Medicine for the third millennium: an historical perspective.

A funny thing happened on the way to the new millennium: the practice of medicine became lost. Science made the trip, and so did the physicians themselves, with their instruments, hospitals, clinics, as well as regulations, insurance companies, HMOs, and of course drugs and pharmaceutical companies. Am I saying that most medical practices do not practice medicine? Well, not exactly.

By the turn of the Nineteenth Century, medicine was an art striving to become more scientific. At that time, a major medical subject was Materia Medica, a ponderous list of natural products, herbs, and simple chemicals. Most were available as powders, liquids and mixtures. In order to use these materials, the physician had to titrate (adjust) the dose for the patient and observe responses. Because so little knowledge existed as to the causes of disease, medicine was mostly an art. Through physician experience and careful observation, a patient's condition was (hopefully, but not always) maintained in such a state that he could function while the disease ran its course. This was either to remission or death. The physician had to know the Individual patient in order to treat him. Much of this medicine was holistic and natural.

This knowing and treating the individual patient continued through the middle of the Twentieth Century. Materia Medica gave way to science and became pharmacology. It was replaced with an armamentarium of new chemical entities we call drugs, specific man-made molecules with very specific strong activities. Some call this hard or harsh medicine. Standard dosages, rather than titration, became the norm. Forgotten was the need to titrate the patient and understand the whole patient. Technical knowledge became so massive that no one physician could begin to know the whole subject, so medicine gave way to specialization and group practice. Science revealed the causes of disease and doctors began treating specific diseases instead of designing their treatments for individual patients. This new medicine has greatly improved the lives of the population in developed countries (and greatly improved the profits of the pharmaceutical suppliers).

But when this new medicine was combined with the economic reality of the late Twentieth Century--of insurance, HMOs, regulations, the need to help too many patients in too short a time (and most critically, lawsuits)--the practice of medicine as an art was lost. Indeed, many feel that the practice of medicine itself has gone, replaced with use of drugs and treatments that are standardized for insurance needs, legal protection, and to appease an ever-expanding population. Symptoms are often treated at the expense of defining the underlying cause of the disease. Patients 'by the number' are treated rather than the individual patient. It is ironic that with the advances of medicine as a science, many feel the practice of medicine has actually declined. Where is medicine going? Look no further than the number of natural product supplement and biotechnology companies. On the surface, biotechnology and natural products seem to be at opposite poles. However, they can be seen as opposite sides of the same coin. Natural products are mild medicines, and use non-synthetic agents to work with the body chemistry to reach a desired end. Biotechnology seeks to make natural body chemicals (usually peptides) to reach this same end. Most proponents in each camp will deny their commonality. Today, there are many new biologicals (drugs derived from human source, as cytokines, interferons, hormones, etc.), highly refined and often pure. Unfortunately, these powerful new products are being used as if they were chemicals, in the same old chemical treatment regimens. We have entered the new century with so much specific knowledge about the human body, but with so little wisdom ms to how to put this information together in order to treat the whole patient.

The field of science which drives much of biotechnology is immunology. A vast number of natural products and therapies actively modify or stimulate immune function. Only in the last fifty years have we come to know that much of disease has a common denominator, failure of immune function. Indeed, many diseases are really symptoms of a non-functioning immune system. Personally, I believe that cancer and other chronic diseases cannot exist in the presence of an intact immune system. These diseases are allowed to progress because the immune system has been compromised. They ultimately succeed by overwhelming immune function. The fact that cancer responds to alternative treatments is explained by the many natural treatments which modify or restore immune function.

The immune system has many functions only recently recognized and whose importance is still not universally accepted. It has a protective function against the enemy from without--bacteria, fungi and viruses--but also the more dangerous enemy within: cancer cells, which are body cells that do not follow the rules. The body is a complex mass of different cells with specific functions. Each cell must be subordinated to the needs of the whole body and follow the control commands of other body mechanisms, and this may include the cell's death in the process. When cells are produced that do not respond to these higher commands, they must be eliminated, a function of the immune system. The immune system is the quality control department of the body. The immune system is subject to many demands which may tax its ability to respond to all needs equally. It may be impaired by exogenous agents, environmental toxins, and carelessly ingested processed foods, etc. When out of control cells are not eliminated in their early stages, they become established as a new entity in the body, at constant war with the immune system. This war may go on for several years, and only when the war is lost is a cancer detected.

Other failures of the immune system lead to other diseases: overreactions (allergies); attacks against healthy cells leading to the autoimmune diseases, as rheumatoid arthritis, diabetes, etc. Many natural medicines modulate the immune system, stimulate generally or only a particular function, occasionally inhibit. Many aspects of aging are slow-programmed immune failure, a condition which can be countered in part with natural products. The natural medicines are most effective for prevention and less so as therapeutics. But they do play a role as components in a therapeutic protocol when combined with some conventional medicine. We call this integrative medicine. There are combinations that restore immune function which allow other treatments to be more effective.

Because immunology has been slow to fully develop, much of conventional medicine has ignored its recent accomplishments and prefers not to learn a new discipline. This issue, combined with the cookbook therapy now so commonly accepted by modern medicine, leaves many patients adrift. Failures in therapy lead them to seek their own remedies.

No one decries this loss of ability to practice medicine more than the patients; they are coming to understand that something of real value has been lost. They are searching for this lost art of medical practice. They are searching on the internet. They are searching in publications such as the one you are reading. They do not trust that the physicians will be allowed to treat them. They are finding that an important part of good health is first avoiding becoming ill by changing diet and lifestyle, by utilizing natural supplements and mind-body spirit training. When ill, they seek more natural courses of treatment such as acupuncture, lymphatic massage, and other physical arts, combined with natural and herbal products. Those few physicians who with open minds survey the old medicine with its natural products and combine some of those agents with the rational use of conventional medicine are redefining medicine.

Medicine should be a holistic approach looking to all possible therapies and seeking to define a treatment protocol using what is deemed best for the individual patient. It may take many years for this integrative medicine to be recognized as the true medicine of the third millennium, but it will occur. Patients will not give up the internet and the publications that empower them. They will not go back to the problems of the past.

Richard Kinsolving, PhD is an immunopharmacologist with many years in drug discovery and research on the immunology of cancer. He is research and technical consultant to Immune Recovery Clinic in Atlanta, Georgia.