Medicine, Systems Thinking, and Alzheimer’s

Medicine, Systems Thinking, and Alzheimer’s

I recently listened to this podcast (click the title for the link, look for episode 68) in the hopes of gaining some insight into Alzheimer’s. While it was worthwhile for that purpose alone, a larger surprise came my way. Dr. Peter Whitehouse gives a compelling view of medicine as systemic. While he never mentions Bowen theory by name, he does name several important insights that systems thinking  echoes.

Dr. Whitehouse, for example, says that genes are not determinative for one’s health. Genes simply don’t work that way. Rather, genes provide potential, but still need to become activated in order to manifest disease. In the case of Alzheimer’s, not everyone who has a genetic predisposition towards AD will manifest the disease. What does this mean? Whitehouse wants to ask larger questions about how we can live a life that would mitigate memory loss, and manage it as it inevitably happens if we live long enough. This idea isn’t meant to blame someone for manifesting AD. It’s simply meant to say that we can look at AD, and, I think, any disease, as a part of the interplay of many variables. What Whitehouse wants to avoid is the linear thinking of health–>cause–>disease–>cure–>health. He is focused on managing health, and the many factors within and outside of a body that either promote health or enable disease. He vehemently rejects the idea that the practice of medicine should be focused on treating disease. This focus on health certainly resonates with Bowen theory’s idea that symptom development is a function of the anxiety of generations and not solely seated in the individual.

Dr. Whitehouse has some interesting ideas on the (de) personalization of medicine. Genetics, for Whitehouse, has elements of being a golden calf. The genetic marker is an idol, partly for reasons mentioned above, and partly because a focusing on the gene leads the clinician away from the person. The classic practice of medicine involves taking a history, learning the narrative of a human being. Or, in other words, a physician needs to learn about the systems in which a patient lives. Some current thinking on genetics talks about personalized medicine based on a patient’s specific genome sequence. But, without the history, without the narrative, this view really treats us all as robots based on our programming and profoundly depersonalizes medicine.

Finally, Whitehouse has some pointed things to say to a culture that thinks, if we can just throw enough money and research we can solve the problem. Adopting a more humble stance at the limits of science, Whitehouse thinks that more effort should be put on our adaptation to living with the reality of disease. Our species will never evolve morally or biologically if we simply think that life is something to be fixed rather than lived. Whitehouse strikes me as one who, to borrow from Edwin Friedman’s view of data collection as an addiction, is seeking sobriety.

So listen to this podcast and see what you think.

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