Weaving the future of massage therapy as a modern medical-science-based healthcare profession

Rear view of the shed on a four-harness table loom. Photo by Aranel, September 28, 2004.

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As any weaver knows, the elegance of a fabric lies in the yarns, not the threads. The whole is lots more than the sum of its parts. In health services, the threads are the diagnoses on which interventions are based. How these threads are spun into yarn (the underlying biodynamic of the tapestry of health) is poorly understood, to the detriment of efforts to understand the genesis of health problems and the interventions associated with them. Part of the problem is the imperative to “sell” diagnoses in order to market the interventions associated with them. Those who make their living by focusing on diseases resist understanding that health is a pattern. Without grasping the pattern, management is at best an approximation of adequate care...Understanding the tapestry of morbidity and the contributions of health services depends on the yarns woven from the threads that constitute diagnoses. The high prevalence of comorbid and multimorbid conditions and their impact on both responsiveness to interventions and the occurrence of adverse effects demand that views of health be changed from its current narrow focus on diseases to a much broader view of various aspects of health and their interactions in patients and populations. -- Barbara Starfield, MD, MPH, "Threads and Yarns: Weaving the Tapestry of Comorbidity", Annals of Family Medicine, March 1, 2006: vol. 4 no. 2, 101-103.

In an elegant metaphorical image, Barbara Starfield sums up brilliantly why it's so important for us to really understand how the natural world actually works.

First of all, it puts our clients and their best interests--instead of our own favored personal beliefs--rightfully at the very center of our practice.

Additionally, it makes patterns in the world around us make sense. If you accept the body of validated chemistry knowledge carefully gathered and curated across centuries and across countries and cultures as the best way of knowing about chemical reactions in life, then you can draw an unbroken line from:

Henry Vandyke Carter [Public domain], via Wikimedia Commons


how digestion works, to

By Quadell (Own work) [CC BY 3.0 (http://creativecommons.org/licenses/by/3.0)], via Wikimedia Commons


why you can safely preserve high-acid fruits (but not vegetables, meat, or fish) in boiling-water baths, to

Martin Pot (Martybugs at en.wikipedia) [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC BY 3.0 (http://creativecommons.org/licenses/by/3.0)], via Wikimedia Commons


why respiratory and metabolic acid-base imbalances are such urgent situations to the mainstream healthcare professionals who are our potential colleagues and teammates.

Matter, and its property of acidity or alkalinity, behaves reliably in the same universal and coherent way through all of those scenarios, and our natural world is--to some degree--a reliable and understandable place.

If you reject chemistry, however--whether practicing flat-out systematic chemistry denialism, such as believing in homeopathy, or just believing isolated junk pseudoscience like drinking lemon juice so that the citric acid will somehow raise the alkalinity of your blood--then nothing makes sense. It's random lurching from validated chemical and physiology science to the very opposite, of those facts, depending on what you need to argue in the moment: for example, if you want to pass a reputable licensing exam, you'd say, correctly, that only the urinary system and respiratory system can make meaningful changes in blood pH.  Then, to defend the alkaline diet, you have to contradict those facts, and claim that, somehow, more citric acid survives the hydrochloric acid in the stomach to make it intact into the blood to have a meaningful paradoxical effect there of making it less acidic.

It's exhausting to keep all those stories straight, and there's really no reason to do it, when our clients are best served by seeing patterns as they are in reality. If we accept the reality of the natural world, and we do the work to understand how it actually functions, then we can better grasp the threads of the tapestry of the complex conditions that our clients are living with, and we will have so much more high-quality, meaningful, and relevant care to offer them.

Cheers to Maureen Johnson, who introduced me to the writing of Barbara Starfield!