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. 

Solution

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')

Full compensation

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.

Physician

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.

Decompensation

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.

Therapy

Has to slow down disease progression, like in  some diseases described elsewhere: Diabetes mellitus (*Parkinson's disease and cancer ,

If this narrative seems too abstract, examine it in Parkinson's disease

Acute infection

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.

Medical Platonism

What brought about the current confusion in medicine, where glucose is dangerous, hypertension 'the silent killer', and tumor  a hallmark of evil?  When  19t^h 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 20^th century technology provided means for studying compensated disease, medicine regarded  it as an ever rising risk  of decompensation, since organism is essentially flawed.

Cartesian reductionism

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 overman

Summary

Disease definition involves: ::
1. A disease indicator (DI)
2. Three phases of its progression.
3. Relevant WOB messages.
4. Mind role (Mind-disease)

Additional reading:
Four causes of disease

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