Saturday, December 26, 2009

Meditative medicine: a new distinction

This article in the Hastings Center Report, “Toward a Meaningful Alternative Medicine” by Vinay Prasad, has shifted the way I think about “alternative medicine” and health care in general. He starts by sharing this quote by Phil Fontanarosa and George Lundberg which I instinctively agree with: “There is no alternative medicine… there is only scientifically proven, evidence-based medicine supported by solid data or unproven medicine, for which data is lacking.” Alternative medicine is often considered unscientific and faddish. But then why are so many people drawn to it? Is there more besides “evidence-based medicine” that we are missing? Is health care more than “an unrelenting devotion to outcomes”?

Prasad suggests we think about meditative medicine in parallel with our evidence-based framework. He refers to German philosopher Heidegger’s work contrasting poetry and technology as differing ways of making sense of the world. Technology represents “calculative thinking,” using objects to achieve a purpose. Poetry and art represents “meditative thinking,” reflecting on the beauty inherent in how things are. Both ways of thinking are important. Heidegger was concerned that “the approaching tide of technological revolution in the atomic age could so captivate, bewitch, dazzle, and beguile man that calculative thinking may someday come to be accepted and practiced as the only way of thinking.”

Prasad then applies this to medicine: 
“The worry, if one takes Heidegger’s perspective, is not that health is an outcome to be optimized by cost-effective, evidence-based medicine, but that this might be the only way of thinking about health – that no alternative exists. Unfortunately, practitioners do little to provide a true alternative when they use complementary medicine in purely calculative terms: sometimes but not always relying on randomized controlled trial data, and sometimes but not always trusting anecdotal evidence. Heidegger teaches us that ‘Western’ and ‘alternative’ are not meaningful categories. A better distinction is ‘calculative’ and ‘meditative.’ And what we need is meditative medicine.”
 The point is: we can’t think of all alternative medicine in terms of the evidence-based model, just like we can’t think about art and poetry like we do technology. So, the distinction is as follows:

Calculative medicine: A medical intervention (can be ‘Eastern’ or ‘Western,’ unconventional or mainstream) that is aimed at producing an outcome (such as reduced cancer recurrence, longevity, reduced menopausal symptoms, etc.) that can be studied with evidence-based methodology. Examples of calculative medicine include giving a statin to lower cholesterol, yoga for blood pressure control, or acupuncture for pain control.

Meditative medicine: Meditative medicine includes practices (exercise, eating healthy, meditation, etc) which “are done not with a particular outcome in mind, but as part of living a healthy life… they provide a way of making sense of health, illness, and the good life. Becoming vegetarian because you wish to lower your LDL is calculative. Does it work? A well-designed trial could tell us, but it would miss the point.” Meditative medicine also applies to the patient-doctor relationship: “Allowing doctors to develop relationships with patients beyond what is necessary for good primary care is meditative.”

As Prasad explains:
“Some people exercise because studies have shown a correlation between twenty minutes of aerobic activity and longevity (a calculative view), while others do so because an active life is healthy (a meditative view). Some drink a glass of wine each night because it has been shown to decrease cardiovascular risk (calculative), while others never needed that study to know that drinking wine in moderation, as part of a broader set of practices, is healthy (meditative).”
Meditative medicine is why I’m a vegetarian, why I exercise, why I do yoga... not for a specific outcome that can be studied with randomized controlled trials, but because it feels right and is part of a healthy, balanced lifestyle. It is also why I want to do family medicine and provide both calculative and meditative health care. So much of healing and health is in the patient-doctor relationship, and that is not something that can be measured with RCTs. 

1 comment:

  1. Tina, I love this article and distinction. I'm going to share it w/ my students.