“Holistic Medicine”–It means whatever we say it means

The American Holistic Veterinary Medical Association (AHVMA) has a statement on their web site explaining what “holistic” medicine is. I was interested in this because it’s a slippery word, seemingly simple on the surface but hard to pin down. Superficially, the word comes from the Greek root for “whole” and simply means a perspective that looks at phenomena (organisms, systems, etc) as wholes, rather than analyzing them at the level of component parts. This is simply one of many levels on which phenomena can, and should be examined.

The problem is that this perspective is difficult to distinguish from mysticism and the notion that natural phenomena are irreducibly complex and nothing meaningful can be learned by examining their components. Reductionism and holism should be complementary, but philosophically and politically they are more often seen as incompatible. Thus “holistic” becomes less a term describing an epistemological perspective and more a philosophical or political shibboleth distinguishing those who disdain the methods and explanatory power of science and prefer mystical, vitalist explanations to scientific ones from those of us who see utility and real truth in the explanations science gives at the component as well as the system level. Let’s go through the AHVMA statement and see if we can find some clarity.

 First, it recommends looking at “all aspects of the animal’s life.” Of course, that isn’t what they really mean since that is a practical impossibility. Could the patient’s cancer have been caused by once walking across a linoleum floor? Is she diabetic because the light shining through the bedroom window is filtered by oak leaves not maple? If we truly believe everything is relevant then we are helpless to make any useful conclusions at all. What they really mean is just that they want to know about things they consider relevant and which scientific medicine often does not. The trick, then, is to demonstrate that these things truly are relevant, which often fails to happen.

Next the statement recommends “employing all of the practitioner’s senses” when evaluating the patient. I’d be surprised if holistic veterinarians make a lot more use of taste than conventional vets, so generally the idea of using all ones senses in examining a patient doesn’t distinguish scientific from holistic medicine since both use a multisensory examination. Of course, this may be referring to “senses” which science does not acknowledge as being real, such as the psychic awareness of thoughts and emotions or “bioenergetic field” techniques that have been discussed in some of the organization’s continuing education literature and its journal. In that case, it would be true that conventional vets don’t use these “senses.”

Now we get to the heart of what “holistic” is truly used to signify, when the statement recommends “the combination of conventional and alternative (or complementary) modalities of treatment.” There is nothing intrinsic in the concept of holism that requires accepting or using CAM therapies. As I’ve pointed out before, CAM therapies often have theoretical foundations that are completely incompatible with each other, though they tend to be united by vitalist tendencies. Chiropractic is not “holistic” at all according to the root sense. It focuses exclusively on supposed misalignment of the spine as the source of all disease and the object of all treatments. Homeopathy, on the other hand, couldn’t care less about the spine when diagnosing or treating an illness but does treat all diseases with whatever substances are believed to mimic the symptoms of the patient when given to healthy people. CAM therapies are not necessarily any less reductionist than scientific medicine, so identifying their use as a component of the holistic veterinary medical approach betrays the ultimately political and marketing nature of the term. It is a warm and fuzzy umbrella under which to gather methods not usually validated by science. CAM therapies are often very narrowly focused on “one true cause” of all disease or the “one true therapy” for all ailments, they just pick a cause or therapy that is unproven or disproven by science.

The statement claims that a vet who follows the holistic approach “wants to find out all about its behaviors, distant medical and dietary history, and its environment including diet, emotional stresses, and other factors.” These sound like the same sort of historical variables any veterinarian considers in gathering data about a patient’s health and disease. The specific meaning attributed to each factor is likely different between science-based and “holistic” vets, but it is a bit of dishonest marketing to suggest conventional doctors are reductionist to the point of ignoring such obviously relevant factors as diet and prior medical history. As I’ve said before, ” I’ve never actually met a veterinarian who considers the patient irrelevant to the health of the knee or the gallbladder or the white blood cell, but CAVM practitioners like to suggest that such myopia is the only alternative to embracing vitalism and faith-based medicine.”

Next we have a very broad-brush paint job illustrating how really nice holistic vets are:  

“Holistic medicine, by its very nature, is humane to the core. The wholeness of its scope will set up a lifestyle for the animal that is most appropriate. The techniques used in holistic medicine are gentle, minimally invasive, and incorporate patient well-being and stress reduction. Holistic thinking is centered on love, empathy and respect.”

All of these vague, pleasant characterizations apply equally well to veterinarians who practice science-based medicine. I might quibble with what is really meant by “love” and “empathy,” since I think these terms are often a cover for claims that alternative practitioners are psychically in touch with the spirits or souls of their patients, a claim I think is more about religion than medicine. But the fact that conventional veterinarians are interested in facts, evidence, and truth does not, as CAM vets like to suggest, imply that somehow they aren’t human beings capable of treating their patients and clients with as much kindness and compassion as anyone else. I would argue evidence-based medicine is a pre-requisite for truly compassionate care since without it we are likely to offer our patents ineffective and even harmful therapies that don’t really help them.

Now comes a summary of the holistic medicine methodology:

“The holistic practitioner is interested in genetics, nutrition, family relationships, hygiene, and stress factors. Many patients present in a state of “disease.” At this point the holistic challenge lies in the question “why?” By a series of analytic observations and appropriate testing the goal becomes finding the true root source of the pathology. A simple-appearing symptom may have several layers of causation. Only when the true cause of the ailment has been found is there the possibility for a lasting recovery.

It is at this point that the most efficacious, least invasive, least expensive, and least harmful path to cure is selected. “

This sounds like a fair description of clinical medicine in general. Nothing here distinguishes a holistic approach from a conventional approach. The implication, of course, is that this is not the method a conventional veterinarian follows because presumably we’re so busy focusing with tunnel vision on superficial symptoms and reaching for toxic drugs that we aren’t looking deeply enough. Fortunately for our patients, this is just a vapid cliché.

Finally, we have this qualifier:

” In many acute situations, treatment may involve aspects of surgery and drug therapy from conventional western technology, along with alternative techniques to provide a complementary whole. This form of treatment has great value for severe trauma and certain infections. It often outperforms other methodologies. It is also at this time that other treatment plans such as those listed below are brought into use. Once the symptoms have been treated, the task is not complete until the underlying disease patterns have been redirected. The patient, as well as the client, will be guided to a new level of health. “

I have taken the liberty of translating this for those not intimately familiar with CAM-speak:

When we have a definable disease or an urgent medical problem, we reach for scientific medicine because it works better. However, when we have vague or hard to define symptoms or we’re just trying to convince the owner that ongoing health can only be achieved and maintained by constant subtle adjustments of the unmeasurable essence of life, then we reach for alternative methods since they and their effects are also vague and hard to define.

 

There is no question that the concept of holism in its original form has some value. Things can be understood about complex systems at the whole system level that may be missed when looking at their component parts. And some systems may exhibit behavior that is intrinsically not predictable at the component level even though they are fundamentally deterministic (see chaos theory) while other systems may be fundamentally indeterministic. However, none of this legitimate epistemological theory has anything to do with vitalist mysticism or the embracing of unproven or even disproven medical approaches. Looking at the whole patient in its real life context is a valuable element to understanding health and disease. Using any and all therapies that sound good to us regardless of whether or not they have real value is a mistake. Unfortunately, the popular use of “holistic” to market CAM therapies confounds these unrelated approaches.

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13 Responses to “Holistic Medicine”–It means whatever we say it means

  1. Bartimaeus says:

    Nice post. It really is kind of sad that for practical purposes, “holistic” too often means “what useless or evidence free things can we sell to the client”.
    Articles by prominent business people in the profession detailing how much profit you can make off acupuncture, chinese herbs, or whatever reinforce this impression.

    I liked the translation at the end too. 😉

  2. Rita says:

    “Holistic medicine, by its very nature, is humane to the core. ” Ooooooh no it isn’t, what a porky! I’m tired of telling people about homeopathic “provings” which involve killing various animals and some of the others aren’t too picky, either. Most of these (mutually contradictory, as you so truly point out, this can’t be said too often) systems date from times when it never occurred to the practitioners that anything you could lay your hands on wasn’t at your disposal for any dubious human benefit you might dream up. Humane, indeed, whatever next?

  3. v.t. says:

    I too loved the translation, skeptvet! Would you consider an article of such CAM-speak “translations” in the future? 🙂

  4. Rita says:

    Here are some humane remedies from TCM, if anyone needs an example to use:
    Quan xe – buthus martensi or Scorpions. Yes dried scorpions are used to treat seizures and toxic sores – pretty much like the effgects of being bitten by one.

    Di long – lumbricus or Earthworm is another. Because they are wet, cool and wriggly, they are used to treat fevers and also hot joints with a reduced range of motion. Yum yum.

    Wu gong – scolopendra – Centipede. They are also cold and wriggly and used to dissipate carbuncles and neck sores.

    She tui – Snake Skin slough – used to treat superficial visual obstruction – such as opaque cornea, as after all the snake skin is semi-opaque itself.

    E jiao – Donkey-skin gelatin – like a good stew it’s supposed to be a blood tonic.

    Sang piao xiao – Oootheca mantidis – The Preying mantis – dried and crusty to soak up dribbling urine in the case of enuresis.

    Hai gou shen – Callorhius ursinus – Penis and testicles of the seal – for impotence, predictably.

    (fom comments on Colquoun’s Improbable Science blog). If these don’t convince people, try mentioning Dog’s Penis soup. (To me no more or less humane than foie gras, of course, but the point here is that these are supposed to be humane MEDICINES).

  5. skeptvet says:

    Yes, the element of “sympathetic magic,” in which obvious physical characteristics of something are assumed to imply a usefulness for a disease or symptom the practitioner imagines is somehow similar, is a huge part of traditional folk medicine. Despite the fact that it is a childish idea that canot today be taken seriously, it lies behind the traditional recommendations for many TCM and herbal remedies.

  6. Bartimaeus says:

    Thanks Rita, whether a person chooses to eat meat or not, a lot of those traditional uses of animal parts as medicines need to be exposed for what they are-cruel, wasteful and pointless uses of animals-that should be repellent to everyone. I wonder how many who are vehemently opposed to bullfighting, veal and foie gras production accept TCM and similar uses of animals uncritically.

  7. Rita says:

    “I wonder how many who are vehemently opposed to bullfighting, veal and foie gras production accept TCM and similar uses of animals uncritically.” I can tell you – quite a lot of them! The cognitive dissonance set up by the wildly differing thinking about other species should be enough to give anyone a headache – that’s humans for you.
    My husband was present recently at a lecture given by a concerned aromatherapist-for-animals (yes, I’m afraid so) who had strayed into TCM territory in her talk – how respectful of nature, how humane, etc etc etc – until a pierced Goth-type at the back of the hall sat up and said “How come they kill and eat anything that moves, then?”
    I don’t mean to suggest that any one nation is more disposed to weird cognitive dissonances over animals than another – it seems to be a universal phenomenon which I suppose we will all gradually get over, like racism, sexism and so forth. The important first step is recognising it – as these conflictive ” alternatives” point up.

  8. Rita says:

    Just come across (on Science Based Medicine) another splendid example of sacrificing animals to woo:

    “The first study comes out of South Korea and involves using acupuncture in a rat model of spinal cord injury. The researchers used a standard method of inducing spinal cord injury in rats, and compared various acupuncture locations to no-acupuncture control. They followed a series of metabolic outcomes, as well as the extent of spinal cord injury and functional recovery. They conclude:

    Thus, our results suggest that the neuroprotection by acupuncture may be partly mediated via inhibition of inflammation and microglial activation after SCI and acupuncture can be used as a potential therapeutic tool for treating acute spinal injury in human.”

    SBM takes the study apart, of course – but too late for the rats……..

  9. skeptvet says:

    Yes, I thought about writing about that article, but they did such a good job at SBM there wasn’t much else to say!

  10. Rita says:

    ……and yet again! :

    “in which Wakefield and Hewitson subjected infant Macacque monkeys to hepatitis B vaccination spiked with extra thimerosal, twice, once on the basis of a couple of abstracts presented at IMFAR and then once based on the actual manuscript describing the study results. Suffice it to say that this study was, in my not-so-humble opinion, bad science, unethical, and a waste of valuable and sensitive primates, who were all killed at the end of the study to examine their brain and organs, as well as to perform whole genome expression profiling on tissues harvested from the GI tract of the dead monkeys.”

    I need hardly say to which Wakefield they refer. How is it possible for these people to get animal “models” into their pitiless hands? Is there no control?

    This was felt to be “unethical” a “waste” of “valuable” and – NB – “sensitive” primates. Of course, they wouldn’t be so damn sensitive – or it wouldn’t matter? if they were being experimented on by REAL scientists…………….

  11. Rita says:

    …………and again, same crew:
    Wakefield and the colostrum nostrum
    I’m thinking this is an aspect of the Wakefield situation that has been underexplored. Do the parents who idolise Wakefield know what he was really planning to inject into their children – and may actually be injecting?

    Colostrum is the first milk produced by most mammalian species and contains the antibodies that provide passive maternal immunity to the newborn. The human placenta is very unusual in being permeable to macromolecules such as antibodies, with the result that the human infant is born with its passive immunity safely on board. Antibodies in human milk fulfil a fairly minor role and breast-feeding is not essential to the acquisition of maternal antibodies. (This has its downside in that maternal anti-foetal antibodies will affect the foetus in utero while in most animals the danger does not present until after birth.)

    In non-human mammals the placenta is impermeable to antibody molecules and the neonate is born with no passive immunity. This has to be acquired within the first hours of life by consuming the mother’s colostrum, specially-secreted milk that is extremely high in immunoglobulins. To this end, the gut mucosa of the neonate is permeable to these molecules, which are absorbed intact. This permeability begins to decline quite sharply after about eight hours, and has vanished entirely by two days of age – by which time the mother is secreting ordinary milk.

    Wakefield’s notorious patent application for a “measles vaccine”, which was also in some miraculous way a treatment for MMR-induced autism, was for a product derived from goat colostrum. Brian Deer has made available images of the entire text of two versions of the relevant patent applications.

    http://briandeer.com/wakefield/vaccine-patent.htm
    http://briandeer.com/mmr/1998-vaccine-patent.pdf

    The product is described by Wakefield as “transfer factor”, and in his usual confident manner he has pontificated about the “extensive scientific literature, demonstrating safety and efficacy of TF in different diseases” and the number of experts he consulted on this subject. However, this literature seems conspicuous by its absence and this is not a product with a scientific pedigree. The Wikipedia article on transfer factor doesn’t mention colostrum, merely describing a component of cell mediated immunity, and states in relation to therapeutic uses, “the United States Food and Drug Administration regulates transfer factors as a dietary supplement and has issued a warning notice to a website selling transfer factors that they have not been proven to be effective or safe in the treatment of any condition, nor have there been any biological licenses or New Drug Applications produced for the substance.”

    Deer’s treatment of this aspect acknowledges that the approach is quackery, but otherwise majors on the evidence contained in the patent application literature of Wakefield’s plans (even from before the controversial paper was published) to carry out a standardised testing protocol on the 12 children described, and to profit from the discrediting of the MMR by offering his product not only as a treatment for “vaccine-induced autism” but as a measles vaccine in its own right. However, closer examination of the nature of the product and its production is very instructive, and might be rather disturbing for any parent already concerned about what is being injected into their children’s bodies.

    I am not an immunologist, but the basic biology of transfer factor as a component of CMI appears to be uncontentious enough. Nevertheless, virtually all the returns for a google search on “transfer factor” are quack sites. Exactly where colostrum comes into it, I’m not certain. However, this seems to be Wakefield’s (and woo in general’s) preferred method for manufacturing the stuff.

    I am a vet, and I have to say that my knowledge of colostrum is confined to its immunoglobulin content. Standard veterinary teaching does not acknowledge that colostrum intake provides any active immunity, whether humoral or CMI. I have been unable to find any mainstream information on this subject online apart from an isolated 1977 paper describing T-lymphocytes in human colostrum. Any link combining transfer factor and colostrum appears to be woo.

    Wakefield’s patent application’s description of the production of his transfer factor product makes startling reading.

    First he describes the injecting of mice with “live or killed virus or an antigen derived from such a measles virus”. The mice are presumably killed and their lymphocytes harvested. A filtrate of these lymphocytes is then added to “an immunologically virgin human lymphoblastoid cell line”. The source of this cell line is not specified, however this seems to resonate with his guru Hugh Fudenberg’s statement to Deer that he was curing autistic children with a preparation derived from his own bone marrow.

    Then, “one cell is serially expanded 10-fold with killed measles virus and interleukin-2, to a billion cells. Measles virus-specific TF preparations are made from this expanded cell population.” Following some description of a purification process, the recipe then introduces the goats.

    “The ability of TF to stimulate further TF production, and the cross-species reactivity of TF are subsequently exploited in order to produce large quantities of concentrated TF at low cost. This is achieved by injecting the TF preparation into pregnant goats 3 times prior to delivery. Colostrums are collected for the first 3 days post-delivery and TF preparations were made from these by micropore filtration.”

    So, we have measles virus and mice. Then we have the mice lymphocytes and a human cell line. Then more measles virus, for some reason. Then goats, and the final product coming from the colostrum of the nanny-goat. The route of administration described in the patent application is oral, but intramuscular injection is also referred to. There is description of reactions of human patients to this preparation, but absolutely no hint of any of the normal drug testing procedures that would have to be undertaken for any product to be licensed as a safe and effective therapeutic agent. Really, read the original text. It’s a classic example of junk science.

    Just how happy should concerned parents be to have something like this injected into their children? Mice? Human bone marrow? Goat’s milk? Measles virus involved in the production process? Absolutely no background literature supporting the process, and no evidence of any safety or efficacy testing?

    Just this year, something else has emerged that should put a whole new perspective on the use of animal colostrum as a therapeutic agent. A new, fatal syndrome, bovine neonatal pancytopenia, has recently been identified in young calves. The cause of this is as yet unknown, but suspicions currently centre on toxic properties of the colostrum of cows which have themselves been vaccinated. The syndrome has not been recognised in goats, nevertheless the wisdom of consuming colostrum or a colostrum-derived product from any animal has to be questioned – especially an animal that has been subjected to an unorthodox vaccination procedure.

    A further area of concern is the welfare of the goats used in the production. In order to harvest colostrum, the newborn kids must be prevented from sucking. This will necessitate someone observing the animals constantly so that the neonates can be whisked away before they have got to their feet. (If anyone has devised a mechanical system for ensuring that a newborn kid can’t get to its mother’s udder even if parturition is unobserved, I really, really, don’t want to hear about it.) Kids would have to be fed artificial colostrum for the three days described in the patent, before they could be allowed to nurse. Maybe. Or would there simply be so many unwanted kids, these would be shot at birth?

    Where is all this being done? How many goats are involved? What are the welfare standards? Did any of this animal experimentation (for that is what it is) have a proper Home Office licence, if it was done in Britain? Where might one find answers to these questions?

    It would be perfectly possible to do this with acceptable welfare standards as a small cottage industry, with just a few animals. However, Wakefield clearly envisaged mass production of a product intended to supersede the MMR he was trying to discredit. How many litres of colostrum a day would the new industry require? Just how was this to be achieved? How many barns full of battery goats would be needed to supply this market? How many unwanted kids would be shot?

    I wonder how many of Wakefield’s disciples have any idea about the production of this stuff he wants to give to their children. Do you think we should tell them?
    – from a James Randi forum

  12. Rita says:

    and yet again: actually, I’ll just stop posting these and collect them somewhere else, but meanwhile:

    “That is, in fact, largely what the National Center for Complementary and Alternative Medicine does, which is why they funded (along with the National Cancer Institute) a study of shark cartilage in non-small cell lung cancer.

    The study was a double-blind placebo controlled trial with 379 subjects of standard therapy + placebo vs standard therapy + AE-941 (a brand of shark cartilage). You can read the details in the linked abstract – suffice it to say the results were dead negative. There was no benefit.”

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