recent trial found that adding acupuncture to usual care yields a slightly better outcome than usual care alone. This is hardly a big deal; adding a good cup of tea and a compassionate chat to usual care might have done a similar thing. Acupuncturists, however, will say that their holistic approach is successful.

How holistic is acupuncture?

A ‘Western’ acupuncturist would normally ask what is wrong with the patient; in the case of neck pain, he would probably ask several further questions about the history of the condition, when the pain occurs, what aggravates it etc. Then he might conduct a physical examination of his patient. Eventually, he would get out his needles and start the treatment.

A ‘traditional’ acupuncturist would ask similar questions, feel the pulse, look at the tongue and make a diagnosis in terms of yin and yang imbalance. Eventually, he too would get out his needles and start the treatment.

Is that holistic?

Certainly not! If we look at alternative practitioners in general, we cannot fail to notice that they tend to be the very opposite of holistic. They usually attribute a patients illness to one single cause such as yin/yang imbalance (acupuncture), subluxation (chiropractic), impediment of the life force (homeopathy), etc.

Holistic means that the patient is understood as a whole person. Our neck pain patient might have physical problems such as muscular tension; the acupuncturists might well have realised this and placed their needles accordingly. But neck pain, like most other symptoms, can have many other dimensions:

  • there could be stress;
  • there could be an ergonomically disadvantageous work place;
  • there could be a history of injury;
  • there could be a malformation of the spine;
  • there could be a tumour;
  • there could be an inflammation;
  • there could be many other specific diseases;
  • there could be relationship problems, et. etc.

Of course, the acupuncturists will claim that, during an acupuncture session, they will pick up on all of these. However, in my experience, this is little more than wishful thinking. And even if they did pick up other dimensions of the patient’s complaint, what can they do about it? They can (and often do) give rather amateur advice. This may be meant most kindly but it is rarely optimal.

And what about conventional practitioners, aren’t they even worse?

True, there often is far too much room for improvement. But at least the concept of multifactorial conditions and treatments is deeply ingrained in everyone who has been to medical school. We learn that symptoms/complaints/conditions/diseases are almost invariably multifactorial; they have many causes and contributing factors which can interact in complex ways. Therefore, responsible physicians always consider to treat patients in multifactorial ways; in the case of our neck pain patient:

  • the stress might need a relaxation programme,
  • the work place might need the input of an occupational therapist;
  • in case of an old injury, a physio might be needed;
  • specific conditions might need to be seen by a range of medical specialists;
  • muscular tension could be reduced by a massage therapist;
  • relationship problems might require the help of a psychologist; etc. etc.

I am NOT saying that all of this is necessary in each and every case. But I am saying that, in conventional medicine, both the awareness and the possibility for a professional multidisciplinary approach is well established. You don’t believe me? Ask a physiotherapist or an occupational therapist who refers more patients to them, an acupuncturist or a GP!

Alternative practitioners claim to be holistic and some might even be aware of the complexity of their patients’ symptoms. But, at best, they have an amateur approach to this complexity by dabbling themselves in issuing more or less suited advice. They are not adequately trained to do this job, and they refer very rarely.

My conclusion: professional multidiscipinarity is an approach deeply engrained in conventional medicine (we don’t often call it holism, perhaps because many doctors associate this term with charlatans), and it beats the mostly amateurish pseudo-holism of alternative practitioners any time.

15 Responses to Multifactorial beats ‘pseudo-holistic’ by a mile

  • Excellent and important post!

    How holistic can it be when a modality fails to take human physiology — as it actually exists, as opposed to how it is assumed to be in order to make the therapy plausible — into account?

  • Yes, a lot of alternative practitioners seem to use the word “holistic” simply as some kind of positive feel-good tag-line they can add to their title, frequently without much grasp of what it actually means. I think the general perception these days is that the word means “not taking pills from the pharmacy.”

    But it is a troublesome term anyway. You have to decide at what level of manifestation you’re going to evaluate the condition. The limb, the body, the lifestyle, the society, the planet? There are people who assert that depression is the result of a overly goal-seeking, stressful society, and that even if you treat individuals effectively it will just pop up somewhere new, perhaps as something worse. Maybe they’re right. Who knows?

    Personally I think effective complementary therapists are usually just more empathetic and heartfelt people and there are people that need this to feel better or get better.

    BTW, I don’t think acupuncturists really look at things the way you outline above. Most “energy medicine” approaches assert that treating one or a group of energy points will heal multiple symptoms which have the same energetic root. Thus in this paradigm the stiff neck, the difficulty in letting go of the past and the issues in relating might all be considered as emanating from a single energetic disturbance, which they try to treat.

    Dev

    • Dev

      “BTW, I don’t think acupuncturists really look at things the way you outline above.”

      Based on the descriptions of acupuncture treatments…I think this post is supposed to be satire.

    • Dev, lack of knowledge does not make approach holistic.
      And more empathetic/less empathetic, it is subjective criterion – two different patients can describe one and the same doctor in a radically different ways. Do you think subjective criteria alone make a person able to treat diseases? Especially those that are neither self-limiting nor psychosomatic? And there are patients that hate sympathetic doctors, especially among regulars at the hospitals – they just want to get treatment, recover and get on with the previous life, they are familiar with their diseases and don’t need holding hands, encouragements etc. Actually any such attempts may discourage them (make situation worse).
      I am not saying that doctors should turn into machines compassionate practitioner of CAM is not successful, he is lucky. Sometimes.

      • Do you think subjective criteria alone make a person able to treat diseases? Especially those that are neither self-limiting nor psychosomatiIc?

        …………………

        No. I don’t. Personally I’m happy to use anything that works. Whether “works” refers to “works objectively” or “works subjectively” depends on the condition. Most conditions are evaluated subjectively and some can also be evaluated objectively. If I break my arm I’m happy that an X-Ray finds it’s finally in one piece again, as well as feeling better. If I’ve got chronic fatigue syndrome then I’m just happy to feel like I can move around again.

        Dev

        • “I’m happy to use anything that works”

          I think you mean “anything that *appears to* work”.

          • Sometimes feeling better is all you have. Ask a GP. Doctor’s surgeries are full of people reporting feeling unwell where no test can find anything wrong.

            Dev

          • jack of all trades, eh? first you dabble in philosophy and now a bit in general practice.

          • “Sometimes feeling better is all you have. Ask a GP. Doctor’s surgeries are full of people reporting feeling unwell where no test can find anything wrong.”

            Yes, the worried well inhabit hospitals too, according to a friend of mine who works at a women’s hospital. As there is nothing wrong with them, they are easily “cured” by homoeopathy, or reiki, or therapeutic touch, or chiropractic, or any of the other alt-meds, because, according to you, it works “subjectively”.

            I’m with Frank Odds on you; “I think you come over as thick as two short planks.”.

            “jack of all trades, eh? first you dabble in philosophy and now a bit in general practice.”

            Doesn’t know philosophy, science, and general practice, you mean?

          • “the worried well inhabit hospitals too, according to a friend of mine who works at a women’s hospital. As there is nothing wrong with them”

            So you conclude that if tests are negative, there’s nothing wrong with the patient?
            How does this follow?
            Perhaps the right test hasn’t been done. Perhaps the right test hasn’t yet been developed.

          • “So you conclude that if tests are negative, there’s nothing wrong with the patient?
            How does this follow?
            Perhaps the right test hasn’t been done. Perhaps the right test hasn’t yet been developed.”

            Perhaps fairies only come out at midnight, perhaps the Energium Cortex only co-ordinates on the alternate hyperbola, perhaps Alice doesn’t see which burrow the rabbit dived down, perhaps no test will ever be developed to determine the why some people think they are very sick when others just get on with life, perhaps some people will never stop wondering when there will be a test that will answer your last question. I wish you and your energy healer well, particularly if real illness strikes.

  • Yes, absolutely!

    A couple of years ago I was lethargic and losing weight. My holistic healer used blood tests (should we call it phlebomancy to sound more mystical?) to diagnose and treat anaemia, and referred me to a colleague for colonoscopy, but further blood tests revealed tTG antibody, which lead to a jejeunal biopsy and a diagnosis of coeliac disease, followed by tests (positive) for osteoporosis. Contrary to the narrative of the quacks, the final course of treatment involves no drugs at all: I am on a gluten free diet and am no longer a frequent flyer at the surgery. My migraines have stopped, my asthma is under good control. A brief course of calcium and vitamin D tablets dealt with the osteoporosis, as far as can be seen.

    What would a homeopath, acupuncturis, naturopath or other charlatan have done? They might, quite accidentally, have put me on a GF diet, as a currently popular fad among such loons, but would they have spotted the osteoporosis? Would they have correctly treated the anaemia with folic acid and iron? I doubt it.

    There is only one type of truly holistic healer: a good GP.

  • As Edzard has pointed out, the benefits of camistry arise from ‘C4’ – ‘Cup o’ char and compassionate chat’. I might make it C6 by adding ‘care and condolence’.
    ‘Holism’ is a term which has been appropriated and is now mostly used for marketing practices which have no inherrent benefit.

    Conventional practitioners do practice ‘holistically’ – but in order not to be tarred by the brush of nonsense, Edzard’s phrase ‘professional multidisciplinary approach’ (PMA?) has my endorsement.

    “Thank you for coming to see me Mrs Smith. I recommend PMA…”

  • True. Like a chiropractor acting as a primary care provider – suppose somebody comes in with lower back pain.
    Is the chiropractor going to very likely recommend chiropractic manipulation?
    And maybe the lower back pain is due to something else. Like a urinary tract infection. I’ve had UTI’s with few or no other symptoms.
    And a UTI needs antibiotics, otherwise it might turn into a kidney infection.

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