Suggested Citation: Garko, Michael (2018, June). Comparing and contrasting medical paradigms. Retrieved from www.letstaknutrition.com.
Comparing and Contrasting Medical Paradigms
Dr. Michael Garko, Ph.D.
Host & Producer Let’s Talk Nutrition – Health Talk Radio for the 21st Century
A considerable amount of conceptual confusion spawned by misunderstanding, misrepresentations and misapplications characterizes discussions on medical paradigms found in the literature (i.e., allopathic medicine, functional medicine, holistic medicine, integrative medicine, naturopathic medicine, osteopathic medicine, regenerative medicine and western medicine).
The purpose of this June, 2018, edition of Health & Wellness Monthly brief is to describe the primary medical paradigms identifying their major features and goals and along the way compare and contrast them, mention how they may overlap and note if nutrition is included with each paradigm. Finally, attention will be given to whether the described paradigms can or should work together or otherwise be integrated, with a particular focus on nutrition and how it can enhance the different paradigms.
Allopathic medicine refers to what is termed traditional, conventional or Western medicine. It is frequently contrasted with complimentary or alternative approaches to medicine (see National Center for Complementary and Integrative Health, 2017). Allopathic medicine is an approach whereby medical doctors and other conventionally-oriented healthcare professionals (e.g., nurses, pharmacists, therapists, technicians) rely upon drugs, surgery, various diagnostic tests and procedures and therapies (e.g., chemotherapy, radiation, physical therapy, psychotherapy), among other methods, procedures and practices to diagnose, treat and ideally cure disease, relying on medical technology, scientific research (e.g., randomized clinical trials) and research based practice. Compared to the methods, procedures and practices of other medical paradigms (e.g., naturopathy & functional medicine), nutrition is not a hallmark of conventional medicine, while prescription drugs are (see National Cancer Institute, n.d.; National Center for Complementary and Integrative Health, 2017).
Functional medicine is a clinical operational system emphasizing the causes of disease from a patient-centered systems biology perspective, which brings the patient and practitioner together in a therapeutic relationship (Bland, 2015). It dovetails with integrative medicine, an evidence-based approach focusing on the whole person and using dietary-nutritional and lifestyle therapies (Bland, 2017). With functional medicine, there is less focus on dysfunction/disease (the endpoint) and more attention on the underlying causes of disease. It treats the whole person and seeks to restore homeostasis by taking into account how the interconnectedness of the body’s systems and creating and implementing a personalized therapeutic program to address the patient’s functional needs (Bland, 2017). Functional medicine integrates conventional treatment methods with complementary, genetic, holistic, and nutritional therapies (Richer, 2017). Hence, it includes the use of “acupuncture, Ayurveda, chiropractic manipulation, detoxification programs, herbal and homeopathic supplements, specialized diets, massage, meditation and mindfulness practices, neurobiofeedback, nutritional supplements, t’ai chi, and yoga” (Richer, 2017, p. 206).
Rather than a defined set of medical techniques, holistic medicine is more of a perspective on addressing the psychological, familial, societal, ethical, spiritual and biological dimensions of a person’s health and wellness. It integrate Western and alternative approaches, while celebrating the patient’s uniqueness, mind, body and spirit, promoting the mutuality of the doctor-patient relationship, encouraging people to take responsibility their health and encouraging the use of complementary and alternative therapies (e.g., acupuncture, chiropractic care, homeopathy, massage therapy, naturopathy), along with diet and nutrition, exercise, psychotherapy, relationship and spiritual counseling and even medications and surgical procedures (see Gordon, 1982). Taken together, these principles represent the cornerstone of holistic medicine and become integrated into other medical paradigms (e.g., naturopathic medicine).
Integrative medicine (IM) combines/integrates conventional medicine with complementary and alternative (CAM) therapies, with the former working together with conventional medicine and the latter used instead of conventional therapies (National Center for Complementary and Integrative Health, 2016). CAM represents all that is outside of conventional or Western medicine. IM employs CAM therapies and modalities supported by evidence of safety and efficacy in conjunction with conventional medicine (Petri, 2015). IM is patient-centered, placing responsibility for health and healing on patients and healthcare providers but with patients assuming the lead role. It is also evidence-based in terms of the integration of conventional, complementary and alternative therapies (see National Center for Complementary and Integrative Health, 2016; Petri, 2015). Nutrition is an important part of IM. The American Board of Physician Specialists is illustrative of the importance attributed to nutrition in the care of patients (see American Board of Physician Specialists, 2018)
Naturopathic medicine is often described as an art, science, philosophy and the practice of medicine focusing on prevention, treatment and attaining optimal health using therapeutic methods and substances that promote self-healing (e.g., see American Association of Naturopathic Physicians, n.d.). The following principles represent the foundation of how naturopathic medicine should be practiced:
- The Healing Power of Nature (Vis Medicatrix Naturae) – The body has the inherent ability to heal itself. Identify
- Treat the Causes (Tolle Causam) – Focus on the underlying cause(s) of illness rather than managing symptoms.
- First Do No Harm (Primum Non Nocere):Accomplished by 1. Using methods and medicinal substances that reduce risk of harmful side effects and employ the least force when diagnosing and treating the patient, 2. avoiding the suppression of symptoms and focusing on the self-healing process.
- Doctor as Teacher (Docere):The goal is t educate patients and encourage self-responsibility for health.
- Treat the Whole Person:Focus on and recognize the physical, mental, emotional, genetic, environmental, social, spiritual factors when treating patients.
- Prevention:Prevention of disease is a first principle (see American Association of Naturopathic Physicians, n.d.).
Naturopathic medicine embraces the use of conventional and natural diagnostic and therapeutic methods and therapies such as “clinical and laboratory diagnostic testing, nutritional medicine, botanical medicine, naturopathic physical medicine (including naturopathic manipulative therapy), public health measures, hygiene, counseling, minor surgery, homeopathy, acupuncture, prescription medication, intravenous and injection therapy, and naturopathic obstetrics (natural childbirth)” (American Association of Naturopathic Physicians, n.d. p. 1).
Osteopathic medicine is not all that different from the principles and practices of allopathic medicine in that relies upon prescription drugs, surgery and medical technology in diagnosing and treating patients. However, it also employs the use of what is referred to as hands-on diagnosis and treatment by osteopathic manipulative medicine. Osteopathic medicine emphasizes helping each person achieve a high level of wellness by focusing on health promotion and disease prevention.
The goal of regenerative medicine is to create living, functional tissue with the purpose of repairing or replacing tissue or organ function caused by aging, disease, damage or congenital-associated defects in a p (National Institutes of Health, 2010).
The differences between and among the medical paradigms discussed above should not serve as an impediment to integrate the strengths and uniqueness of one paradigm with another. For example, it would serve allopathic medicine well to adopt some of the principles, practices and therapies of functional medicine, integrative medicine and naturopathic medicine so as to introduce more CAM therapies into the day-to-day practice of medicine. Doing so would give allopathic physicians more degrees of medical freedom in diagnosing and treating patients and perhaps even improving the prognosis of their patients and not being so reliant on prescription drugs. Conversely, some of the less conventional medical approaches would do well to adopt some of the proven medical technologies and practices of the allopathic medical tradition, which some do (e.g., integrative medicine, naturopathic medicine, holistic medicine). The medical paradigms discussed above, except for osteopathic and regenerative medicine embrace and integrate nutrition into their approach. Nutrition plays a vital and proven role in the practice of medicine no matter from which perspective it may be approached. Diet and nutrition taken together are among the most important first principles in medicine or at least they should be so considered. In that regard, nutrition is a first line therapy some alternative therapy. Somehow along the way, nutrition became relegated to an alternative or complimentary therapy. Perhaps it should be the other way around and other therapies should be considered alternative or complimentary to nutrition.
American Association of Colleges of Colleges of Osteopathic Medicine (2018). What is osteopalthic medicine? Retrieved from (https://www.aacom.org/become-a-doctor/about-om.
American Association of Naturopathic Physicians (n.d.) Definition of naturopathic medicine. Retrieved from https://www.naturopathic.org/content.asp?contentid=59.
American Board of Physician Specialists (2018). Integrative medicine: Better health through individualized nutrition. Retrieved from https://www.abpsus.org/integrative-medicine-nutrition
Bland, J. (2015, October). Functional medicine: An operating System for integrative medicine. Integrative Medicine, 14, No. 5 • October 2015
Gordon JS: Holistic medicine: Advances and shortcomings (Special Essay). Western J Med 1982 Jun; 136:546- 551
National Center for Complementary and Integrative Health (2016). Complimentary, alternative, or integrative health: What’s in a name? Retrieved from https://nccih.nih.gov/health/integrative-health.
National Institute of Health (2010). Regenerative medicine fact sheet. Retrieved from https://report.nih.gov/nihfactsheets/ViewFactSheet.aspx?csid=62.
Osher Center for Integrative Health and Medicine (n.d.). What is integrative medicine and health? Retrieved from https://www.osher.ucsf.edu/about-us/what-is-integrative-medicine/.
Petri, R. (2015). Integrative health and healing as the new health care paradigm for the military. Medical Acupuncture, 27(5), 301-308.
Richer, A.C. (2017, August). Functional medicine approach to traumatic brain injury Medical Acupuncture, 29(4): 206–214.