The Words Matter Podcast with Oliver Thomson - The CauseHealth Series: Chapter 5 - Complexity, Reductionism and the Biomedical Model with Dr Elena Rocca and Dr Rani Lill Anjum

The CauseHealth Series: Chapter 5 - Complexity, Reductionism and the Biomedical Model with Dr Elena Rocca and Dr Rani Lill Anjum

01/08/21 • 60 min

The Words Matter Podcast with Oliver Thomson

Welcome to another episode of The Words Matter Podcast.

So we are up to the fifth episode on this CauseHealth Series, in which I’m speaking with the authors of The CauseHealth book Causality, Complexity and Evidence for the Unique Patient.and that you can download for free or order a hard copy.

So in this episode I’m speaking for the final time with Dr Elena Rocca and Dr Rani Anjum about Chapter 5, which they co-wrote titled Complexity, Reductionism and the Biomedical Model (read Chapter 5 here)

The chapter is a comprehensive analysis of some pretty hefty topics, who’s depths are rarely appreciated in day-to-day discussions in healthcare practice or academia. How often do we use terms and concepts such as reductionism or biomedicalism, without really knowing the premises of these positions? Fortunately, Rani and Elena do a great job of laying out these positions clearly so we can all have a greater handle on these theses so as to be more deliberate when using them or dismantling them.

In this episode we talk about:

What reductionism is in medicine and how this relates to the biomedical model.
We ask what does it mean to be a reductionist ontologically and epistemologically?
Biomedicalism is frequently represented or Straw-manned, so we attempt to steel-man reductionism and offer an argument for its strengths, merits and contribution to healthcare.
The role of the biomedical role in the (over)medicalisation of people (eg burnout into depression).
The biopsychosocial model, and how this acknowledges complexity in theory and practice but how the CauseHealth approach argues we need to move beyond the BPS model by starting with a change in ontology, and how we can learn from ecology to resist the fragmentation of complexity and preserve it in its wholeness.
We once again talk about the importance of the patient's narrative and the causal story it can tell.
Finally we talk about how our ontological bias with respect to causation influence our norms and practice.

As always, I loved talking to Elena and Rani. Our discussion on complexity, biomedicalism and reductionism can help us become aware of our philosophical biases with respect to our practice, allowing us to analyse and reflect on them so we can begin to change them.

Find Elena and Rani on Twitter

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Welcome to another episode of The Words Matter Podcast.

In this episode we talk about:

What reductionism is in medicine and how this relates to the biomedical model.
We ask what does it mean to be a reductionist ontologically and epistemologically?
Biomedicalism is frequently represented or Straw-manned, so we attempt to steel-man reductionism and offer an argument for its strengths, merits and contribution to healthcare.
The role of the biomedical role in the (over)medicalisation of people (eg burnout into depression).
The biopsychosocial model, and how this acknowledges complexity in theory and practice but how the CauseHealth approach argues we need to move beyond the BPS model by starting with a change in ontology, and how we can learn from ecology to resist the fragmentation of complexity and preserve it in its wholeness.
We once again talk about the importance of the patient's narrative and the causal story it can tell.
Finally we talk about how our ontological bias with respect to causation influence our norms and practice.

Find Elena and Rani on Twitter

Follow Words Matter on:

Instagram @Wordsmatter_education @TheWordsMatterPodcast

Twitter @WordsClinical

Facebook Words Matter - Improving Clinical Communication

★ Support this podcast on Patreon ★

Previous Episode

The CauseHealth Series: Chapter 4 - When a Cause Cannot be Found with Dr Rani Lill Anjum and Dr Elena Rocca

Welcome to another episode of The Words Matter Podcast.

So we are up to Chapter 4 of the CauseHealth Series, and I hope you’ve enjoyed the previous episodes.

In this episode I talk again with two of the editors of the CauseHealth book (download here), Dr Rani Lill Anjum and Dr Elena Rocca about Chapter 4 which they co-wrote titled ‘When a Cause Cannot be Found’ (read Chapter 4 here).

In this episode we talk about:

Medically unexplained symptoms (or MUS) and how such health conditions, which defy a clear biomedical explanation, offered a practical and clinical challenge for CauseHealth to take on (see paper here by Rani, Roger Kerry and others).
We talk about how the mere accumulation of more biomedical knowledge and scientific discoveries won’t necessarily lead to a satisfactory explanation of MUS in individual patients, and how and why a dispositionalist view of causation offers a deeper and person-focused understanding to the complexity associated with MUS.
We discuss the Problem of Uniqueness –and outline the challenge this poses both practically (i.e. clinically and methodologically), and also the broader and more fundamental philosophical challenge of medically unexplained symptoms.
We talk about how methodological and evidential pluralism and inclusivism can help provide this deeper contextual understanding, which is not captured by RCTs and other quantitative methods alone.
Finally, we talk about how other forms of evidence such as patient narratives, case studies and qualitative research, which don’t traditionally get involved with causation, that when taking a dispositionalist view, do in fact have lots to say and contribute to in regards to causation in healthcare

This episode really made me reflect on the role and contribution of qualitative research towards causal explanations in healthcare whether it be recovery or the onset of pain and illness.

The dispositionalist view opens up space for qualitative methodologies and methods to sit at the table of causation and offers researchers from these disciplines a theoretical framework to allow rich, detailed and sometimes abstract qualitative evidence, constructed from multiple individual perspectives and experiences to add to a causative understanding of individual patients.

Find Elena and Rani on Twitter

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Next Episode

The CauseHealth Series: Chapter 6 - The Guidelines Challenge with Dr Samantha Copeland

Welcome to another episode of the Words Matter Podcast.

We continue our journey into the CauseHealth book, and this time talking again to Dr Samantha Copeland about Chapter 6 (see chapter 6 here), which is titled ‘The Guidelines Challenge’. Chapter 6 closes Part 1 of the book, the Philosophical Framework, and the next episode represents Part 2, the Clinical Application, where quite rightly, I’ll be speaking with Christine Price about her experience as a patient, of complexity and her persistent pain (see all episodes of the CauseHealth Series here).

In this episode we talk about:

The original aims and purpose of clinical guidelines, and how they were developed to operationalise evidence-based practice.
The ontological and epistemological assumptions around causation that are built into guidelines.
The tension between evidence based guidelines and a dispositional view of causality for understanding health, disease, and the effectiveness (or not) of medical Interventions.
The sorts of evidence (methods) which make up guidelines and what is the problem/conflict here when practitioners implement these to individual patients.
How guidelines should be developed to account for the particulars of individual patients? (not just methodological pluralism but a revised ontology of causation).
How guidelines should be utilised or viewed by clinicians.
The integration of guidelines with expertise, judgement, decision-making
Finally, we talk about Lessons learned from Oxford ‘Guideline Challenge’ conference, and in the show notes have linked a editorial paper by Samantha and colleagues (see here) which outlined the major problems and positions presented in relation to guidelines, and how dispostionalist theory might provide some solutions to enable the better development and utilisation of guidelines for person-centred care.

So this episode has it all; EBM, clinical reasoning, judgment, ethics and even AI. Samantha does a fantastic job in articulating hers and the CauseHealth’s vision of guidelines.

Find Samantha on Twitter @samdotC

If you liked the podcast, you'll love The Words Matter online course and mentoring to develop you clinical practice - ideal for all MSK therapists.

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Twitter @WordsClinical

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