© 1999 Robert A. Freitas Jr. All Rights Reserved.

Robert A. Freitas Jr., Nanomedicine, Volume I: Basic Capabilities, Landes Bioscience, Georgetown, TX, 1999

1.2.4.1 Specialization and Holistic Medicine

Holism is a philosophy which holds that individuals function as complete units that cannot be reduced merely to the sum of their parts.²²²³ It is unarguable that a simplistic reductionist view of the patient which ignores the complex interactions among the many cells, tissues, organs, and systems constituting the human body is deeply flawed. For example, an understanding of the molecular basis of the contractile proteins of heart muscle will not alone tell us how heart muscle cells will look or act; knowing only about the parts of something is not sufficient to predict the behavior of the whole.²²³⁹ However, traditional concepts of holistic medicine go well beyond such basic systems philosophy -- incorporating requirements for a consideration of all physical, emotional, social, spiritual, environmental and economic needs of the patient.

N. Jewson²²⁰³ and others²²⁰⁵ have decried the modern shift away from holistic medicine, which is asserted to have taken place in three historical phases in the West. The initial phase is identified as the practice of "bedside medicine," where wealthy fee-paying clients in the 17th and 18th centuries helped shape their own diagnosis and treatment by medical practitioners in an holistic manner. Aspects of the patient's emotional and spiritual life were seen as central by the practitioner in making a diagnosis, since most physical treatments were only palliative and so the doctor had to focus on nonphysical supportive measures. This frame of reference was progressively replaced during the 19th century with the trend toward "hospital medicine," wherein physicians concentrated on generic classifications of diseases that were manifested in the patient, moving doctors away from the earlier focus on the individual as a whole person. The 20th century saw the development of "laboratory medicine," which moved diagnosis and therapy even further away from the whole patient, "who came to be medically conceived as little more than a depersonalized object, comprised of a complex of cells."

A more charitable view is that physicians have increasingly specialized in treating those physical diseases for which effective treatments may be readily specified, leaving nonphysical and nontreatable issues for psychiatrists, social workers, fitness coaches, priests, lawyers, or other professionals to deal with. In the 21st century this operational specialization may become complete, since nanomedicine phenomenologically regards the human body as an intricately structured machine with trillions of complex interacting parts, with each part (and each subsystem of parts) subject to individual scrutiny, repair, and possibly replacement by artificial technological means. In this new medical cosmology, the concept of the whole patient almost completely dissolves into a data-intensive whirlwind of molecular detail at the cellular, tissue, organ, and systemic levels.

And yet, as in a bygone era, patients once again will help to shape their own diagnosis and treatment at the hands of medical practitioners who begin to apply the volitional normative model of disease (Section 1.2.2) in their practices. This may breathe new life into the age-old medical school dictum to "treat the patient as a person" and to "focus on the sick person" rather than exclusively on the body.²²³⁰

The availability of extremely powerful and transforming molecular technologies also argues for a return to the romantic and perhaps quaint concept of a single doctor taking care of a single patient. The potential for interactions among highly potent nanorobotic instrumentalities argues for diagnostic and therapeutic "gatekeeping" by a single trusted practitioner in whom strategic treatment responsibility is vested -- in partnership, of course, with the patient.

Last updated on 5 February 2003