Editorials

Enhancing human healing

Directly studying human healing could help to create a unifying focus in medicine

All therapeutic avenues meet at life's innate healing or destructive processes. So direct study of human healing might serve as a unifying focus, bridging disparate worlds of carea truly integrated medicine. In recent decades orthodox medicine's successful focus on specific disease interventions has meant relative neglect of self healing and holism, and from this shadow complementary medicine has emerged, with its counterpointing biases. The gap between them is, however, narrowing with the emerging view, backed by the study of placebo and psychoneuroimmunology,¹ that to ignore whole person factors is unscientific and less successful.

Almost 20 years ago young doctors' interest in complementary medicine surfaced,² presaging major changes in Western medicine that seemed unimaginable at the time. For example, acupuncture is now used in most chronic pain services,³ and about 20% of Scottish general practitioners have basic training in homoeopathy.⁴ But is integration just bolting on the scientifically proved bits of complementary medicine to the "leaning Tower of Pisa" of orthodoxy?⁵ To stop there would ignore the fundamental imbalances that complementary medicine's rise reflects but cannot fix. Indeed, complementary medicine may be largely driven by medicine's main omissionthe failure of holism. Consider the needs (of both doctors and patients) revealed by these remarks of doctors after training in complementary medicine: "This has rekindled my interest in medicine" and "I now see the whole person and not a biochemical puzzle to be solved."⁴

But how can primary care deliver its whole person perspective and honour a biopsychosocial perspective⁶ in too short consultations with rushed doctors whose human contribution is so undervalued it is excluded from treatment protocols? The back up is a pressured secondary care system designed around a mind-body split. So we end up too often resorting to our Western based, limited range of interventionist, expensive tools, with their resultant iatrogenesis. A Trojan horse delivery of holism by complementary medicine may help but won't cure this system failure.

Both orthodox and complementary medicine are in danger of identifying themselves and their care with the tools in their tool boxesbe they drugs or acupuncture needles. Our research and our "evidence based" treatment guidelines echo our focus on technical treatments for specific diseases, ignoring the critical impacts of whole person factors in these diseases. We are the artists hoping to emulate Michaelangelo's David only by studying the chisels that made it. Meantime, our statue is alive and struggling to get out of the stone. Take ischaemic heart disease, for example: evidence that hopelessness accelerates the disease and increases mortality⁷ is ignored in our guidelines. In developing and assessing care we cannot ignore that human caring and interaction is a powerful, creative activity with impact, which tools can serve but should not lead. Complementary medicine has similar blind spots, and its need to defend its specific interventions undervalues what it has to teach about holism and healing.

It might help to speak of integrative care (as in the United States), rather than integrated care. If we defined it as care, aimed at producing more coherence within a person or their care it would be measurable. For example, Howie's patient enablement index⁸ has been used to show that a homoeopathic consultation alone has a healing impact before any additional effect from subsequent medicine (SW Mercer et al, Scottish NHS research conference, Stirling, September 2000). Critics and advocates agree that complementary medicine produces non-specific benefits, soapart from the debate about specificsif the greater emphasis on human care and holism encouraged by complementary medicine can result in better outcomes, long term cost effectiveness, and reduced drug use, iatrogenesis, and spirals of secondary care,⁹ then how will orthodoxy change to get similar results?

We should explore how therapeutic engagement (and qualities like compassion, empathy, trust, and positive motivation) can improve outcomes directly in addition to any intervention used. But can the creation of therapeutic relationships be taught? Could we do for the healing encounter what Betty Edwards has shown for other creative processes, with "non-artistic" people's ability to draw being transformed in days by activation of so called right brain processing?¹⁰ Creative medical caring might similarly require balancing short term analytic, quick fix, technical thinking with analogical, holistic processing.

The study of human healing would ask, on multiple levels, what facilitates or disrupts recovery processes in individuals, with what potentials and limits? Founded on clinical care, it would gather knowledge from other placesplacebo effects, hypnotherapy, psychoneuroimmunology, psychology, psychosocial studies, spiritual practices, art, and complementary medicine, not as ends in themselves but as portals to common ground in creative change.¹¹ It needs to be practicalfor example, if fear affects physiology, say in bronchospasm,¹² what help can we offer other than drugs?

I hope in future that we routinely ask: what is the problem, is there a specific treatment, and how do we increase self healing responses? Then "show me your evidence" will require evidence of effective human care and facilitation of healing and not only data that our chisels were sharp. Because sometimes there is no chisel.

David Reilly, consultant physician. 

Glasgow Homoeopathic Hospital, Glasgow G12 0XQ