10

Reductionist Medicine

We can’t solve problems by using the same kind of thinking we used when we created them.

—ALBERT EINSTEIN

In the last few chapters, I’ve shown how reductionism distorts the way we do science, especially regarding the workings of our bodies. If the only victims of this distortion were biology textbooks and organic chemistry final exams, it would be sad, but not a great tragedy. The problem is, of course, that scientific theory and popular understanding of science determine the way our society teaches, funds, and rewards the practice of medicine. In this chapter, we’ll see reductionism’s fingerprints all over the way we view and treat disease.

I began this book with the idea that something is fundamentally wrong with the way we do medicine—that the so-called health-care system in the United States doesn’t really have much to do with health. Instead, it’s more properly called a disease-care system, because it just reacts to and manages disease, producing the expensive and disappointing outcomes we’ve come to tolerate and expect without knowing there’s another, better way. While many medical experts and politicians have floated proposals to improve health care and reduce costs, the vast majority of these proposals seek to tinker around the edges rather than address the root cause of the problem: its reductionist operating system.

THE DISEASE-CARE SYSTEM

In chapter four, I introduced the fable of the blind men and the elephant. Let’s imagine that the blind men assumed responsibility for the elephant’s health and well-being. What would this look like?

Obviously, none of the blind men would be tasked with monitoring the whole elephant—that would be impossible. Each would focus on his own area of “expertise”: the leg, the tusk, the trunk, the tail, the ear, and the belly. If the elephant ate some moldy peanuts and began developing liver cancer, none of the blind men would notice, as none of the parts they were tasked with monitoring would be sufficiently affected yet. Only when the cancer reached a critical mass would its symptoms become noticeable: first as decreased appetite that the “trunk doctor” would notice, next as intestinal distress that the “tail doctor” would certainly smell, and ultimately as a fever that the “ear doctor” could sense and measure.

The blind men, limited by their experience of the elephant as a collection of individual, unrelated parts, have no ability to discern and deal with root causes that precede symptoms. By necessity, their treatments will react to problems that have already developed rather than preventing those problems in the first place. This is also the first major characteristic of our disease-care system: reactivity.

Because the blind men can discern symptoms but not causes, they treat those symptoms as if they were the entire problem. The trunk doctor might sugar-roast the moldy peanuts in an attempt to stimulate the elephant’s appetite. The tail doctor, having no way to intervene in the elephant’s gastrointestinal workings, might just fit the poor creature with a large carbon-filter diaper and explain that modern medicine doesn’t really have a cure for that sort of thing. And the ear doctor might treat the ear fever with ice packs, and declare the elephant “cured” once the ear temperature returned to normal. This is also the case with our disease-care system: it focuses on treating symptoms as if they were root causes, and as a result, it tends to choose interventions that completely ignore the true root causes and thus make it highly likely that symptoms will reappear.

Since our reductionist elephant doctors ignore the entire system called “elephant,” they cannot call upon natural means of healing that have evolved along with elephants, such as the leaves of certain trees that elephants know to eat to induce vomiting. Instead, they invent specific treatments that target the symptoms they observe, often causing new problems elsewhere. This, too, is emblematic of our reductionist disease-care system: a reliance on chemicals that don’t exist in nature, that narrowly intervene in a small subset of our biochemistry while producing inevitable negative “side effects.”

Let’s move from metaphor to medicine, and explore how each of these reductionism-induced characteristics plays out in our disease-care system.

Reactivity

When you’re talking about the kind of sudden, traumatic injury that sends you to the ER, reactivity makes sense. We don’t go around giving people preventive casts on their legs or braces around their necks just in case they crash their motorcycle sometime in the future. But the entire system is as reactive as the ER, if you think about it. “Medicine” is practiced on people when they are uncomfortable, when they have just been diagnosed with an ailment or disease. As patients, we’re trained and incentivized to avoid the doctor unless we have a presenting problem.

As I said, this makes sense in the case of traumatic injuries that occur suddenly and unexpectedly. You can’t address something that hasn’t yet happened. But medicine in the United States is almost entirely reactive. The medical profession treats all manner of diseases and disease progressions as if they are also sprung on us without notice. As if one day you’re fine, and the next you’ve got cancer. Or one day your arteries are perfect, and the next you’re in the operating room receiving a triple bypass.

We know this is crazy. By the time a biological process has progressed to the point of clinical symptoms, it’s already been in the works for weeks, months, or, commonly, years. Yet the medical profession, through its reductionist guidelines and co-pays and ten-minute doctor visits, discourages patients from optimizing their health prior to full-blown disease. “Wait until you’re really sick,” could be the motto of doctors and hospitals in the current system. “We can do nothing for you until your symptoms surpass the subclinical and reveal themselves in pain, loss of function, or a particularly worrisome test result. Until then, keep calm and keep eating the Standard American Diet.”

Treating Symptoms, Not Underlying Causes

In the ER, it makes sense to first remove the steering wheel from the car crash victim’s chest and set any broken ribs. Now’s not the time to deal with the texting while driving, or drinking, or poor exit ramp design that was the root cause of the accident. That can wait until the victim’s body has been stabilized. Similarly, when someone enters a hospital suffering from a heart attack, stroke, or diabetic coma, the first order of business is to ameliorate the most serious symptoms so the patient can survive the night.

But medicine stops at symptoms. With rare exceptions, we do not treat the causes of disease; we treat its effects. And we convince ourselves that those individual effects are themselves causes. Got hypertension? We better lower your blood pressure with an antihypertensive drug, because high blood pressure causes heart disease. We’re not interested in why your blood pressure is high to begin with. Got cancer? Let’s irradiate and chemo-poison the tumor. We don’t care that the tumor may have been caused by a diet too rich in animal products. (As we saw in chapters eight and nine, the reductionist genetics movement wants us to believe there’s nothing that could have been done—that cancer is inevitable because it’s in our genes.) Had a heart attack? Let’s put stents in your arteries so the blood can flow more freely in the future. The root cause of the blocked artery doesn’t matter. The practice of medicine focuses almost exclusively on treating symptoms as the whole of the problem.

Can you see how crazy and counterproductive this is? By focusing on the symptoms, we steadfastly ignore the actual root causes, making it exceedingly likely that the symptoms will recur with a vengeance. If your lawn turns brown because you forgot to water it, you wouldn’t paint it green and think you’d solved the problem, would you? But too often that’s how the medical establishment thinks.

Prescribing Specific and Reductionist Treatments That Make Things Worse

Clearly, a coat of green paint on your lawn won’t solve the problem of not enough water to the grass’s roots. But depending on the paint, that “solution” could also make things much worse. Standard paint contains formaldehyde, volatile organic compounds (VOCs), mercury, cadmium, lead, and benzene. These chemicals can kill the earthworms and bacteria that contribute to healthy soil. The VOCs can produce gas that harms the birds that eat bugs. So you see, treating the symptom of the brown lawn by addressing just that symptom—brownness—in isolation from its wholistic environment not only doesn’t solve the problem, it makes it much worse.

As we’ve seen, Western medicine actually prefers treatments that are specific to particular ailments. The more targeted and less general the positive effects of a drug, the more highly regarded it is. Drugs are often chemically designed to act on specific events that lie in the pathway of disease development, perhaps involving a key enzyme, hormone, gene, or gene product. (Chemotherapy drugs are spectacular examples of this kind of super-narrow targeting; they are very specifically engineered to disrupt a very specific step on the pathway to disease formation,¹ as if all other contributing steps do not matter.) This practice of trying to be precise and specific is usually considered a hallmark of good science. But as you know if you’ve ever looked at the back page of a magazine ad for a new drug, this precision and specificity comes with lots of very unpleasant and often potentially life-threatening side effects. Just like the toxic green paint, the drugs that target specific nodes in the disease process tend to wreak havoc on other parts of the human body.

Relying on Unnatural Drugs

Most drugs originally came from plants. Humans (and animals) have known for millennia that certain plants have biological properties potentially useful in treating disease. Traditional healers the world over used the plants in wholistic ways to bring their patients’ bodies back into balance. They saw these plants as having a “spirit” that embodied and channeled the healing effects.

From the modern medical perspective, this approach is fundamentally problematic. First, the idea that the entire plant has a spirit that needs to be honored in its wholeness—the idea that there is anything special about the plant as a whole—reeks of superstition and nonsense to the Western scientific mind. If the plant has healing properties, then somewhere in there is a chemical that can do all the work in isolation. Our job is to not just find it, but figure out how to recreate it, so that we can manufacture it in a sterile and scalable way.

Pharmaceutical researchers try to isolate and determine the chemical structures of the “active agents” responsible for healing properties of particular plants.² In the process of synthesizing these new, unnatural chemical structures, pharmaceutical companies try to maximize potency (i.e., efficacy) and minimize toxicity (i.e., side effects)—or so cheerleaders for the drug industry would have us believe.³ In fact, the reverse is true. The more the natural chemical is structurally changed, the more problematic it becomes for the body. That’s the source of the unintended and undesirable side effects common to all drugs. And this negative reaction to pharmaceuticals is often made worse by unnatural timing and dosage protocols, which sidestep the orderliness with which nature manages this extraordinary complexity.

Here’s what happens. When the body senses that it’s been poisoned (invaded by foreign chemicals), it raises the alarm and, among other responses devised through evolution, calls on its army of enzymes to convert the foreign chemicals to less harmful metabolites that can be excreted from the body. One of these enzymes is MFO. As I discussed in chapter seven, MFO performs a wide variety of biological activities, including the metabolism and disposal of drugs.

It’s pretty ironic that specific drugs, formulated to target specific reactions within the body, all tend to evoke a response from the MFO enzyme system. But as we’ve seen, there’s no such thing as a targeted strike when it comes to biochemistry. So the strategy of using these chemicals to treat disease is akin to the infamous Vietnam War strategy of “burning the village to save the village.” Just as in actual war, it leaves in its wake a predictable killing field of collateral damage.

The story of side effects actually gets worse. To counteract the harm done by one chemical treatment, a second pharmaceutical may be administered, perhaps even a third or a fourth, each trying to mop up the mess left behind by the preceding drug. Also, as time elapses, drug doses often need to be increased, because the body gets progressively more efficient at detoxifying and voiding such chemicals before they can do their intended work. And we incorrectly take for granted that such a pill pile-up is normal!

A DISEASE BY ANY OTHER NAME

The reductionist nature of research, whereby scientists are encouraged and rewarded for looking very closely at very small areas of knowledge, contributes mightily to the blind-men-and-elephant problem that is our disease-care system. But the language our medical system uses, and the way we use it, reinforces those reductionist tendencies by making it difficult to think of the body as an integrated system in which all the elements interact with and influence one another.

Perhaps the most powerful example of this can be seen in the word disease itself. What do we mean when we use that word? Are the various diseases recognized by medicine actually individual entities? Or is the grouping of sets of symptoms into new diseases more arbitrary than that?

The history of disease classification goes back at least to 1662, when records on causes of death were first assembled and published in England.⁴ A total of eighty-one disease types were recognized. Since then, this initial list has been revised many times; in its latest, tenth edition, it’s generally called the International Statistical Classification of Diseases and Related Health Problems, or ICD-10. Its constant updating is maintained by the United Nations’ World Health Organization. Many “new” diseases have been added, along with many subclassifications of disease and disease conditions. Today there are about 8,000 such entries—a bit more complex than the original eighty-one!

When we look at some of the historical disease classifications, we realize the limitations of our understanding and the arbitrariness of our disease taxonomy. Take, for example, one of the most common diagnoses of women in nineteenth-century Western Europe: hysteria. The word itself betrays the causal theory of the disease: a malfunctioning of the uterus (Greek name, hystera). The symptoms of hysteria included feeling faint, nervousness, sexual desire or lack of sexual desire(!), fluid retention, irritability, loss of appetite, and “a tendency to cause trouble,” among many others. You have to wonder: Did men therefore not suffer this particular cluster of symptoms?

Thankfully, the diagnosis of female hysteria is a thing of the past. But why did it disappear? Obviously, the symptoms that characterized a diagnosis haven’t gone away. Nobody got a Nobel Prize for curing hysteria. It’s simply that Western doctors have stopped attributing these symptoms to a misbehaving uterus. The symptoms are real, but the “disease” is subject to cultural and gender bias. A disease is nothing more than a theoretical model applied to a cluster of symptoms.

Conversely, the medical establishment sometimes denies the existence of a disease—the relationship between a cluster of symptoms—that many people claim to have. Modern examples of this denial include chronic fatigue syndrome, chronic musculoskeletal pain, and fibromyalgia. When many doctors hear these disease names, they roll their eyes and translate them into a single diagnosis: hypochondria. The reason they don’t consider them diseases is that their sets of symptoms cannot be correlated to particular, reductionist “underlying pathologies,” like an infection or an immunological response. In other words, if a doctor can’t reliably diagnose it through an objective test, it isn’t actually a disease. See the circular logic at work here? The definition of a disease is whatever the medical establishment rather arbitrarily calls a disease.

The initial purpose for naming and monitoring disease occurrence was to detect patterns of changes in people’s health that might forecast emerging epidemics. The naming system was also used to standardize medical records, so that health practitioners could more easily communicate with each other when patients changed doctors or when discussing hereditary conditions. Proper disease classification is crucial throughout the medical practice and research communities for the conduct of research as well, especially for epidemiological studies.

But the tendency to think of each disease as a separate, distinct entity has a dark side. It encourages tunnel vision, and promotes the idea that each disease has its own specific cause(s), its own unique explanatory mechanism, and its own targeted treatment (usually a specific drug).

The classification and treatment of disease isn’t always so strictly reliant on this single-factor model. Medical professionals sometimes recognize that there may be more than one cause for a specific disease, or more than one drug to treat it. For example, many cancers are attributed to multiple possible factors: genes, environmental toxins, and viruses, working either separately or in combination. And most doctors can think of a few different antibiotics that are equally useful for bacterial infections, a few different analgesics for pain, or a few different antihypertensives for controlling blood pressure. This type of thinking definitely goes beyond the one cause/one disease worldview upon which much of medicine rests. But most practitioners view such instances as exceptions rather than the rule, and this line of thought still diverts attention away from the possibility that there are more effective natural ways of treating ailments. This is a shame, since really paying attention to the amount of overlap among causes, mechanisms, and outcomes could help more medical professionals break out of the narrow disease paradigm.

NUTRITION: WHAT WHOLISTIC MEDICINE LOOKS LIKE

Most people in the medical community of practitioners and researchers do not regard looking for global mechanisms of health and disease as proper science. Before admitting nutritional medicine to the “legitimate disciplines” club, they would want to know the precise details of how such a complex system works for each disease event. Short of that, they would insist on identifying the “active agents” of food, rather than simply accepting that the food itself is what’s good for us. Of course, they are asking for something that is impossible, at least when it comes to nutrition—we don’t know exactly how it works, because we cannot identify all the parts, what they do, and how they do it. We just know that it does work.

The medical community often cites the mantra that there is no such thing as “one size fits all,” revealing their inability and abject refusal to fully embrace the idea of complexity and its implications. Nature does a far better job of arranging for proper biological functioning than we like to admit, and once we accept the ability of the body’s infinitely complex system to attain and maintain health, then the one-size-fits-all philosophy begins to make sense. We can imagine “one size” being whole, plant-based foods, with an almost infinite number and variety of parts acting harmonically as one, as in symphony, and “fits all” as their ability to act on a broad variety of illnesses. While the one-size-fits-all approach cannot be applied within the paradigm of targeted drug therapy, it is immensely useful and powerful within the wholistic nutrition paradigm.

Another way to say this is that poor nutrition causes vastly more diseases than the disease-care system currently acknowledges; and that good nutrition, in contrast, is a cure for all those diseases and more. Poor nutrition is the root cause that all those blind elephant doctors can’t see.

Nutritional solutions to disease should seem like just so much common sense at this point, but it’s still worth taking a moment to look at how a medical system based on nutrition contrasts with the reductionist system we have today (see Figure 10-1).

FIGURE 10-1. Disease management versus nutrition

While the disease management system is reactive, nutritional medicine is proactive in preventing diseases before they develop. Disease management focuses on symptoms, while nutrition addresses the underlying causes of those symptoms. Disease management chooses isolated, reductionist treatments that attempt to target specific sites in our bodies, while nutrition simply gives the body the resources to select what it needs to maintain and regain health wholistically. And while disease management favors synthetic drugs that our bodies recognize as toxins, nutrition deploys the foods we have evolved to eat over hundreds of thousands of years, thereby avoiding side effects.

Medicine has become synonymous with ingesting foreign chemicals when our health deteriorates to the point that we have recognizable diseases. Medical practice means chemical practice—on our bodies. There is and always will be a place for the use of isolated chemical substances—even foreign chemicals—but only when all else fails. Reductionist disease management should, however, be a last-ditch accessory to health practice. It can’t be the main game in town.