Normality is a matter of perception. Place yourself in a different time and location and suddenly today’s common thoughts and activities may seem very odd. Change your philosophy, your religion (if you have one ) or even your sex and it is likely your daily motivations and objectives will also change. What we accept as normal practice is often a convergence of circumstance.
The biggest event to occur in the development of what we see as modern health care is in my opinion the discovery of penicillin. Could any of us imagine the time before its momentous introduction when the hand of fate was balanced solely upon our own physical capability to endure overwhelming bacterial infection and survive its onslaught. The doctors of a previous age would care for their patients with a range of now often discredited or forgotten practices that may or may not have benefited the eventual outcome. If a patient survived then the doctors care was surely influential if the patient died than it was the will of a power greater than us all.
Alexander Fleming
The introduction of penicillin was not an overnight event, it took over a decade from its accidental discovery by Alexander Fleming and the battlefields of the second world war for its therapeutic benefits to become widely recognised and accepted by the medical community. It saved tens of thousands of lives and continues to do so today.
The discovery of a single effective therapy for acute infection changed medical practice from that point onwards. New hope emerged that just maybe humankind could overcome age old ailments and health and longevity was within it’s grasp. Scientific research and an expanding knowledge in biochemistry fuelled the introduction of pharmacological medications. Medical practice now had researched and tested interventions for a broad range of common diagnosed conditions. We had entered a new medical age which linked the diagnosis of a condition with a named medication.
During a recent trip to the US, I sat on the edge of my hotel bed and flicked aimlessly through a hundred or more television stations. I found it hard not to notice the constant stream of adverts bestowing the benefits of this or that medication or as is the law in the US, the list of potential side effects they may cause. At the end of the ad it invited you to talk to your doctor about the benefits of this particular medication.
In the 80 or so years since the discovery of penicillin the pharmaceutical industry has become a global business employing hundreds of thousands of people. It spends billions of pounds each year on research and clinical testing for a broad range of medications targeting specific medical conditions. It is not uncommon for older US citizens today to be taking between 4 and 6 prescription medications, each one for a different diagnosis.
The options we have for our personal health care depends upon what is politically and socially accepted. The range of therapies or treatments provided in the UK are broadly overseen by the National Institute for Health and Care Excellence (NICE) www.nice.org.uk
and the Medical and Healthcare Products Regulatory Agency (MHRA) www.mhra.gov.uk.
NICE provides health care professionals with guidelines for the treatment of a significant number of named diagnosed conditions. The protocols are freely available on their website and detailed flow charts guide the physician through the maze of options finally resting upon a series of suggested treatment protocols. For this process to work effectively you must have a diagnosis else you fail to fit into the system.
The MHRA regulates all pharmacological and herbal medications in addition to an ever expanding backdrop of associated developments. It is responsible for monitoring the safety of any form of medication ensuring that quality of manufacture is maintained and monitors for the emergence of any new research or information that may alter prescribing procedures.
The combination of NICE, MHRA and accepted medical practice provides the framework in which the general public is treated for health concerns in the UK. Doctors have range of regulatory bodies overseeing and monitoring performance and efficacy, above this we have the Care Quality Commission (CQC) that seeks to maintain and improve patient care by ensuring procedural systems are efficient, mistakes are reported and patients are treated with respect.
The health care system has grown in line with the level of population and its demands. The system requires a diagnosis to act and once elicited through a range of investigative procedures an accepted protocol is prescribed. The protocol will most likely be the result of clinical testing on a large group of people and commonly consists of a singular medication, a magic bullet. The research group most likely will not have any other condition other than the one being treated.
In the search to replicate Alexander Fleming’s momentous magic bullet we now have a system that places the disease under the microscope in order to find more magic bullets. Give a name to a disparate group of symptoms and you have a diagnosis, develop a drug that suppresses these symptoms and you have a treatment, health must surely follow.
The major difference between an antibiotic and lets say a statin is that an antibiotic is targeting a specific bacterial organism that is overwhelming an immunological system, it is like sending in an extra army of troops to help us win a battle between life and death. The statin on the other hand is prescribed in response to an accepted level of total cholesterol being exceeded. High cholesterol is associated with cardio vascular disease (CVD) and lowering total cholesterol has been shown to reduced this risk. The statin targets the enzymatic pathway that leads to the synthesis of cholesterol, inhibit the pathway and you will in most cases lower total cholesterol.
From a Nutritional, Naturopathic and Functional Medicine perspective the first question I ask myself when seeing a client for the first time is, what is this persons true state of health. Health is not simply the absence of disease or a symptom, or a normal total cholesterol level, it is a vitality for life, mental clarity, being part of a community that provides support but which in turn you positively contribute to, it is about being connected, being caring and being cared for.
By giving a statin has the process of CVD been halted, slowed, diverted or reversed ? If we give a statin and the patient carries on exactly as before has the process truly been resolved ? Is the statin a magic bullet or simply a delaying tactic whilst other factors that were the real drivers for this condition carry on unabated. The largest growing health concern we face in the UK and the USA is chronic illness, in the UK it is now accepted that by the time we reach 70 we most likely will have 3 chronic illnesses.
Nutritional Therapy and Functional Medicine place the patient at the centre not the diagnosis. Rather than seek a diagnosis it looks for connections and interactions, we fit the protocol to the patient rather than the patient to the protocol. Magic bullets are few and far between and only through individualised protocols and patient involvement can we address chronic illness in the 21st century.
Simon Bradley
February 2014
