The Integrative Approach in Medicine—Implications of Neuroendocrine Mechanisms

THE INTEGRATIVE APPROACH IN MEDICINE— IMPLICATIONS OF NEUROENDOCRINE MECHANISMS* JOHN W. MASON, M.D.f In considering the implications of neuroendocrinology as a medical frontier, I believe it may be helpful to view this field in the perspective of some rather basic issues concerning strategy in medical research. In general, two different fundamental strategies have emerged to guide the study of the living organism during the long history of biology and medicine. One approach, usually called the "analytical" or elementalistic" or "reductionistic " approach, is based upon the premise that an understanding of the complex living organism can be achieved by breaking it down in a part-by-part analysis ultimately to the point of its smallest component units. Historically, the influence of this approach is evident in the long progression from the study of the organism at the level of major body systems, then organs, then tissues, then cells, then cytoplasm, and now down to the analysis of the organism at the molecular level. The second approach, variously called the "integrative," or "synthetical ," or "organismic" approach, is based upon an alternative premise, namely, that ultimate understanding of the organism lies not only in knowing its ultimate parts, but also in knowing how the many separate bodily parts or processes are organized or integrated into the organism as a whole. Of these two strategies, the "analytical" approach has long been by far the predominant approach in biology. It is generally viewed as originating almost 4 centuries ago with Descartes's postulation that living organisms , as well as inanimate matter, obey the laws of physics and that animals are essentially complicated machines, comparable in principle to man-made machines. Consequently, he assumed that the scientific method, which was proving so promising and productive in physics, should be equally useful in biology. In 1637, Descartes set forth the *This paper was presented at the Wilson Day Symposium on Frontiers in Medicine, University of Rochester Medical Center, Rochester, New York, November 10, 1972. !Department of Neuroendocrinology, Walter Reed Army Institute of Research, Walter Reed Army Medical Center, Washington, D.C. 20012. Perspectives in Biology and Medicine · Spring 1974 I 333 following basic guideline for the scientific method: "It is wise to split each difficulty under examination into as many separate parts as possible and convenient, in order the better to solve it." "Analysis," said Descartes , "is the means of establishing the truth of the first principles of all knowledge" [1, p. 300]. Descartes's assumption that the "analytical" method would be productive in biology was readily borne out in practice. In 1628, Harvey had, in fact, already applied the "analytical" approach successfully to the study of the mechanics of the circulatory system. Many other fruitful applications of this approach followed, and the "piecemeal" study of the organism became firmly established in biological research. Following the development of the cell theory in 1839, there was, in fact, a prolonged period in which polarization of thinking became so extreme along "elementalistic" lines that is was widely believed that the only legitimate business or strategy in biology was to reduce organisms to as few and as simple elements as possible in a search for the final physicochemical units which underlie every phenomenon of life [2]. There is no question but that 4 centuries of laborious application of the "analytical" method to the study of life has yielded enormous progress . It has resulted in the accumulation of a massive number of accurate facts about the functioning of various component units in the body. In spite of this tremendous productivity, however, there have been recurrent periods when some biologists have expressed serious doubt that the "analytical" approach is alone sufficient to achieve a full understanding of the living organism. The basic argument has been that fundamental differences existing between inanimate matter and living organisms require special theoretical and experimental approaches in biology, beyond those of the physical sciences, in order to deal with the unique problem of the complex organization of living beings. While this basic conception is an ancient one dating back at least to Aristotle and the Greek physicians [1, 2], a solid, scientific foundation for the "integrative" approach did not develop until the time of Claude...