Back in 1977, the eminent American psychiatrist Dr George Engel published a paper asserting that the prevailing biomedical model – built on a foundation of molecular biology – was inadequate to deal with many of the diseases of the time.1
That model, he claimed, would encourage ‘fixes’ that involved putting new molecules into the body in an effort to quell symptoms of disease, but couldn’t cure it.
Criticism of this type is heard much more often these days, but when Dr Engel issued his warning, there were very few prepared to put their heads above the parapet. Ivan Illich had broken the ice just a few years earlier with his controversial 1974 book Medical Nemesis: The Expropriation of Health, in which he claimed “the medical establishment has become a major threat to health.”
Engel’s central concern was that the biomedical model didn’t take into account incredibly important factors that have a major influence over our health, including the fact that disease often has behavioral, psychological and social (inter-personal) origins.
He also was highly critical of the reductionistic principle that underpins biomedicine – that all disease can be explained using the language of physics and chemistry.
This meant that the mind-body connection so revered by many traditional systems of medicine for millennia was now irrelevant. What was previously seen as a single, holistic system that might even encompass spirituality (mind-body-spirit) had been broken down to a dualistic model in which mind and body were entirely disconnected, and cultural and environmental influences were cast aside.
Dr Engel’s solution to the biomedicine dogma was to propose a new model of medicine, the biopsychosocial model. Although Engel’s ideas were not widely appreciated during his lifetime (he died in 1999), today there’s more than a hint of interest.
This interest is arising from need, after decades of failure – as was already evident in the 1970s when Engel described it. Good ideas will always manifest when the time is right, and that time has come.
But let’s not get too excited. Even though there’s interest, turning a supertanker isn’t something you can do quickly. Especially not when there’s still a very hefty group of pharmaceutical interests crowded inside the supertanker’s bridge, their hands firmly on the wheel, trying their hardest to prevent it changing direction.
Decades on, we still have eminent doctors telling us the biomedical model is broken. Take physician and former editor of the New England Journal of Medicine, Dr Marcia Angell, and her revelations in her 2004 book The Truth about the Drug Companies: How They Deceive Us and What to Do about It (Random House) or Cochrane Collaboration cofounder Dr Peter’s G¿tzsche’s powerful 2013 expos Deadly Medicines and Organised Crime (Routledge).
Dr James Le Fanu’s Too Many Pills: How Too Much Medicine is Endangering Our Health and What We Can Do About It (Little, Brown, 2018) and Dr Seamus O’Mahony’s Can Medicine Be Cured? The Corruption of a Profession (Apollo, 2019) have recently joined the chorus.
We’re surrounded by evidence that the biomedical system is broken, if we choose to look for it, yet this system remains the primary way people seek treatment for disease. There are millions of incredibly well-meaning professionals working inside of it – my son, a surgeon with the UK’s National Health Service, is one of them.
But younger doctors simply cannot afford to rock the boat – they get removed from the system and lose their livelihoods if they do. That’s why the whistleblowers tend to be senior doctors and scientists, at the tail end of their careers, with nothing to lose by speaking out.
It isn’t enough to imagine that a new model will emerge when the old one is shown to be broken. We might take this approach when our cars or laptops are beyond repair, but we don’t when it comes to healthcare systems.
There are simply too many people – plus corporations and governments – who benefit from the broken model. These interests work very hard to maintain the illusion of the system’s effectiveness, but it is nothing more than an illusion.
That’s why we at the Alliance for Natural Health hold the view that it’s the people’s responsibility to create a new, holistic model, building on what Dr Engel and many others since have proposed: a crowd-sponsored, sustainable, collaborative and community-based model, built on ecological foundations.
We must build it at sufficient scale to evaluate it rigorously. That’s what the ANH sustainable health blueprint project is all about (see my column in the March issue of WDDTY).
As Engel made so clear, our interactions with the outside world, as well as our behaviors within the context of life’s demands, expectations and culture, are at least as important as the state of biochemistry going on inside our bodies.
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