Saturday, January 16, 2010

Integrative Thinking for Preventive Medicine


It is time for a new paradigm in preventive therapy. RCTs and meta-analyses are not suited for complex interventions as primary prevention. For primary prevention we need to eat well, exercise regularly, and sleep well. I do not believe that family physicians are trained enough in these areas. More, I do not believe that the science in these areas has reached where it is supposed to be.

It is a shame that over 70 years after the death of Dr. Alexis Carrel his observation holds true till today:
Medicine is far from having decreased human sufferings as much as it endeavors to make us believe. Indeed, the number of deaths from infectious diseases has greatly diminished. But we still must die in much larger proportion from degenerative diseases.

Roger Martin the dean of Toronto’s Rotman School of Business has a suggestion that I think is worth trying in medicine. You can find his suggestion in his book ‘The Opposable Mind: How Successful Leaders Win Through Integrative Thinking

1. Have a good stance. A stance is how we think of the word, and what we value. Thinking high of RCTs can be thought of as a stance. Refusing to accept any reductionist science to guide preventive medicine is another stance. Always being open to different ideas is another stance.

2. Use abductive reasoning along with adductive and inductive reasoning. You may need to read the book to understand abductive reasoning. My understanding is to use our current knowledge to come with new and imaginative solutions. Abductive reasoning is imagining the possible.

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