Integrated health and post modern medicine

For many years, I have advocated an integrated approach to medicine and health. By integrated medicine, I mean the kind of care that integrates the best of new technology and current knowledge with ancient wisdom. More specifically, perhaps, it is an approach to care of the patient which includes mind, body and spirit and which maximizes the potential of conventional, lifestyle and complementary approaches in the process of healing. Integrated health, on the other hand, represents an approach to individual and population health which respects and includes all healthrelated areas, such as the physical and social environment, education, agriculture and architecture. I know that this is a somewhat wider definition of integration than commonly used, but I want to argue that a successful health service needs to embrace this broader and more complex concept of integration. I hasten to say that the point of this article is not to confront accepted medical wisdom, but merely to suggest that there is a case for reaching beyond it, and that is to explore how we might be able better to align the ambitions of patient and clinician within medicine and how we might maximize the ability of every professional and citizen to create better personal and community health outside of it. Exactly 30 years ago, in a speech to the British Medical Association (BMA), I quoted George Engel, who wrote ‘A Modern Science of medicine still tends to be based on the notion of the body as a machine, of disease as the consequence of breakdown of the machine, and of the doctor’s task as repair of the machine’. I fear that what was true 30 years ago remains equally true today. It is why for a rather long time now, and not without criticism from some quarters, I have been attempting to suggest that it might be beneficial to develop truly integrated systems of providing health and care. That is, not simply to treat the symptoms of disease, but actively to create health and to put the patient at the heart of this process by incorporating those core human elements of mind, body and spirit. To achieve this – and there are many who support this – I would suggest that medicine may sometimes need to become less literal in its interpretation of patient needs and more inclusive in terms of what treatment may be required – in other words, to understand how symptoms may often simply be a metaphor for underlying disease and unhappiness. It is also vital, it seems to me, to recognize that treatment may often be effective because of its symbolic meaning to the patient through effects that are now being increasingly understood by the science of psychoneuroimmunology. In short, I suspect it will always be a struggle if we continue with an over-emphasis on mechanistic and technological approaches. Please do not misunderstand me – the best of science and technology constantly needs to be harnessed and deployed to obtain the best effect – but, I would suggest, not at the expense of the human elements. These, after all, provide the whole rationale for medicine and health care going back to our roots. The importance of those human elements is becoming all too apparent in contemporary medical science. Sir Michael Marmot has shown convincingly that the health of employees is related to the extent to which they feel empowered to fulfil their role, according to their own judgement. Professor Blackburn, the Nobel Medicine Prize winner, has provided evidence indicating that high levels of stress can result in shortened telomeres, the critical elements which bind chromosomes together. This in turn quickens the ageing process. With research of this kind, we can no longer continue to see mind and body as separate and occasionally interacting entities. That is because they are one and the same thing. Our DECLARATIONS