Today, primary care health services are predominantly provided by physicians within a contextual framework that emphasizes the authority and expertise of the practitioner, focuses on disease and disease categories, encourages episodic care, and promotes the underlying assumptions of the biomedical model: objectivism, determinism, and positivism. These assumptions, although unknown to most practitioners, exert a compelling influence on the practice of primary care.

In brief, objectivism asserts the unqualified and exclusive validity of sensory based observations that are considered to be untainted by subjectivity. The observer is believed to be independent of his observation and science is seen to be non-relativistic and extra-cultural. Determinism is the belief in a direct linear upward chain of causality linking a singular cause to its specific effect, the process of reductionism. This view underlies the "gold" standard in scientific research, the clinical controlled experiment in which a single variable is manipulated while all others are kept constant. Positivism is the view that the ongoing accumulation of data from sensory based experiments will provide us with a progressively more accurate and life enhancing understanding of nature.

It is the premise of this paper that the meaningful integration into our health care system of holistic principles and complementary healing practices will require a fundamental re-orientation of our current approach to primary care. To do otherwise would more than likely result in a distortion and corrosion of holistic principles, a reduction of complementary practices into disease oriented treatment modalities, and a corrupting influence on the alternative practitioner whose practice style would invariably fall under the hegemony of the reimbursement system and the biomedical world view. Complementary approaches will invariably be re-shaped to conform to the contextual framework of biomedicine rather than extending and expanding this framework. Stated in another way, the existing system will change the alternatives rather than the alternatives changing the system.

There are ample examples of this for us to draw upon. In the 1970s John Travis¹ initiated the wellness movement. His conceptual model was educational in orientation and based on the principles of psycho/social/spiritual development. Immersed in the context of our scientific world view it was quickly reframed in a manner that exclusively emphasized its most physical and material aspects: smoking cessation, exercise, and nutritional changes. The core and soul of this model was lost through its integration into our contemporary context. Much the same can be said regarding the concept of holism. Holism, a concept which is based on an expansive view of the human experience, emphasizes the essential and irrevocable interaction of mind, body, and spirit.² In the context of our cultural paradigm, the concept of holism has been distorted and mistaken for alternative treatment practices. Although a practice may derive from a conceptual framework that is more or less holistic, the actual practice, as integrated into our culture, is most often used as a reductive treatment practice oriented towards repair and restoration of function. Holism is not a practice. It is a perspective.