Limitations of Western Medicine and Models of Integration Between Medical Systems

Abstract

This article analyzes two major limitations of Western medicine: maturity and incompleteness. From this viewpoint, Western medicine is considered an incomplete system for the explanation of living matter. Therefore, through appropriate integration with other medical systems, in particular nonconventional approaches, its knowledge base and interpretations may be widened. This article presents possible models of integration of Western medicine with homeopathy, the latter being viewed as representative of all complementary and alternative medicine. To compare the two, a medical system was classified into three levels through which it is possible to distinguish between different medical systems: epistemological (first level), theoretical (second level), and operational (third level). These levels are based on the characterization of any medical system according to, respectively, a reference paradigm, a theory on the functioning of living matter, and clinical practice. The three levels are consistent and closely consequential in the sense that from epistemology derives theory, and from theory derives clinical practice. Within operational integration, four models were identified: contemporary, alternative, sequential, and opportunistic. Theoretical integration involves an explanation of living systems covering simultaneously the molecular and physical mechanisms of functioning living matter. Epistemological integration provides a more thorough and comprehensive explanation of the epistemic concepts of indeterminism, holism, and vitalism to complement the reductionist approach of Western medicine; concepts much discussed by Western medicine while lacking the epistemologic basis for their emplacement. Epistemologic integration could be reached with or without a true paradigm shift and, in the latter, through a model of fusion or subsumption.

Introduction

In Western countries, alongside scientific medicine (or Western medicine) there coexists an important, often underestimated, aspect of health care known by different names but with very similar meanings: alternative, nonconventional, traditional, or complementary medicine. More specifically, “complementary” medicine refers to healing practices that work in conjunction with Western medicine, whereas “alternative” medicine differs in that it is not used as a complement to but rather a substitute for Western medicine. In this work, therefore, the better-known term “complementary and alternative medicine” (CAM) is used. In recent decades, many countries have gradually come to accept the contribution that CAM can make to the health and well-being of individuals and to the comprehensiveness of health care systems.¹ At the same time, an increase in CAM publications has been reported,² from 2865 documents between 1990 and 1999 to 9711 documents between 2006 and 2011.

The World Health Organization has long been engaged in search strategies for integrating these practices into the Western health care system. These strategies are centered on three objectives: “(1) to build the knowledge base for active management of Traditional and Complementary Medicine (T&CM) through appropriate national policies; (2) to strengthen quality assurance, safety, proper use, and effectiveness of T&CM by regulating products, practices, and practitioners; and (3) to promote universal health coverage by integrating T&CM services into health care service delivery and self-health care”.¹ Specifically, these objectives involve, respectively: policy and organization; effectiveness, safety, and education; and integration into the health system. Only the latter deals with operative integration among different medical systems, particularly focusing on the accessibility of services, the informed choice of the patient, and communication between practitioners of the two systems. The US National Center for Complementary and Integrative Health and the Australian National Institute of Complementary Medicine are other important centers that have developed programs for the integration of CAM into Western medicine.^3,4 In all cases, the implicit or explicit premise is the immutability and supremacy of Western medicine within which the CAM must be adapted and integrated.

This article, starting from a different viewpoint, considers Western medicine to be an incomplete system with respect to a wider explanation of living matter. Therefore, through appropriate integration with other medical systems, in particular with some aspects of CAM, it may increase its knowledge base and elucidation.

On the other hand, because CAM does not represent a single and compact medical system, this article discusses only one nonconventional medical system to help make the discourse more concise and simple. Homeopathy and acupuncture are by far the most widely used CAMs in Western countries; however, because acupuncture is only part of the wider medical system of Traditional Chinese Medicine, homeopathy, a more compact system, was selected to elaborate on a possible integration with Western medicine. Accordingly, this review presents possible models of integration between Western medicine and homeopathy, the latter viewed as representative of the characteristics common to all CAMs. Therefore, what will be said about homeopathy can be partly applied in general to many other CAMs. This discussion will not address the problem, however crucial, regarding the effectiveness of CAM, a topic already widely debated elsewhere.

Medical Systems

Before the integration of medical systems can be discussed, the definition, typology, and classification of medical systems must be clarified. The concept of the medical system is different from that of the health care system. A health care system comprises the complete network of agencies, facilities, and providers of health care in a specific geographic area and does not include the cultural and sociologic components of medical practice. Indeed, Leslie⁵ defines a medical system as “the pattern of social institutions and cultural traditions that evolves from deliberate behavior to enhance health, whether or not the outcome of a particular item of behavior is ill health.” Press⁶ reported many definitions and classifications of medical systems with a view to proposing the following definition: “a patterned, interrelated body of values and deliberate practices, governed by a single paradigm of the meaning, identification, prevention, and treatment of sickness.” Finally, and with respect to the paradigm perspective, which is the main view of the present work, different medical systems may be regarded as “competing paradigms to explain the domain of health.”⁷

Under what criteria can it be determined whether two different therapeutic approaches belong to the same medical system or can be considered as two different medical systems? Intuitively, Western medicine and homeopathy belong to two different systems; perhaps even homeopathy and Chinese medicine are two different systems. Alternatively, it might be assumed that homeopathy and homotoxicology belong to the same medical system.

This article proposes three levels of explanation through which it becomes possible to distinguish among different medical systems, namely epistemological (first level), theoretical (second level), and operational (third level), these levels being based on the characterization of any medical system as consisting of three elements: a reference paradigm (first level), a theory on the functioning of living matter (second level), and clinical practice (third level). The three elements are consistent and closely consequential in the sense that from epistemology derives theory and from theory derives clinical practice.

Therefore, two medical systems can differ on one, two, or all three levels. However, when they differ only on the third level (i.e., clinical practice), they could not be considered as two therapeutic approaches within the same medical system; this would depend on the extent of the difference. For example, homeopathy and homotoxicology differ only slightly on the first level and should be considered as belonging to the same medical system.

Consequently, two medical systems could be defined as different when they diverge widely, at least regarding the type of clinical practice, the most evident and comprehensible component; of course, the difference becomes more evident when they also differ in theory and epistemology. For example, Chinese medicine and homeopathy appear to differ widely in their clinical approach and slightly in theory, while being very similar in epistemology. Even more obviously, scientific medicine differs from homeopathy, and in general from all CAM, on all three levels (Table 1). It should also be noted that the epistemological and theoretical components, above all in poorly evolved systems, may be absent, unclear, or implicit.

Table 1.

Comparison Between Western Medicine and Homeopathy on Epistemological, Theoretical, and Operational Levels

Western medicine	Homeopathy
1. Epistemology
In general
Reductionism	Holism
Mechanicism	Vitalism
Determinism	Indeterminism
In disease interpretation
External causation	Internal causation
Negative expression of the body, disease meaningless	Disease as expression of body language
Single organ disease	Systemic disease
2. Theory on the functioning of living matter
Chemical	Physical
Molecular	Electromagnetic
Short-range	Long-range
3. Clinical practice
Doctor–patient relationship
Specialist approach, targeting a single organ	Systemic approach, targeting the whole person
Explanatory approach	Comprehensive approach
Diagnosis
On single organ	Systemic, on the whole body
Therapy
Chemical–molecular therapy	Physical therapy
Strong action	Weak action
Local effect	Systemic effect

Epistemology, Theory, and Practice of Western Medicine

The main objection to the integration of Western medicine and other medical systems is that Western medicine does not need integration because it is self-sufficient and much more scientific and developed in comparison with other medical systems. Therefore, when discussing integration, proponents of Western medicine take for granted that the three levels on which Western medicine is built should remain unaffected. By contrast, starting from the aforementioned three levels and for the purposes of this discussion, the goal here is to show that Western medicine has two important epistemological limitations: incompleteness and maturity. From these limitations derive further theoretical and practical limits.

For these very reasons, medicine in general could realize and improve patient care on the foundation of a model of integration for different medical systems. Consequently, this article proposes to show, via the exemplar of homeopathy, that CAM could fill the gaps in and overcome the limitations of Western medicine. From this premise may arise deeper models of integration of Western medicine with CAM than those hypothesized thus far by others.

The epistemological collocation of biomedicine is an issue widely debated because Western medicine has long been blamed for a too reductionist approach to living systems and patients, with all the flaws it entails. Similar to reductionism, the biomedical paradigm has been named the Cartesian, Newtonian, mechanicist, and molecular paradigm. All such characteristics of Western medicine have been widely discussed since the birth of scientific medicine (see, for example, a book by Capra⁸). The theoretical consequence of this paradigm involves the belief that the entire functioning of living matter is the result of the interaction between molecules.⁹ The ultimate expression of this attitude is to attribute to DNA all responsibility for the final configuration of living beings. Consequently, medical practice is centered primarily on molecular therapy using drugs. In summary, the three elements of the system are mutually consistent, apparently offering a satisfactory, or even full, explanation of living matter.

Incidentally, the molecular paradigm is not a monolith impermeable to other scientific explanations or integrations; in fact, many criticisms of this paradigm have been published and discussed in orthodox scientific journals.^10

–13 Nevertheless, because of the predominance of the molecular paradigm, and the idea that it provides a satisfactory explanation of biological systems, it tends to underestimate and belittle alternative or additional mechanisms of the functioning of living matter.

Maturity of Western medicine

Maturity of the biomedical paradigm means that it has been able to explain almost all of the normal and pathological functioning of living matter, as well as to develop a huge therapeutic arsenal. Paradoxically, the excess of success has brought the molecular paradigm into crisis, according to the following sequence. In the early stage of a paradigm, the simplest and more evident problems are resolved. Later, increasingly more complex and costly problems are solved, to the exclusion of the so-called anomalies¹⁴ that the molecular paradigm is unable to explain. Nowadays Western medicine is faced with many problems that are difficult to solve or that engage an enormous burden of economic resources.

Usually the rising health care costs are attributed to the increase in technology costs, the increase in the elderly population and their prolonged survival, and so forth. A further explanation is that the molecular paradigm responds to the classic economic law of decreasing marginal returns, which consists of a gradual reversal of the cost/benefit ratio. Being now in a very advanced stage of maturity of the paradigm, any further small increase in knowledge involves ever greater resources: for example, the huge costs engaged for research on AIDS, development and production of new technologies, and research and application of new drugs.¹⁵

Incompleteness of Western medicine

According to the Kuhnian notion of paradigm,¹⁴ the concept of incompleteness derives from the premise that each paradigmatic vision is always a partial view of the world of interest. In this case, incompleteness means that adherence to the molecular paradigm is a partial vision of the functioning of living matter. In brief, this reductionist and mechanistic epistemology is consistent with the molecular and linear theory on the functioning of living matter, and with the therapeutic approach, centered on single organs, specialism, and explanation (Table 1).

Instead, much research, proposed, for example, from studies of CAM, has shown that living organisms operate not only through the interaction between molecules but also through physical modalities. These studies, being located outside the molecular paradigm, are poorly understood and little researched by Western medicine.^16

–21 The scientifically advanced mechanism discussed in the literature, which can be integrated into the molecular paradigm, involves the physics of living systems. This mechanism is fairly well known but somewhat underestimated. The sensitivity of biological systems to electromagnetic fields is an indirect demonstration of this and concerns all types of biological systems, be they isolated cells, microorganisms, insects and other animals, or humans. Besides the experimental level, this susceptibility might be involved in many empirical situations or common experience: the ability of animals to recognize long-range signals, the cohesion of colonies of the social insects, the phenomenon of hormesis, the therapeutic tradition of bioenergetics, and homeopathy and other alternative medicines. As a result of such sensitivity, it is possible to assume that a similar electromagnetic organization exists in biological systems, which acts as a decoder of the external physical input, acting in resonance with it.

An important expression of the physics of biological systems is the physics of biological water.^22

–25 Such properties of water might be considered a classic anomaly of the molecular paradigm. Biological water is able to generate frequency domains and then to store and transmit information, giving coherence to the whole system. Indeed, from a scientific viewpoint the physical (electromagnetic) organization of living matter could better explain the long-range coherence of biological systems than could molecular organization, and from an epistemological viewpoint could better explain the concepts of holism and vitalism.

Epistemology, Theory, and Practice of Homeopathy

The properties of biological water have also been considered to be the mechanism of operation of some alternative medicines, primarily homeopathic medicine.^26

–29 Moreover, homeopathy is well known for its systemic and holistic approach to the patient; for anamnesis and diagnosis that are not limited to organ disease but investigate the overall physical and psychological characteristics of the patient; and for therapeutic activity based not on molecules but on water, appropriately diluted and dynamized to resonate with the living matter.

Therefore, in this case also, the three components of this medical system are consistent with each other: a holistic, vitalist, and apparently indeterministic³⁰ epistemology; a long-range and systemic explanation of living matter; a comprehensive, mind–body, and systemic approach to the patient and the disease, seen as a disease not of a single organ but of the whole organism; and a weak therapy free of molecules (Table 1). Presumably, hostility toward homeopathy is of a paradigmatic nature rather than of a scientific nature (i.e., the so-called incommensurability between different paradigms).

Patterns of Integration

To explore possible models of integration of Western medicine and CAM, in particular homeopathy, the previously described distinction of medical systems according to the operational (third level), theoretical (second level), and epistemological (first level) components is used.

Operational integration

Operational integration is widely described elsewhere,^1,31

–34 also in low- and middle-income countries.³⁵ In general, however, four models of integration are identified: contemporary, alternative, sequential, and opportunistic.

Contemporary

This mode involves the simultaneous use of the two systems on the same patient. It assumes that coadministration of therapies from different medical systems can be of greater benefit for patients. This approach would require further information on possible synergistic or adverse effects between the two medical interventions. For example, using acupuncture during anesthesia might reduce the dose of traditional anesthetics required. This policy presupposes a fairly egalitarian relationship between medical systems, as will be seen in the theoretical and epistemological models.

Alternative

This policy starts from the assumption that some diseases might respond better to Western medicine whereas others respond better to CAM. This policy also presupposes an egalitarian relationship between medical systems. Specific examples on this topic are not cited here because effectiveness has been deliberately excluded from this discussion. However, it is plausible that some medical systems are more effective than others in certain clinical situations.

Sequential

This criterion involves, in the first instance, the use of Western medicine. Only in case of its failure might CAM intervene. This approach presupposes a relationship of subordination of CAM to Western medicine.

Opportunistic

To avoid excessive rigidity, an opportunistic approach is more interesting. Thus, the integration can be contemporary, alternative, or sequential according to the characteristics of the setting, the patient, and the disease. Practitioners well educated in more medical systems should recognize how, where, and why to use one medical system rather than another.³⁶

In any case, it is necessary to establish whether clinicians should be expert in both systems or whether specialists are required for each system. If a theoretical and epistemological integration is also assumed, the first solution would be consequential and inevitable. Ideally, in a rationale of better integration, it would be preferable to have a single competence and responsibility, but this would require a significant cultural change in the training of health workers. Otherwise, each system will retain its responsibility. Obviously, these four models are also subordinate to an informed choice of the patient, who has to decide autonomously to which system he or she is assigned.

There are two preliminary considerations regarding theoretical and epistemological integration. First, although analyzed separately, the two modes are more interconnected than they appear on the page. Second, given the great heterogeneity of hypotheses reported in the literature about possible integration of Western and CAM, and on how these models of integration can be developed theoretically and practically, only general considerations can be covered.

Theoretical integration

Theoretical integration involves an explanation of living systems simultaneously covering a molecular mechanism and a physical mechanism of the functioning of living matter. Surprisingly, many studies attempt an additional explanation of living systems, implying a theoretical integration of these two modalities, sometimes also including CAM. However, these studies do not represent a single, coherent body of knowledge, attributable to a single scientific hypothesis, because they cover topics quite different and apparently also incompatible with each other. Indeed, these studies do not cite each other and, in fact, ignore each other. Moreover, in the absence of clear scientific evidence, they are mainly centered on theoretical speculation. Preparata,³⁷ even 20 years ago, suggested that living matter seems governed by the quantum field theory, with electrodynamic coherence as a bridge between physics and biology. Annila and Baverstock¹⁰ seek solutions in the second law of thermodynamics. Others seek the study of “crowding” in living systems, such as the effect caused by crowding conditions from the standpoint of statistical physics.³⁸ Another, more recent theory tries to assign to ultra-weak photon emission the role of nonchemical, distant cellular interaction.³⁹ Probably the most developed hypothesis is the one we have already discussed concerning the physical properties of biological water. Finally, it cannot be excluded that all of these studies are resting on a shared and deeper ground, ever expanding. It is important to emphasize that the papers cited here form only a small part of the huge bibliography exploring alternative and integrative viewpoints to the molecular paradigm.

Why are all of these studies essentially ignored or undervalued by the scientific community? First, they address topics totally or partly beyond the competence of biochemical researchers, who thus find it difficult to understand and, more so, judge the quality and plausibility of the hypotheses presented. These difficulties are further increased by the wide heterogeneity of these studies. Second, scientists working within a given paradigm have more resistance to accepting theories that challenge the paradigm and do not have access to most of the relevant accredited scientific journals as they are considered heretical.

Epistemological integration

Theoretical integration of the chemistry and physics of living systems is the basis and premise of epistemological integration, allowing us to overcome the incompleteness of Western medicine. Moreover, it provides a more thorough and comprehensive explanation of the epistemic concepts of indeterminism, holism, and vitalism to complement the reductionist approach of Western medicine, concepts that Western medicine talks so much about while lacking the epistemological basis for its emplacement.

In addition to the merger between theoretical chemistry and physics, there may be important operational impacts. One can surmise the unification of all diagnostic-therapeutic pathways, and the subsequent unification of the training of medical staff, in a single, integrated model that at present is not possible to define.

However, this integration could take place according to the following modalities: in a weak integration (i.e., there is a deep enrichment of the Western paradigm without an evident change) or in stronger integration characterized by the so-called paradigm shift.¹⁴ In turn, the paradigm shift could result in two subdivisions: subsumption or fusion of paradigm.

According to the classic Kuhnian approach, when a scientific paradigm reaches its maturity and is no longer able to support the recurrent anomalies, it is replaced, after a scientific revolution, by a new scientific paradigm. In the present case a fanciful, but theoretically possible, hypothesis foresees the birth of a new scientific paradigm whereby the two medical systems of departure are harmonized on a higher level of explanation of living matter that is not simply attributable to one of the previous two systems.

Finally, this new paradigm could be imagined as a merger between the current scientific paradigm and that of the CAM (model of fusion), or that the epistemology and the theory of CAM is included within the current paradigm, deeply modifying and reinterpreting it (model of subsumption). In the first model, an equality and mutual dignity between medical systems is assumed; in the second case, the supremacy of Western medicine over CAM is reaffirmed.

The practical problem is how this paradigmatic shift should be implemented. The Kuhnian concept of scientific revolution is perhaps a little too strong. Instead, a slow transformation could pass through scientific, educational, and organizational steps, with all the economic consequences that this entails.

The first step should be the definitive scientific validation of CAM by rigorous experimental studies. Any validated CAM should be included in medical school curricula, be integrated with Western medicine (more suited to epistemological integration), or be included in postgraduate courses (more suited to operational integration). This will generate organizational problems: how to change health systems to achieve practical integration. This was described previously in the discussion of operational integration, and four models of integration have been identified.

The economic consequences of these changes are difficult to predict. They depend on too many variables. Ideally, deep integration would cause Western medicine and CAM to be provided by the same physicians and institutions (e.g., hospitals), creating a unified model of medicine that might not result in additional economic cost. The only certainty in this field is that CAM treatments—consider acupuncture needles or ultra-diluted homeopathic remedies—are substantially cheaper than the treatments and drugs of Western medicine.

Footnotes

Author Disclosure Statement

No competing financial interests exist.

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