Before reading this chapter please start with:
WOB is optimal
A simple model and a short narrative offer a new insight into some chronic diseases like, diabetes mellitus, Parkinson's disease , cancer and secondary polycythemia. It is a convenient way to describe chronic diseases. A framework in which disease evolution might be studied. Since it is an abstraction of disease narratives described elsewhere, it is suggested that the reader starts with Parkinson's disease. When we speak of a disease we generally refer to a conspicuous process that typifies it, like hypertension, or hyperglycemia (sweet urine). This outstanding feature is called here disease indicator (DI).
A simple model
DI calls physician's attention when examining a patient., It is generally one component of an extremely complex situation known as disease. Medicine generally regards DI as disease embodiment. Hypertension is 'the silent killer'. Hyperglycemia is the main culprit of diabetes. Tumor, which is only one component of cancer, is regarded as cancer .Actually tumor and cancer are synonyms. Yet DI is only a one component in a disease. Without diminishing it's significance, physician ought to be more concerned with what drives a disease? In order to simplify the forthcoming arguments we shall assume that disease is driven by a demand for a vital substance (VS) by organism.
DI intensity (size) depends on birth and death rates of its components. When demand for VS is high, DI component birth rate rises, death rate declines, and DI increases. When demand declines DI birth rate declines, death rate rises, and DI shrinks. DI is a process which is controlled by WOB.
Environment and mind indirectly drive VS demand. Suppose DI stands for glucose. During daytime, demand rises, and at night it declines. When demand is high, glucose birth rate rises, death rate declines, and glucose level increases. When demand declines glucose birth rate declines, death rate rises, and glucose level declines. Demand for VS is the only drive for DI birth.
When mind is worried, DI may rise like in the case when DI is blood pressure. Mind's worrying instructs WOB to raise birth rate of its components and reduce their death rate.
WOB controls all processes and adjusts them to meet the demand of the organism, constrained by environment and mind. When it gets cold WOB turns the heat on , and vice versa. When it gets cold WOB adjusts also DI. WOB responds also to the mind, which receives signals and directives from society (culture). The adjustment of processes at any instant is called WOB solution. It is always the most optimal solution in circumstances. This is the modern interpretation of Galen's principle: Nothing is done by Nature in vain.
In previous example DI adjustment, e.g., glucose was negatively correlated with patient's condition. When it went up patient's condition got worse, and vice versa. In many diseases DI may be positively correlated, or even uncorrelated with patient's condition. We shall therefore focus on DI change and less on it’s direction.
Optimally changing DI
This optimality principle underlies also the evolution of any disease. At any instance WOB adjusts DI (and other components) to meet the demands of the organism for VS. What may appear to the observer as a change to the worse is an evolution of optimal solutions.
Disease proceeds through three phases:
1. Full compensation when DI birth and death rates are high and equal and patient feels healthy.
2. Decompensation, when DI birth and death rates are high and death rate is lower than birth rate. Patient feels sick, and suffers from secondary manifestations induced by DI, like glucose toxicity in diabetes mellitus.
3. Total decompensation, like intractable heart failure.
Rising demand for VS drives disease, however only WOB knows what drives a disease and adjusts its solutions accordingly. Actually we may ignore VS and focus on a particular DI. (from the metaphysical perspective VS might be Kant's 'The thing in itself')
A disease starts with changing DI birth and death rates. Initially they are equal and DI amount does not change. Next, organism starts demanding more VS and DI amount changes. It may rise or decline, what matters is that it changes. Then comes the first complication, and disease enters its second phase. Clinical manifestations are interpreted from WOB perspective. When WOB fails to control one of its processes it signals the mind a sense of dis-ease as if saying:" Get medical help!" Concomitantly , in order to meet the emerging shortage WOB restructures tissues. It has a rich repertoire of messages directed to mind, which indicate which processes are disturbed.
From the clinical perspective WOB main task is to prevent VS depletion, and when it fails, patient is at a great risk to die.
WOB solutions do not meet patient's (mind) expectations, who insists on a better life. Physician has two main responsibilities: To help where WOB failed, and to improve patient's quality of life. All this without interfering too much with WOB solutions. He has to work out a compromise between WOB and mind demands. Since patient cannot be cured the main objective is to slow down disease progression.
As DI change becomes excessive, patient suffers from complication induced by it, like polyuria in diabetes mellitus or glucose toxicity. All along disease progression WOB solution remains the most optimal under circumstances. In order to keep the patient alive it has to give up many less vital processes, otherwise patient will die. WOB task is to maintain life at all cost.
If this narrative seems too abstract, examine it in Parkinson's disease
Driving factors of two groups of diseases are known. In acute infections VS is a bacterium or virus, and in vitamin deficiencies, VS is a vital molecule. Acute infection is a prototype of an 'ideal disease' with an etiology. Once etiology (cause) is known, disease is understood, and a rational (specific) therapy is at hand. This conceptual model is applied also to cancer treatment. Accordingly, tumor is a parasite which ought to be treated with chemotherapy (a conceptual analog of antibiotics). Once infection takes a sub acute course, this 'rational' approach fails, and in chronic infections it is irrelevant. Think of a sub acute hepatitis, or cirrhosis, which are driven by a well known virus.
What brought about the current confusion in medicine, where glucose is dangerous, hypertension 'the silent killer', and tumor a hallmark of evil? When 19th century pathologists dissected diseased cadavers, they found diseases in a state of decompensation, which convinced them that organism is essentially defective. Then came western religions according to which sin drives disease. . Even today, when medicine became secular its view of the organism did not change. It still regards it as flawed, and sin gained a modern interpretation. Patient sins since neglecting prevention, like the warning of Surgeon General. When 20th century technology provided means for studying compensated disease, medicine regarded it as an ever rising risk of decompensation, since organism is essentially flawed.
Medicine regards the organism as a complex machine, and therapy as replacement of defective parts. Disease is an error (malfunction) of machinery. Medicine attempts to attain the status of physics, with its atoms, and elementary forces. Like physics it applies machine statistics to study disease. When Virchow declared that "omnis cellula e cellula" (cells breed cells) medicine got its atom. Then came the first conceptual twist. Since cells inherit their characteristics from their parents, how to explain a tumor which is essentially bad? An error of cell division created an outlaw tumor cell. Today the culprit is a mutated gene. While 'mutation' means change, in medicine it means a change to the worse. Fortunately medicine discovered the 'book of life' (genome), and prepares itself to replace mutated outlaw genes.
Despite this tremendous progress patients are advised to
follow the path of a Disease-Yogi, which
is the medical version of Nietzsche's
Disease definition involves: ::
1. A disease indicator (DI)
2. Three phases of its progression.
3. Relevant WOB messages.
4. Mind role (Mind-disease)
Four causes of disease