TREATING PEOPLE, NOT DISEASES
Diseases are not isolated discrete entities. There is not something called asthma, or sinusitis, or migraine, distinct from the person suffering from it. A disease isn’t a thing inside you in a little box, separated from the rest of you. It might work that way with something as relatively unsophisticated as a car; maybe if there is something wrong with the gearbox, it does not affect all the other systems (although maybe a mechanic might think otherwise.) But a human being is much, much more complex. Another difference of course is that a human being is alive.
What this means is that medical treatment and health care needs to take cognisance of the person as a whole, and not just focus on the disease. This also has repercussions for medical research: suppose you read that research shows that statin anti-cholesterol medication reduces the risk of death from cardiovascular disease in women who take these drugs: if you are a woman, you might then conclude that you should take statins. However, it seems that such women do not in fact live any longer; they just die of something else. (See Dr. Malcolm Kendrick’s provocative book, “The Great Cholesterol Con”). The question we need to ask of any treatment is not, “does it cure the condition?”, but, “will I be healthier?”.
A simplified model of how a human being works involves thinking of them in terms of a number of systems; the respiratory system, the digestive system, the nervous system, and so on. This is no doubt an over-simplification, but even so it does not take much thought to realise that all these systems are dynamic and inter-related, so that a small change in one of these systems has knock on effects in all the others. For instance, if your digestive system gets upset, maybe through eating some dodgy take-away, this has a knock on effect on all the others because they all rely for essential nourishment on the digestive system processing what you eat. For medical treatment to be really effective, therefore, it needs to take stock of the whole person and not just focus down on one system, or even on one sub-system, as if that system existed in isolation from all the others. It doesn’t.
To understand this, consider the case of Fred. Fred grows up as a fairly healthy child, albeit with a tendency, inherited from his dad, to be a bit on the chubby side. He does well at school and goes to university to study computer science. He enjoys his subject and happily spends long hours studying away; to unwind he goes for a few (or sometimes more than a few) beers with his mates. Already he is developing something of a beer belly, which is perhaps not helped by his reliance on fast food and take-aways. Still, he does not have any major health problems and rarely if ever sees his GP, although he notices that his stools are tending to get loose and, I’m afraid to say, rather smelly.
At this point Fred is beginning to suffer from what in Traditional Chinese Medicine we call ‘Pi Qi Xu’, which basically means a weakness of the main digestive organ, the ‘Pi’. This is weakened by a poor diet, but also by excessive intellectual work (think about the way we link intellectual activity with digestion, as in phrases such as ‘food for thought’, ‘chewing it over’, and ‘digesting information’). Intellectual indigestion causes actual indigestion. A likely consequence of this disharmony is what we call ‘damp accumulation’, an over-retention of moisture in the body, manifesting, for instance, as weight gain around the abdomen, and loose smelly stools, possibly with mucus in them (charming, I know.).
Ten years down the line, Fred has a good job in IT, which unfortunately is fairly desk-bound. He is more over-weight, still fond of a few beers, and the less said about his toileting the better. But he is also struggling a bit now. Never a morning person, he now wakes with difficulty from heavy sleep and is reliant on strong coffee to get him going. Even then he is prone to lethargy and when he gets home from work he tends to slump in front of the telly a lot. He knows he should get some exercise, but the trouble is that his knees ache and are a bit swollen, and any way he hasn’t got the motivation. In Traditional Chinese Medicine this is all more dampness, which typically produces feelings of heaviness, muzziness, dullness and apathy, like being bogged down. Fred’s long-suffering girlfriend knows that something is not right (and if truth be told is not overjoyed by the lack of bedroom action these days, and the snoring), and eventually prevails on him to see the GP. The GP thinks Fred is depressed and prescribes a low-dose antidepressant.
Ten years later Fred is still taking the anti-depressant, which did at least seem to lift his mood for a while, although the effect has worn off and his GP is reluctant to increase the dose. He is snoring badly now and may have sleep apnoea. He also seems to catch colds a lot, and his sinuses are almost constantly blocked with thick mucus which is often yellow. He is also a bit wheezy if he has to walk up a flight of stairs. The dampness has led to phlegm in the lungs and sinuses. This leads to Fred having a lot of dull headaches. Although, as you may have gathered, Fred is quite good at just putting up with less than optimal health, these headaches combined with the sinus problem have really started to get to him. He tries over-the-counter decongestant medication, he goes to his GP to get some better decongestant medication, he tries using olbas oil, but nothing seems to work for very long.
However, for as long as Fred, or the people treating him, just focus on his sinus problem, nothing much is going to happen. Whether you call this disease sinusitis or not, it has not come into existence on its own, but is simply what is, for Fred, the most obvious manifestation of something which has been going on throughout his entire being for at least 20 years. Even if he finds some slick new decongestant pill that does unblock his nose, this is just suppressing a symptom rather than healing a person, and there will no doubt be some side effects from the pill which might even mean he needs another pill. (Possible side effects of one of the most common decongestants include insomnia – which will at least put a stop to the snoring – anxiety, restlessness and a fast pulse). Fred does not need treatment for sinusitis, he needs treatment for his whole being, body and soul.
Hopefully this makes clear why we say treat the person, not the disease. We sometimes talk about treatment principles, which are the goals of treatment. If we think of treating the disease, there is only one treatment principle:
• Clear the sinuses
If, however, we think of treating Fred, the person, there are many treatment principles, some of which might be:
Clear the sinuses
Strengthen the digestive system (the ‘Pi Qi’)
Drain excess moisture from the body (‘drain dampness’)
Strengthen the respiratory system
Work with Fred to help him develop the motivation to do more exercise
Treat the joint pain
Help Fred develop the motivation, and the understanding, to modify his diet to avoid clogging up his system
Help Fred to start to consider that he might benefit from cutting down on the beer
The point is that, to really clear the sinuses and keep them clear, we need to apply all of these treatment principles. This is, of course, not the work of a day, and it is undoubtedly easier in the short term to just pop a decongestant pill. It is easier for Fred, who does not have to consider changing his life much. The trouble is that, at best, this approach frees up Fred’s sinuses for a bit, without doing anything to help with his other problems. In the long run it may see him taking several pharmaceuticals – pain-killers for his knees for instance – none of which are addressing the fundamental problems.
But, if Fred gets some kind of treatment which addresses all the principles listed above, by which is meant he gets some form of holistic treatment, and if he is able to work with whoever provides this treatment, he could end up having a life which is a whole lot better than the one he is having. So that is why it is important to treat the person and not the disease.
Written by Vimalaprabha