GUEST ESSAY: The metaphysical rubber meets the road in healthcare reform

By Rogier Fentener van Vlissingen

(This is a guest essay submitted to the Metaphysical Speculations Discussion Forum, reviewed and commented on by forum members. The opinions expressed are those of its author. For my own views on the subject of this essay, see my recently revised book Brief Peeks Beyond.)

The problem in healthcare today is not access (but of course some form of universal access would be better, if only “healthcare” worked). Nor is it that some people cannot afford it—nobody can. Rather, the core problem is the uncontrollably spiraling healthcare inflation that has US healthcare spending at $10K per person—almost 20% of GDP (145% higher than the OECD median) with no end in sight and yet, in terms of health outcomes, we rank #48 in the world anyway!

Merely spreading healthcare costs out over more people does not solve that problem, nor does controlling the cost of pharmaceuticals. Access to healthcare and escalating costs, including drugs, are purely red-herring issues in a system that so clearly does not work. I develop the case here that this phenomenon of out-of-control healthcare inflation and the concomitant failure in health outcomes ultimately result directly from the materialist worldview that continues stubbornly to be embraced by medicine—in spite of all we have learned from quantum physics and depth psychology, elaborated so clearly in Bernardo Kastrup’s work, which expresses the value and the necessity of the idealist view of our living experience. In particular, his essay on integrative medicine, which was published first online and then revised in his book Brief Peeks Beyond, is very helpful in this regard and forms the backdrop for my comments here.

The failing healthcare paradigm

It is not just that books could be written about the failings of Western medicine—they have been. There are a few in particular that I want to mention, for they directly inform these comments and might be helpful to readers. My comments reflect today’s reading strictly for the purpose of this article.

1. Ivan Illich, Medical Nemesis: The Expropriation of Health (1976). Philosopher and cultural critic Illich gives a devastating critique of how modern medicine devalues the body to mere machinery and how its priesthood – the medical profession - usurps individual responsibility for our own health and so expropriates health from all of us by means of modern medical protocols, often with enthusiastic encouragement from patients who don’t know any better.
2. Seamus O’Mahony, Can Medicine be Cured? The Corruption of a Profession (2019). Here’s the MD who sees how medicine is past its prime and has arrogated omniscience, based on victories over infectious diseases (the last war) and is really ineffective beyond the limits of the germ-theory of disease. In this book, he is not (yet?) aware of the budding paradigm shift to prevention and reversal, by diet and other lifestyle changes, of the degenerative diseases of which people overwhelmingly die today.
3. Jacob Stegenga, Medical Nihilism (2019). Philosopher of science Stegenga analyzes why the current “scientific” method of the biosciences—reductionist analysis—for the validation of medical treatment protocols tends to overestimate the benefits and underestimate the side effects. Vide, e.g., the current statin crisis.
4. Dean and Anne Ornish, Undo It! (2019). One of the pioneers of Lifestyle Medicine and probably his magnum opus. He has been instrumental in the acceptance of the new nutrition/lifestyle paradigm, specifically in getting Medicare/Medicaid and other insurers to support it. Ornish says that all these diseases have one common cause: nutritional deprivation resulting from our industrial processed-food system. He proposes a unified theory of disease for all of the degenerative illnesses of which people die today, since they have a single cause: diet (and lifestyle in general), so we are wasting our time with chasing symptoms as in the heyday of the germ-theory of disease.
5. T. Colin Campbell, Whole (2014). The pioneer of Whole Foods, Plant-Based nutrition (see The China Study (2004)) explains the holistic nutritional paradigm (as in Whole Foods, not isolated nutrients) as a necessary advance over the accepted reductionist paradigm, which of necessity leads to nonsensical conclusions. The upshot is this: 100% of RDA for all nutrients does not healthy nutrition make. A Whole Foods, Plant-Based diet does. A simple example shows this: Vitamin C is absorbed 265x better from food than from supplements. Both nutritional research and drug research will need to be controlled for diet by having groups of standard eaters, with control groups of Whole Foods, Plant-Based eaters.

Besides my own lifelong interest in the metaphysics of medicine, another good recent source for me has been Amit Goswami's The Quantum Doctor, which argues the idealist worldview. He speaks of downward causation (or, as Bernardo puts it, the body is in the mind, not the other way around) as opposed to the materialist (Newtonian/Darwinian) model of upward causation of the universe, where the mind is an epiphenomenon of the body. Whoever wants to understand the political history of the monopolistic, allopathic healthcare system, which gained its status based on its successes in the last war, I refer you to E. Richard Brown’s Rockefeller Medicine Men. A more current analysis of the disastrous state of affairs is Elisabeth Rosenthal’s An American Sickness: How Healthcare Became Big Business and How You Can Take It Back (2018).

My MD father (psychiatrist) in Holland saw, even in the 50s and 60s, the coming of what I now call ‘Pharmageddon.’ He would hold “salon” at our dining-room table with colleagues from a variety of specialties. One key issue that I would often hear and always stays with me, was the growing awareness that the pharmaceutical industry was usurping the doctor-patient relationship and the healing process, including promoting the notion that a doctor’s job was to prescribe medications. My father and many of his colleagues were put off by that. The central concern in those discussions—and this goes straight to Bernardo’s emphasis on the centrality of the relationship between healer and patient—was that the big-pharma style of medicine reduced the physician to the status of a car mechanic and excluded the patient from his own healing process by its very focus on medical intervention (mostly pharmaceutical), as if you were dropping off your body for service and picking it up at the end of the day, fixed. Needless to say, patients bought into the idea and their very expectations reinforced the problem.

My father's way of dealing with pharmageddon was outright rejection, for he saw it innately as a confusion of cause and effect. His practice evolved more towards Jungian psychotherapy than traditional psychiatry. Psychopharmaca, he felt, put him on a path that erroneously placed the cause of illness in the body when his premise was that the cause was in the mind. Not that he was always consistent in every way. I remember a conversation I had with him when I was in my early teens (I was studying Advaita Vedanta at the time) about psychosomatic illness, as if it were a special case, as medicine tends to view it. My question to him was: "But is there any other [than psychosomatic illness]?" He reflected for a moment and then said: "I guess you may have a point."

A few years later, in my late teens, I had an experience with a spiritual teacher I had from about age 15 until nearly 40, when he died, that was a perfect corollary to this. My teacher asked me if I believed in reincarnation. I responded that I did not have any particular quarrel with it, except that I did not think it was a necessary explanation. Apparently, I already had a taste for parsimonious explanations at the time, although I could not have put the argument together clearly. He responded with: “You may have a point.”

The bottom line is that the materialistic model of our lived experience, in conjunction with the period of fighting infectious diseases, created the illusion of grand success of “modern medicine” and reinforced the materialist worldview by virtue of that seeming success, helped by the reductionist model of the validation of supplements and drugs.

The Lifestyle Medicine Revolution

Campbell’s work on nutrition, popularized in his The China Study, has become the definitive anchor for the entire field of Lifestyle Medicine. It offers a unified theory of nutrition and represents a complete paradigm change. It is gaining wide acceptance, now reinforced more and more with the expanding list of stories of clinical success with many of the most difficult systemic, degenerative illnesses from which people die today. In Campbell’s work, we have a completely coherent nutritional paradigm that has been meticulously peer reviewed and has demonstrated to represent optimal human nutrition. With that firm foundation, many clinicians who had advocated plant-based nutrition to one degree or another now had a cohesive foundation in nutritional science. All the pioneers in the field gathered around: Dean Ornish, Caldwell Esselstyn, Neal Barnard, John McDougall, and many others. We are on the threshold of seeing the professionalization of this rapidly growing new trend by such organizations as the Plantrician Project and the American College of Lifestyle Medicine (ACLM).

Besides these emerging professional organizations, and with their help, we are seeing a growing number of medical organizations and single practitioners adopting a Lifestyle Medicine focus (and getting appropriately certified) along with a growing body of literature, both scientific articles and popular books. Some folks are educating their doctors with the idea that Type 2 Diabetes is not incurable after all, but can in fact be prevented and/or reversed with diet. Many doctors see this development as an opportunity to finally get to practice medicine as it was meant to be and really help their patients to be healthy. Others may resist it, for the threat to their paradigm is too much for them. Adoption of it, however, is picking up speed and there can be little doubt that the healthcare paradigm is shifting. The old mechanistic one, with the doctor as the magician, is losing ground to a new lifestyle model with the focus on prevention, and where the patient is in charge. Clearly, the patient controls what is at the end of his fork. Even if some will appreciate the empowerment, others will resist it tooth and nail.

Waiting for the other shoe to drop

Lifestyle Medicine, now the most important healthcare reform nobody knows about, risks missing the boat all over again as long as it clings to the materialist worldview, in which Whole Foods, Plant-Based nutrition is viewed as merely a better alternative to pharmaceuticals. Whole Foods, Plant-Based (#WFPB) nutrition is a holistic concept and an extraordinarily powerful healing modality and it represents a paradigm shift in nutrition and in medicine. Before, there had never been a coherent nutritional paradigm—nutrition was an agglomeration of seemingly reasonable assumptions predicated on the historical accident of the discovery of nutrients, lacking any form of organization per se. But T. Colin Campbell has changed all that, which explains why he is about as popular with traditional nutritionists and the food industry as Galileo Galilei was with the Roman Catholic Church in his lifetime. But the real paradigm change has only just begun, and it rests in the empowerment of the patient, which will forever change the doctor-patient relationship. The predominant focus will now be a partnership for prevention and disease reversal, driven by the actions of the patient and, most importantly, by the mind of the patient.

The psychological supports that ACLM embraces, which are mostly the work Doug Lisle, are helpful because they provide an understanding of the neuropsychological dynamics of diet failure. However, merely understanding the physiological drivers for why we like the wrong foods, is not enough. The neuropsychological understanding risks reducing the issue to a matter of willpower, which does not do anything to resolve the patient’s inner conflict and accomplish any healing. Secondarily, ACLM has recently taken to embracing something it calls positive psychology, which seems to be an updated version of New Age ideas like the power of positive thinking and The Secret (Rhonda Byrne), which do not transcend ego-centrism and therefore never resolve our inner conflict that guarantees continued failure.

A paradigm change cannot be complete without its metaphysical foundation, and I have been arguing for some time that the fundamental part is to understand that, first of all, Whole foods, Plant-Based nutrition (based on T. Colin Campbell's The China Study and Whole) is an instrument of healing and is very powerful at that because it empowers the patient to take responsibility for his own healing, health, and wholeness. The #WFPB diet is not merely better than medical intervention, but if we do not change the medical paradigm we are still lost at sea. It is a tool for health and healing if the patient becomes willing to take responsibility for his/her own health. That is a giant step, for the favorite position of the ego is to see itself as a separate individual and a victim of an outside world, elevating that belief to gospel truth, whereby it escapes responsibility for sickness and healing.

It is not safe to assume that people want to be healthy without consciously assuming that responsibility and resolving the inner conflicts around it. Among other things, there are such things as secondary gain: it “pays” to be sick, because it gets you lots of attention, as Freud well understood.

There is an old adage in psychotherapy that therapy is hopeless until the person is willing and able to take responsibility for their condition. This is different from saying they “attracted it,” as New Agers tend to say, but it does entail a willingness to examine their own role in it. A typical example is the abused woman who cannot even begin successful therapy until she realizes that she has responsibility, not for what occurred, but in how she deals with it. As long as she gets no further than blaming her abusers, no therapists can help her. Therapy begins when she questions her habitual assumptions and is willing to explore her own emotional role in the situation, for that empowers her to change the things she can actually change – her own thoughts and behavior. Of course an abusive boyfriend or a virus or an avalanche all come from the unconscious in the same sense that the whole world does, taking responsibility in that sense means she would be ready to look at her own role and reactions and emotions, including the need to see “bastards.” With regard to diet, accepting that what you put at the end of your fork either heals you or makes you sick(er) is a responsibility that many try to avoid—they prefer to be “a helpless victim” and have the doctor be their legal drug dealer, where they can pick up a fix at will.

We are getting into territory here where the very concrete and practical meaning of the idealist worldview, the world of downward causation (Goswami's favorite term), which sees the cause of illness in the mind and the effects in the body, becomes clear. I wrote about this recently in a blogpost on the drivers of healthcare inflation, where I argued that the physicalist worldview that medicine has clung to for so long is the reason why.

The reductionist approach of functional decomposition of a disease experience into symptoms that need medical treatment is arguably more profitable. Various specialists will see various issues and hence polypharmacy has become a widespread problem in its own right, especially with older people. Medicine with its physicalist worldview is like the proverbial blind men describing the elephant, in this case selling the elephant’s driver medications to treat all the symptoms they see, without ever realizing that they are treating an elephant. In the meantime, they are exposing patients to numerous risks of drug interaction and side effects, not to mention they are not halting the disease process in the first place. In a popular saying in the Lifestyle Medicine field: they are mopping up the floor without turning off the faucet that is causing the flood.

Dean Ornish increasingly speaks instead of the ‘unified theory of disease’ (see his recent book Undo It!) because nearly all of the causes of premature death are diet related and can be prevented or reversed (partially or wholly) with a single method: a #WFPB diet. His recommendations include some other lifestyle changes (loving relationships, sleep hygiene, reasonable exercise), but undoubtedly better nutrition is the predominant factor in the solution. Lifestyle Medicine is doomed until we get the paradigm right, in two steps: first, to incorporate prevention or disease reversal with a whole foods, plant-based diet; and, second, to realize that the mind of the patient is in charge of the process of healing and that, without it, nothing changes. Allopathic medicine’s acceptance of its limitations will inevitably lead to leveling the playing field for all credible healing modalities. Healthcare reform without changing the paradigm is tantamount to moving the deckchairs on the Titanic. The cost of our failure to integrate the meaning of the idealist worldview, which might have been brought back from oblivion by quantum physics, is truly staggering, and spiraling healthcare inflation will not be stopped unless we come to grips with it.

Conclusion

Healthcare needs to deal with several paradigm changes at once. The first is a transition from treatment to prevention and reversal with food, which is embodied in Lifestyle Medicine. The second is understanding the idealist model and realizing that the mind of the patient is in charge of sickness and healing and that the (lifestyle medicine) physician is there as a health coach and a subject-matter expert to assist. The third, not discussed here, will have to be an economic paradigm shift from outside ‘authorities’ profiteering from disease towards the patient taking charge of his own disease prevention and health maintenance. The doctor’s relationship should be with the patient directly, probably through a mutual society, where specialty care and hospitalization are dealt with through reinsurance, resulting in a more results focused and cost-effective care system.

The outcome is a new model in which the mind of the patient is the locus of the healing and the lifestyle physician plays a supporting role and is the subject matter expert to help the patient maximize the results he or she can achieve with lifestyle changes, supporting those efforts very sparingly with medical interventions, which might include specialist care and medication when unavoidable.

Copyright © 2019 by Rogier Fentener van Vlissingen. Published with permission.