Reductionism vs Holism: is the cell more important than the person in treating chronic disease?
“When we try to pick out anything by itself, we find it hitched to everything else in the universe.” — John Muir
We live in an age that celebrates Reductionism far more than Holism. Reductionism is viewing an object or an organism as nothing more than a sum of all its working parts. In a reductionist philosophy, we can understand everything about the object or organism by knowing everything about its individual parts. If one looks at current areas of research in “science” we see that an almost obsessive drive to understand things exclusively on a quantum level. In fact, as I write this, it was confirmed today that Peter Higgs is to be awarded the Nobel prize for his discovery, amoungst other things, the Higgs-Boson particle – the God particle. There is of course a great need to understand things through the lens of Reductionism. Many of the greatest discoveries in the formal sciences of chemistry and physics have led to countless life saving advancements such as the use of penicillin, insulin, vaccinations, and other medications to treat or cure diseases. Discoveries of elementary particles like the Higss-Boson, electrons, protons, and neutrinos have helped explain things like gravity and the Big Bang Theory.
By understanding the intricate workings of a human’s immune system, we are better able to test how certain medications might work in a laboratory. We would have never been able to advance medicine and the treatment of disease without the underpinnings of chemistry, physics, and biology. The scientific method, while not perfect, does allow a researcher to say with a certain level of confidence that a treatment is effective when applied to the studied pathogen. Without Reductionism, we might still be blood letting for all diseases.
What is holism then? Holism is often viewed as the opposite to Reductionism. Holism views the functioning of a system to be related to all the parts working together and as a result of the influence of other organisms, systems, or environments. While a Holism approach to medicine would not have led to the discovery certain proteins on a white blood cell which increases your risk for certain diseases, a Holism view will attempt to understand the influence of environment and lifestyle on the expression of the disease. Even a Reductionist approach to medicine cannot provide all the answers. Although the human genome has been mapped for the over 25,000 different genes, it is clear that possessing a gene for a specific disease does by no means guarantee the disease will be expressed. When one identical twin develops multiple sclerosis or diabetes and not the other, we need to ask ourselves what other factors (epigenetic) lead to disease expression. Was something different in one of the twin’s environment compared to the other? Holism permits a wider view of the complex interaction of multiple variables contributing to disease.
At the beginning of this article, I said that, “We live in an age that celebrates Reductionism far more than Holism.” What should be obvious is that both Reductionism and Holism are necessary not only for medicine but for understanding all facets of science. The media can be blamed to a certain degree for celebrating Reductionism. Reductionism makes headlines. Here is an example of a media headline regarding fat loss, “Polyphenols in Green Tea Fights Fat.” The media takes a snippet from a study which showed that people who drank green tea tended to weigh less. People love these headlines because it seems so simple. Just drink green tea and voila, you are svelte. Of course the media makes no mention of the influence of other variables that could have led to the observation that svelte people drink green tea. What about the possibility that people who drink green tea tend to not smoke, eat more healthy, and exercise more often. Here then is the Holism headline, “A healthy diet of between 1800-2000 calories when coupled with intense exercise and resistance training for an hour a day, seven days a week, may result in modest weight loss.” Which headline will sell more papers?
What we know for certain is that for chronic diseases such as obesity, heart disease, diabetes (type 2), most cancers, multiple sclerosis, and many more are the interplay of genetic and epigenetic factors such as environment and lifestyle working together leading to possible disease expression. In the subtitle of this article I asked if the cell is more important than the person. It should be obvious that both are important. While a Reductionist view may find dysfunction in a cell in a petri dish, how that dysfunctional cell behaves in a tissue such as cardiac muscle and in an organ like the heart and in a system like the cardiovascular system and working with all the other systems in the human making the person as part of society in a complex environment is anybody’s guess.
We like the information we receive from Reductionism because it seems so simple. It is easy to objectify and easier to fund research that finds a cellular level pathogen and then invents a cellular level, patented medication to destroy the pathogen. It is sexy and it is profitable. It is simply not sexy and not profitable to say, “we don’t know what causes most chronic diseases but lifestyle seems to be an important factor therefore we recommend getting more exercise, reducing stress, and eating a more healthy diet.” While it may not be sexy, if we do not balance the treatment of disease with lab results and lifestyle and environmental modification we will continue on the trend of losing the battle to many chronic diseases.
The time has come to put the pieces of Reductionism back together and view chronic disease through both lenses: Holism and Reductionism