The Holistic practice of Complementary Medicine; as a cure for the NHS’s relationship with patients, An Anthropological perspective.
(Author: Abraham Heinemann)
Looking at how the ideology of the NHS is at odds with the privatisation of its treatment and why its survival as a useful entity to the public can be looked for in the similarity of its ideology to the practice of Complementary medicine. In light of this the relationship of the British public to the NHS can be compared to that of the Kwakwaka’wakw to Potlatch. Using examples we can see that the similarity lies in their function coming under pressure from consumer fetishism.
The NHS as a gift economy
A functional gift economy is a system of value exchange where items or services are habitually given to other members that subscribe to the system, without the receiving party having an explicit agreement to immediately reciprocate the value received (Cheal 1988).
At the basis of the NHS is the idea that the patient receives healthcare from a medical professional, and the Medical practitioner receives their salary. However the value of this salary is not based on the treatment the patient receives but on the value the Practitioner adds to the system; his expertise and time. Taking the NHS as a whole body involved in a one-to-one value exchange with the British public, one can see more clearly the process of gift exchange at work. The NHS provides the public with health and the public provides the NHS with a continued commitment to its survival (Hart 2006: pp1-9).
To pull out the differences to a market economy, one can imagine the NHS as a market economy briefly. The NHS as a market economy would base its treatment of each consumer group on how much monetary value it can create as profit from the exchange, to satisfy its investors. In this process value never cyclically travels around the system as one set of participants -investors- need only add value to the system once, but continually extract value at the expense of other participants (Hart 2006: pp28-92).
We can see from these two examples then that the idea of a gift economy on which the NHS was built can work functionally (Hart 2006: pp2), however as a market economy the value – healthcare- received by patients, is secondary to the profit of the investors (Slocock 2006), thus creating an imbalanced system. This then means that the NHS would not function efficiently as the value of the healthcare would not remain in line with the needs of the patients, as value is continually removed from the system.
So if the NHS where to act like this it would eventually terminate itself, as the patient would not be receiving the return of the value they put in, in supporting the existence of the NHS. The patient would then continually lose value and not be able to sustain its part in adding value to the system, leading exchange to stop. In this scenario no participant can then exist as there is no value exchange happening and so all parties cease to be a part of a gift economy.
In light of this, and the NHS being based on a gift economy, the NHS would then collapse if it involved itself in the dynamics of a market economy.
The Enclosure (Shiva 1997) of Medical treatment
The value that the NHS adds to the gift economy -it is a part of- is diverse. Two main categories include the expertise and treatments it offers (Thompson 2009). As the NHS does not create its own treatments generally (BBC 2008) but sources them from outside the gift exchange it is a part of, then the sources of these treatments also become a part of the gift exchange system as they are involved in the movement of value around the NHS system.
A large part of treatments given by the NHS are the pharmaceutical drugs it prescribes. These make up approximately a quarter of the monetary value it expends, and this is increasing at an exponential rate where the cost has doubled over a period of four years (BBC 2008). The extra revenue (value) received by the manufacturers of these drugs is increasing faster than the value received by the NHS or patients, in terms of the purpose of the system; improved healthcare (Baker 1996). This means that the value within the system is unbalanced.
In terms of the value of medical expertise given out by the NHS, there are many varieties (NHS 2010). A significant part is the one-to-one value exchange between the individual components of the NHS gift exchange; between Medical Practitioner and patient. The amount of time a Doctor spends with a patient has steadily decreased (Quinn 2010), whilst the patients’ monetary contribution via taxes has increased (Thompson 2009) along with a continued giving of value via political support for its existence (Whiteley 1981). So creating further imbalance in the system.
Is the practice of Orthodox Medicine still scientifically driven?
Western medicine (NCI 2010) is the implementation of science to benefit peoples’ health. The NHS is the system by which the majority of people receive medical attention in England. Pharmaceutical drugs and one-to-one consultation with a doctor constitute a large part of this medical attention. Drugs are produced by pharmaceutical companies. Companies are answerable to their investors and work within the context of a market based economy, in which profit not scientific relevance takes precedence. Therefore in terms of drug based treatment, their development is not primarily scientifically driven and so cannot be spoken of as a science led driving force within Medicine.
Orthodox Medicine is based on dividing up the body into parts and treating the affected areas (Sharma 2003). More often than not it focuses on the symptoms rather than the causes, reflected in the mass prescriptions by doctors of antibiotics and painkillers for a large amount of ailments. The drugs then prescribed are designed to act on a certain area of the body. If we are to look at this metaphorically -in terms of a market based economy versus a gift economy- we can see that this approach reflects a market based approach. In the market context the primary area of importance in value exchange is based around the unit of value exchanged; the product . The symptom treating drugs do not address the value needed by the body but merely deliver a product that acts at a surface level to relieve symptoms, rather than delivering value to the entire whole. Whereas in a gift economy, the exchange between individual parts must happen between all parts for the movement of value to pass through the whole, where the unit of value exchanged is secondary to the value felt by the whole. Gift-economy as a metaphor for Medicine is one that allows for health-value to be felt throughout the whole system.
As the market economy metaphor, is the one by which the majority of prescription drugs work, a market based approach to drug design is not modelled on a scientific approach. This is because it does not focus on developing solutions to problems, or creating a better understanding of a system -as science continually endeavours to do- but simply relieves the symptoms of a problem, without investigating it as a part of a whole system.
The Potlatch of the NHS
In reflection if we look at what happened with the Kwakwaka’wakw (Bracken 1997) and other First Nation’s peoples, we can see a comparison to the British public. In the original exchange of potlatch, material wealth was not of purposeful significance, as is the same in the Kula-ring of the Trobriander Islanders (Malinowski 1920). Potlatch was more about its social significance. The physical objects represented the value of a relationship between two or more participants. However with the influx of mass-produced goods into the system with the advent of white settlers, inflation occurred as they come from a market based economy. So when it came round for a group to return potlatch the price of the same material goods cost more in terms of monetary value. So the Potlatch system then also suffered from disproportionate inflation (Bracken 1997: pp159). This led to participants either unable to participate or ruining themselves in the process. This caused the system to disintegrate to a system that signified more the monetary value of the potlatch than its social significance.
If we look at this example and compare it to the NHS and its patients we can see that, including market based economics within a gift culture will ultimately lead to it being undermined. In technical terms what has happened to both practices –NHS and Potlatch- is a form of commodity fetishism (Taussig 1980: pp3-5), where relationships between groups that required exchange of value, inclusive of commodities and monetary wealth,
transformed into objectified relationships between commodities and money, rather than between giving and receiving health, or exchanging social status.
The name complementary medicine is born out of its very own philosophy. Initially being labelled as alternative medicine in the 1970’s and 80’s (Takrouri 2007), its holistic philosophy allowed it to integrate its methods with Orthodox Medicine. The integration is more one way though, in the sense that Complementary medicine integrates Orthodox medicine more than vica-versa (Cameron 2005). However its appeal is slowly causing this relationship to become more integrated from both sides.
At the heart of the practice of most complementary medicines, is the need to treat the whole person and the environment around them as a system that is in constant interaction. As this whole and all its parts are interrelated, treating symptom does not holistically look at the network of interactions that have produced this symptom. So if one looks at this network one can better solve the health problem because if the causalities are treated then the symptoms are less likely to reoccur.
We can see then that if the NHS is far too involved with participants who work within the context of a market economy, its culture of effective gift exchange will inevitably crumble. This market economy model has gone as far as to remove the health from the National Health system and guise itself in Medicine that is scientifically stagnant. The NHS will go the way of Potlatch unless it protects its gift economy more effectively. To do this it must develop many of its areas to act more holistically for the benefit of all participants. As it is slowly integrating with complementary medicine it can learn from it and pro-actively bring the holistic approach back to the centre, whilst reconstituting its participants into a fully functioning gift culture so that it may benefit itself and the healthcare it gives to patients.
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