IT’S all rubbish!” cry the sceptics steeped in conventional medicine. Yet for all their clamour, it’s clear that complementary and alternative medicine (CAM) works, and can sometimes rid people of chronic disease. How do we bridge this gap? Do we continue to treat one branch of medicine as science and the other as magic? Perhaps there’s a third way.
Conventional medicine regards the body as a machine, like a jumbo jet or a computer. It assumes that the body becomes diseased in much the same way a machine breaks downwhen a specific part goes wrong.
CAM has a very different philosophy: the idea that the healthy body is a system in balance, and that disease can be created by a fault that is distributed over the whole body. Because this idea is so obviously at odds with convention, CAM has always appeared unscientific.
But the body is not just a machine, it is also a complex system. Complexity theory now shows us that the properties of some complex systemsnetworks, in particularcannot be attributed to individual components but emerge from the whole system. So why shouldn’t disease emerge from the body in a similar way? If so, conventional medicine will never be enough to cure all our ills. And the assumptions of CAM may not be as unscientific as they seem.
You can think of the body as a series of networks. Networks are systems that can do lots of things simultaneously, and the brain is one. Many of the intelligent features of the brain, such as perception, learning and problem solving, can be explained as emergent properties of the network. Other parts of the body, such as our hormones and immune system, are also networks.
And there’s no need to stop there. The whole body can be looked on as what I call the “extended network”. This is a self-regulating network that governs both the internal environment of an organism by controlling things such as temperature, glucose levels and so on, and the external environment, which the organism can influence by its behaviour.
If we think of the body on the one hand as a machine with parts, and on the other as a self-regulating network, then it’s not unreasonable to think there must be two different types of malfunction or “pathology”. There is the specific pathology familiar to conventional medicine, and another type of network pathology.
Specific pathologies generate consistent signs and symptoms. They can be measured physiologically and form the basis for conventional diagnosis. Network pathologies, on the other hand, can produce a variety of symptoms that prevent them from being detected by existing methods. Pathologies like this are errors in the relationship between parts throughout the system, rather than an error in any one part.
How do network pathologies arise? The answer requires one more assumption: that the extended network is not only self-regulating but also has the ability to learn to self-regulate more effectively. It is my hypothesis that the entire extended network of the body has evolved the capacity to learn and become more complex, forming an “intelligent body”.
Network pathologies arise when the body self-organises in response to some disturbance, but becomes confused and ends up worse at self-regulation than before. Some diseases, such as irritable bowel syndrome and chronic fatigue syndrome, are not associated with any consistent, measurable physiological abnormality. They are primarily network pathologies. There is clearly a failure of self-regulation, in which some parameter of a control system has been set wrong.
One implication of the intelligent body hypothesis is that the assumptions of conventional medicine and CAM are both correct. Specific pathology and network pathology tend to contribute to each other. Faulty regulation can lead to specific pathology and, conversely, specific pathology can contribute to network pathology.
Take asthma, for example, a disease in which the airways become inflamed because the immune system is prone to overactivity. The inflammation and overactive immune system constitute a specific pathology, but exactly why the immune system becomes overactive is not known. Many factors have been linked to asthma. Several genes, an excessively hygienic early environment and polluted air, among others, but how they interact to start the immune system misbehaving is still a mystery.
It’s not unreasonable to imagine that all these different causal factors are inputs to a network, and that they confuse it into thinking that its normal immune response is inadequate. In an effort to self-organise to get the right immune response, the network ends up in the overactive state that creates inflammation. It is rather like being in a thermostatically controlled room where somebody has left the window open, forcing the heating to run at full blast.
Many chronic diseases, including asthma, have proved hard to treat with conventional drugs. Inhaled steroids suppress the inflammation caused by asthma, but if you stop the steroids the inflammation returns. The drugs merely suppress the disease symptoms. On the other hand, treatment by a CAM practitioner can, for whatever reason, create much longer-term changes: it tends to cure rather than simply suppress, suggesting that CAM is working at a network level. CAM treatments don’t “make” a cure. Instead they disturb the system, giving it the opportunity to settle down in a new position. Where it settles down depends on other contextual factors inputting to the network. The implication, which hasn’t been tested, is that lifestyle is an essential factor in complementary medicine.
It would be a mistake to assume that conventional medicine treats only specific pathology and CAM treats only network pathology. Some conventional treatments work for reasons that are not understood: exercise therapy and relaxation for chronic fatigue syndrome and depression are examples. Equally, some CAM treatments involve herbs that have very specific effects.
Rather than distinguishing CAM from conventional medicine, it may be more helpful to distinguish between robust treatments that treat specific pathology and subtle treatments that treat network pathology. Robust treatments correct the “broken” parts of the machine. Subtle treatments teach the intelligent body, or at least help it to relearn so that it self-regulates more effectively. On the whole, CAM treatments are the subtle ones that nudge the body back into balance. Both types of treatment are needed.
But the intelligent body remains no more than a hypothesis, and I would like to see research that tested its predictions. In particular, we need to know more about interactions between different inputs, such as psychosocial and nutritional influences, lifestyle and genetics. In the main, research in conventional medicine does not look for these interactions. Just as physicists needed a new mindset to test quantum theory a century ago, so medical researchers may need to think again if the study of CAM is to develop as a true science.
Michael E. Hyland is Professor of Health Psychology at the University of Plymouth