鈥淚T鈥橲 all rubbish!鈥� cry the sceptics steeped in conventional medicine. Yet
for all their clamour, it鈥檚 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鈥檚 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 down鈥攚hen 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.
Advertisement
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 systems鈥攏etworks,
in particular鈥攃annot be attributed to individual components but emerge
from the whole system. So why shouldn鈥檛 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鈥檚 no need to stop there. The whole body can be looked on as what I
call the 鈥渆xtended network鈥�. This is a self-regulating network that governs both
the internal environment of an organism鈥攂y controlling things such as
temperature, glucose levels and so on鈥攁nd 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鈥檚 not unreasonable to think there
must be two different types of malfunction or 鈥減athology鈥�. There is the specific
pathology familiar to conventional medicine, and another type鈥攏etwork
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 鈥渋ntelligent body鈥�.
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.
Going haywire
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鈥攕everal genes, an excessively hygienic early environment and
polluted air, among others鈥攂ut how they interact to start the immune
system misbehaving is still a mystery.
It鈥檚 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鈥攆or whatever reason鈥攃reate much longer-term changes: it tends to
cure rather than simply suppress, suggesting that CAM is working at a network
level. CAM treatments don鈥檛 鈥渕ake鈥� 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鈥檛 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 鈥渂roken鈥� 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.