Holistic Healthcare and Precision Medicine
Natural/holistic/functional/alternative medicine is rooted in nonmaleficence, prevention, and the empowerment of the patient to become an active participant in his or her health. Its guiding principles recognize the wholeness of each patient and consider the intersection of multiple physiological and psychological bodily systems interacting through a variety of intricate mechanisms to produce nuanced symptoms. In today’s healthcare system, multi-faceted illnesses are often given a diagnosis that does not fully encompass the patient’s distinct symptoms and experiences. Reducing an individual’s unique experiences and complex symptoms to an inaccurate label can be invalidating; it can harm the psychological wellbeing of the patient, disturb the valuable physician-patient relationship, affect response to treatment (by affecting the psychosocial and therapeutic context of the placebo effect), and increase the incidence of polypharmacy. A large quantity of emerging research demonstrates how emotional states can drive physiological responses (i.e. Dr. Melanie Maya Kaelberer’s research on the efferent synapse in neuropod cells and the excitability of gut endothelial cells). Physiology follows psychology, and this is what makes compassion and empathy essential components of the healthcare system. By acknowledging each patient’s distinct pathophysiology, healthcare providers can pave the way for precision medicine (personalized medicine) that harnesses the power of the placebo effect to increase response to treatment, relief, and healing.
Defining Alternative Medicine
Alternative medicine has come to encompass a wide range of healing modalities, some of which are supported by thorough research and others which are not. It is unfortunate that, due to the stigmatization of alternative medicine and the fear of any form of spirituality mixing with science, it is up to the patient to discern which forms of alternative medicine are scientifically-supported. Having an accredited field of naturopathic medicine (as North America does) helps patients distinguish efficacious alternative treatments from illegitimate claims. However, the placebo effect can induce relief with both efficacious and “fake” treatments.¹ A biological response to a treatment is affected by the therapeutic context in which it was given, and whether relief is due to psychological mechanisms of expectation or the treatment itself can be debated in regards to all categories of treatments (pharmaceuticals, homeopathic supplements, etc.).² Nonetheless, prioritizing nonmaleficence (the first guiding principle of medicine) protects patients from negative treatment-induced biological effects, regardless of psychologically-perceived benefits of such treatments.
The Power of the Placebo Effect
Despite the fact that psychological mechanisms of expectation underly the placebo effect, the effect itself can be neurobiological and physiological. In response to a placebo, the brain can produce endogenous opioids, creating an analgesic effect.² If an opioid is administered without the patient knowing, there is a lessened report in pain reduction.² Because the psychosocial context of a treatment alters the response to it, one can imagine how important the physician-patient relationship is, as well as bedside manners, compassion, and empathy. A large appeal of holistic care is the increased patient-contact time: the initial appointment alone can be up to two hours long.
The Reduction of Polypharmacy
The placebo effect is evidence that psychology, which can be adjusted, affects physiology, and that the body is not only capable of healing itself, but wants to heal itself. A physicians’ goal should be to stimulate the body to heal itself before resorting to pharmaceuticals to suppress symptoms. This can reduce, or even eradicate, the incidence of polypharmacy. Polypharmacy is often the result of reductionist prescriptions that do not account for a patient’s complete medical history, as the side effects of one drug require a patient to be prescribed yet another drug, creating a domino effect of negative symptoms that can all be traced back to a root cause. All drugs have side effects, as they affect multiple molecular targets and pathways in the body. For example, NSAIDs are non-selective COX inhibitors, which means they inhibit both COX-1 and COX-2.³ Prostaglandins that cause inflammation, as well as those that maintain the stomach mucosa and gastric function, are blocked, one leading to pain-relief and anti-inflammatory effects, the other increasing the likelihood of indigestion and stomach ulcers.³ Each individual has biological differences that affect his or response to a drug, and naturopathic physicians aim to consider this when prescribing treatment plans.
Precision Medicine & Preventative Care
Individuals differ greatly in their medical needs (psychologically and physiologically). Precision (personalized) medicine is needed to account for these invariable differences between patients. Precision medicine should be the standard of care in all healthcare settings. Increasing patient-contact time, broadening baseline testing, and treating the patient as a whole (not as a set of symptoms) are strategies, amongst others, by which physicians can prioritize personalized and preventative care.
References
Kaptchuk TJ, Miller FG. Placebo effects in medicine. N Engl J Med [Internet]. 2015;373(1):8–9. Available from: http://dx.doi.org/10.1056/NEJMp1504023
Finniss DG, Kaptchuk TJ, Miller F, Benedetti F. Biological, clinical, and ethical advances of placebo effects. Lancet [Internet]. 2010;375(9715):686–95. Available from: https://www.sciencedirect.com/science/article/pii/S0140673609617062
Hawkey CJ. COX-1 and COX-2 inhibitors. Best Pract Res Clin Gastroenterol [Internet]. 2001 [cited 2023 Feb 7];15(5):801–20. Available from: https://pubmed.ncbi.nlm.nih.gov/11566042/