It's time to reclaim holism

Holistic. It's one of those words that's sure to set any skeptic’s teeth on edge. It's basically a codename for woo, bandied about by supporters and pushers of all sorts of magic, unicorn tears, and snake oil.

But should it be? Is it time for the medical profession to reclaim the label holistic as its own, and start shouting from the rooftops about how we are holistic practitioners? I think it is, and here’s why.

holistic

həʊˈlɪstɪk,hɒ-/

adjective

Philosophy

adjective: holistic

1. characterized by the belief that the parts of something are intimately interconnected and explicable only by reference to the whole.

o    Medicine

characterized by the treatment of the whole person, taking into account mental and social factors, rather than just the symptoms of a disease.

There is a general perception, gleefully pushed by proponents of alternative healthcare,  that somehow conventional healthcare and holism are at odds with each other. The image of an uncaring, white-coated medical professionals hell-bent on simply treating that one particular symptom, with no regard for the fact that a patient is attached to that symptom seems pervasive.

We don’t help ourselves, I suppose. With a limited time on GP appointments, for example, its easy to feel like you’re being rushed through the system. Some surgeries ask that you book one appointment per ailment. Our health care professionals tend to specialise in one particular type of illness, and you can start to get the impression that they only care about that particular bit of your life, despite the fact that it’s very often all interconnected. You can feel passed from pillar to post, one day an appointment with a diabetes nurse, the next day an appointment with someone else for your arthritis, and two days later an appointment with a mental health specialist. So I do understand that it can seem like, as healthcare professional, we only care about your symptoms. 

But, even at the most basic level, it is impossible and really quite dangerous  to practice healthcare without looking at the patient as a whole. We’re all trained to do it, and its become so second nature to us that we have all sort of forgotten to be proud of it. As a result, we've lost control of the word holistic and we’re allowing unscrupulous charlatans to creep in to the public’s consciousness on the back of it. Of course, there are improvements to be made, but I think on the whole we do bloody well in the NHS, given the knowledge, funding and time constraints we’re lumbered with.

Now, in my day job as a medicines information pharmacist, I actually have no direct contact with patients. But I still, fundamentally, operate as a holistic practitioner. Here’s a basic example of what I mean:

GP: “Ah, hi there, I’m just wondering if there are any interactions between Champix and CellCept?”

In this sort of seemingly simple interaction enquiry, it is imperative that I look at the patient as a whole, rather than simply as two drugs out there on their own. 

• Champix®▼(varenicline) is a drug used to help patients stop smoking
• CellCept® (mycophenolate mofetil) is an immunosuppressive drug used to stop organ rejection in transplant patients. 

If I were to look at interactions of these two drugs,  I wouldn't find any,So fine, we’re good to go, right? I mean, I’ve answered the question, done my job, and all is well, yes? 

No, not at all. If I’m going to safely answer this question, I need to look at the patient as a whole. I need to acknowledge that they’re not simply a smoking machine that needs to stop but they’re a living, breathing complicated human.  I need to look at the patient holistically, not just as some isolated drugs.

So our patient is in his mid-forties, using the mycophenolate mofetil because he has previously had a heart transplant. He has a history of depression (understandable really, given how ill he has been in the past), and takes a couple of other medicines too (no major interactions on checking). He wants to stop smoking, which is great, a really positive step for him, but he’s failed a few attempts already whilst using nicotine replacement therapies. He's found these failed attempts frustrating in the past,which has then triggered bouts of depression. His liver and kidneys are working just fine.

So, looking at the patient as a whole, I need to think about how using varenicline will impact him as a person. Some of my thoughts go thus:

• Stopping smoking itself might affect some drugs, as there are chemicals in cigarette smoke which can affect the enzymes that metabolise some drugs. Is this the case with any of these drugs?
• Quitting smoking itself can be a trigger for depression or suicidal ideation. 
• There is also an association between varenicline and changes in behaviour and thinking, including depression and suicidal ideation. Given this patient’s history, this will need to be discussed with him and he’ll need to be monitored carefully.
• Certain cardiovascular events were reported more frequently with varenicline than placebo in trials: we need to bear that in mind and monitor him for any adverse reactions, especially given his heart transplant
• Not succeeding in giving up smoking has made him depressed in the past. Continuing to smoke increases his cardiovascular risks. A good old risk vs benefit decision needs to be made.

So I discuss all this with the Dr, and her response is:

“Ah that's great. Yep, I knew about the depression stuff but to be honest I hadn't really thought about the cardiovascular risks. I'll discuss it all with him, and I think we'll go ahead and prescribe it but I'll make sure to keep him closely monitored”

By looking at the patient holistically, his Dr and I have made sure that he will know to look out for any cardiac effects and to report it as soon as possible if he does experience any side effects. We can make sure that he's also prepared for the fact that his mood might change, and knows to report any of that too. He’s willing to take these risks for the sake of stopping smoking, so we’re helping him to take a really positive step in his life, aimed with all the information he needs to do it safely.

That’s just a small example of how I practice holistic medicine in my daily life. All over the NHS, at every level, other healthcare professionals are doing the same thing in their practice. We don’t declare ourselves to be holistic, because its such second nature that we don’t even realise we’re doing it. Maybe its time to start reminding people-and ourselves- that conventional medicine does, fundamentally, mean holistic medicine. 

Hxxx

Album Review: Lychnobite by Simma

There is a particular pub in Gatesheadwhich I rather like. It’s called The Central Bar and it holds good memories for me. It’s a traditional haunt for my good friends and I on Christmas Eve, it has an excellent range of beers, and does some good nosh too.

And so it was that on one particular Sunday afternoon just before Christmas, three friends and I were in there. We were suitably adorned in tacky, sparkly Christmas attire and were festively tipsy, when a chap started playing his acoustic guitar and singing in the corner of the pub.

Given our rather jolly state at the time, we showed our appreciation of this man’s lovely voice by bellowing along to some of the songs and inventing new interpretive dance routines to others (And thus, the great Gateshead Sit Down dance was born). We were a source of amusement for the singer, who declared that he’d never had anyone invent dances for him before and patiently explained that no magic was at play when we had loudly declared that we wanted him to play Fairytale Of New York then he actually did, prompting us to look drunkenly confused. “Girls, I’m not on the radio you know. I can actually hear you.” It was a really fun afternoon, and we left giggling hysterically and wondering if we could ever show our faces in there again.

The singer in question was Simma, and I’ve since seen him play several times. He fairly recently released his new album, Lychnobite, so I snapped up a copy of it and thought I would review it for you dear people.

On first listen, it’s on the whole a cheery affair, with upbeat tunes perfect for having on in the background while you do something else. Subsequent listens via headphones reveal a more melancholic, complex side to the album.

A particular highlight for me is “Black Dog”, a song about depression which combines a nifty little toe-tapping rhythm with an almost monotonous melody. This makes for an atmospheric juxtaposition, much like the illness itself. Next up is the joyous “Sing”, a marching, uplifting little song that I tend to happily belt out when I have it on at home.

Other songs are more calmly folky, all with a touch of cleverness to the songwriting that I find really pleasing. There is a clever use of vocals throughout the album (see Whisky Highway as an example), something which I find quite pleasingly different, given my previous experience of Simma is limited to him and one guitar in the corner of the Central Bar

“The Drink” is gorgeous, plaintive, and full of feeling. Meanwhile, “Sixteen Tons” is bluesy and pleasingly cynical, managing to blend together a very American sound with tales of Benwell woe. “Happy New Year” is likely to make its way onto my Christmas Songs For The Existentially Wounded list this year, with its mix of optimism and sadness for times gone by.

The other thing that I really like about Simma is how his Geordie accent creeps into the edges of his songs, lending them a little bit of added personality. All in all, this is a lovely, complicated album which is likely to be on heavy rotation in my household, nestled in nicely between Great Lakes by John Smith and Under Mountains by Rachel Sermanni. 

Hxxx