Reframing clinical research frameworks: Case for a shift from a biomedical to a biopsychosocial one

The medical science progressed rapidly over the last century. Certain diseases have been eradicated and some others are on the verge; with a progressive increase in life expectancy. The currently followed biomedical, disease centred, reductionist approach to medicine has helped diagnose earlier, probe deeper, and treat in a targeted manner. The downside to the biomedical, reductionist approach is that the part becomes more important than the whole. Ludwig von Bertalanffy's systems theory (1968), emphasised that the whole is greater than the sum of its parts. Building on this perspective, Engel proposed the biopsychosocial model, suggesting that psychological and social factors, while dependent on biological processes, cannot be fully explained by them. He further described the dynamic interactions between these levels of the biopsychosocial hierarchy as emergent properties that shape health and illness. Correspondingly, clinical research too is largely modelled on the reductionist, biomedical approach. It is indisputable that the social, psychological, and behavioural determinants of health contribute to the pathology and health outcomes, all of which are considered in the biopsychosocial framework. We look at the pros and cons of the reductionist system and weigh in on the biopsychosocial approach in modelling clinical research given that it factors for the non-medical determinants of health and disease.