Dementia - Narrow Perspectives Lead to Poor Outcomes

"Doing the same thing over and over again, but expecting different results" - that was Einstein's definition of insanity. But look around you and reflect on how often we find this madness? Why is that we have such a habit of doing the same thing over and over again, even when we keep getting poor outcomes?

"Doing the same thing over and over again, but expecting different results" - that was Einstein's definition of insanity. But look around you and reflect on how often we find this madness? Why is that we have such a habit of doing the same thing over and over again, even when we keep getting poor outcomes?

Poor outcomes are rarely more striking in the modern world than in our treatment of chronic inflammatory diseases like diabetes, arthritis, auto-immune disorders and dementia. Despite the best efforts of contemporary medical science they continue to increase at such a dramatic rate that they threaten to potentially bankrupt our entire public health system.

Having worked in the NHS, dealing with dementia sufferers for the past decade, I'm starkly aware of the need for some fresh thinking. As our population ages, and these diseases continue to boom, we must avoid the fate of the Titanic and change course whilst we still can.

But how? Is there a sane approach?

In my experience, one key to solving any problem lies in the perspective from which we approach it. A lens formed from a cocktail of prior assumptions, inherited beliefs and old habits, we each peer out at the world through the spectacles of our personal perspective. After long enough, our world-views become our very identity - informing every breath, and assuming an air of inevitable, intractable, infinite correctness. We tend to forget that we can actually change the angle from which we are looking at things...

For me, wrestling with the ineptitude of modern medicine when it comes to treating these prevalent diseases, I came to think it was highly unlikely that the answers lay in this or that as yet undiscovered magic pill.

Could it be that changing perspective on the problem gets us further? There is a narrowness, and therefore inevitable limitations to our linear classical western medical system. There might be sanity in a more holistic perspective on disease.

My learnt habits, and an ordinary modern medical perspective, teaches me to look for cause and effect in patients. Or to hunt for pre-defined disease in discreet parts of the body. Flipping perspective, and looking at the whole body as an interrelated organism or ecosystem, the diagnostic focus changes a surprising amount. Suddenly there is sense in the fact that chronic inflammatory diseases are often caused in one system (e.g. the digestive system), yet seen and experienced in another (e.g. the cardiovascular system). Where there was a drive towards patching up or removing an ineffective body part, there begins to be a new possibility when understanding and treating the dysfunctional communication between systems.

Let me give you an example. Despite decades of research, no disease modifying treatment has been found for dementia. The truth is that the near future doesn't look very hopeful either. Presented with a complex condition that challenges our conventional perspective of disease and medical treatment - what do we do about that impasse? Keep trying the same failing approaches over and over again? Or put our minds together to collectively discern alternative possible perspectives?

Evidence shows that it may be early causative factors that start the process of developing dementia, up to 25 years before a patient presents with symptoms. For example a longstanding imbalance of the microbial population in the gut (our digestive system) can lead to low energy and hormonal imbalance (our endocrine system) which in turn affects mood (our nervous system). Combined with other factors (i.e overload of toxins, emotional stress, lack of exercise or social isolation), this can form a chain of reactions and possibly, 25 years later, we find dementia.

According to Craig Ritchie, Professor of the Psychiatry of Ageing at the University of Edinburgh, interventions that can possibly moderate risks of developing the condition are likely to be multi-level, non-pharmacological and proactive (rather than linear, drug based and reactive). When he says "a purely reactionary system of medicine in the case of dementia reacts 25 years too late ", I feel compelled to agree.

None of this is to say that the old perspective is useless. A medical philosophy rooted in linear cause and effect is an excellent approach for acute disease and trauma. Arguably unrivalled throughout history. But when it comes to complex multi-systemic conditions, like dementia, I'm starting to see that a shift in perspective could be a sea change for our times. Not only invaluable to alleviating patient suffering, but perhaps also pragmatically worthwhile - bringing value for money via breaking down professional silos and enhancing inter-disciplinary communications.

Nothing I am saying is actually very radical. It is rooted in the foundations for a healthcare model based on system science which understands and treats the human body and mind as an interconnected living organism and an integral part of nature. Foundations have already been laid by practitioners of Functional Medicine, Endobiogenic Medicine, Ecological Medicine and other holistic approaches to health. What they share and what distinguishes them from the dominant medical model is their proactive and systemic framework. The liberating innovation value thrown up by this potential new paradigm in medicine is not a threat but the next logical step in the evolution of medicine. Reactive acute medicine and proactive holistic medicine could operate side by side as part of an integrative approach to health. This would certainly serve patients suffering from chronic inflammatory diseases much better and save a lot of unnecessary cost and suffering at the same time.


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