In the February 9th 2012 edition of The New England Journal of Medicine, I was struck by two side-by-side articles in the same issue. What can these two articles, describing two completely different approaches to healthcare teach us?
In the first article entitled, “Preparing for Precision Medicine”, the London-based authors who work with the World Economic Forum Health Council, highlight the challenges in preparing for the future of personalized medicine. As an example, they discuss how this medical approach will be based on molecular profiling of individual tumors or an individual’s genomic profiles to help identify the subtypes of chronic diseases (such as diabetes) that are more apt to respond to one therapy versus another. In essence, they raise the questions: How do we prepare for a future where we not only have genetic testing for approximately 2000 clinical conditions (as we currently have), but also have targeted therapies for common and rare conditions? How can we reduce the time to receive regulatory approval (now 12-15 years)? How can we afford the targeted therapies for these conditions when current healthcare costs already consume 16% of our GDP? How will we train tomorrrow’s doctors, who will understand illness using our current models, but also with emerging and more complicated molecular mechanisms?
The goal of Precision Medicine is laudable: “to ensure that patients get the right treatment at the right dose at the right time, with minimum ill consequences and maximum efficacy”. In order to accomplish this, “it will change how medicine is practiced and taught and how health care is delivered and financed”. It is without a doubt that deep structural and economic change is coming over the next decades as the healthcare industry goes deeper into this model.
The other article was entitled, “Tai chi and Postural Stability in Patients with Parkinson’s Disease”. In this article, the authors describe how 24 twice-weekly sessions of tai chi reduced balance impairments, improved functional capacity and reduced the number of falls, in patients with Parkinson’s disease.
How can a technique like tai chi cause the body to regain control of its balancing function? How can it restore or grow new neuronal connections? Likewise, in other areas of research, how can meditation lead to new brain tissue growth? How can a technique that each of us can learn and use everyday be just as or more effective than a targeted pharmaceutical therapy?
The answers lie in the understanding on the whole system level—where disease is considered a process with many components, yet to be fully understood. It is based on the fundamental premise that our bodies can reclaim balance on such subtle levels that most of us are unaware of the intelligence of our whole-system and our ability to regulate ourselves on a cellular level.
Everyone looks forward to the day when debilitating conditions such as cancer, heart disease, immune and neurological disorders can be cured. In the meantime, research continues to build evidence for physiologic impact of non-standard modalities such as tai chi, yoga, meditation, acupuncture, nutrition, herbal and botanical medicine, structural adjustments, etc.
As we begin to understand the effects of these systems-based approaches on the body’s communications networks, we will focus on choosing which modalities work best with each other. Essentially, which aspect of the convergence of the best of modern medicine and the best of other medical traditions is the ideal method to serve a given individual with a given set of symptoms and challenges? Whatever the strategy, it will need to support, strengthen and enable the body’s ability to reclaim its own innate balance and regulatory pathways.
Systems-based approaches are the future of medicine, not symptom-based approaches.