Being Discrete In a Continuous World
In a few years, the use of pharmaceutical drugs to alleviate disease will be considered a ridiculously inefficient and outdated method of caring for our health. An archaic racket.
Why?
It is already about to be replaced by more rational and modern methods, methods that are in tune, rather than at odds, with the fundamental nature of the complex biochemical systems that keep us alive.
You can see clearly that the current health paradigm is failing. Chronic disease is killing people at unprecedented rates. Even the most celebrated pharmaceuticals fail to make any real difference. In fact, side effects from pharmaceutical drugs are a very common cause of death. Properly prescribed pharmaceuticals were recently recorded to be causing 198,815 deaths per year in the US, which amounts to about 3 jumbo jets falling out of the sky each day for a year.
If the dismal rate at which side effects are recorded is taken into account, the real figure becomes much higher. It has been estimated to be as high as 1,988,150 people per year, or 30 jumbo jets crashing every day.
AN ONGOING CATASTROPHIC FAILURE
There are many reasons for this failure, but one fundamental reason has to do with the fragmented nature of the current state of knowledge. You could wish we had a large detailed working model of all the complex interactions of the feedback-looped systems that define who we are. Something similar to the way we model and predict weather. What we have instead is a discrete patchwork of theories, giving only enough clues to formulate drugs that artificially manipulate and interfere with these systems in ways that give a host of unpredictable consequences since the drugs coax these systems into states they never were designed to attain.
DISEASE SYNDROMES
Many of the serious diseases that afflict us are not well-defined discrete illnesses, they are part of diffuse disease syndromes which are poorly understood, manifesting a lot of individual variation.
What is a disease syndrome?
You could say it is a collection of several clinically recognizable signs, symptoms, or other characteristics that often occur together. A syndrome often change into a more well-defined disease as a single underlying cause is found.
Should we expect all syndromes to eventually be well-defined diseases with single well-understood causes?
That seems to be a goal for much of the research in medicine. The only problem is that most serious chronic diseases that plague mankind seems to resist all efforts to find simple well-defined causes.
A lot of people have a collection of symptoms that cannot be classified either as a known disease or a disease syndrome. And this is to be expected.
We are all unique, and not only because our genes are unique. We are kept alive by complex adaptive systems that change and evolve throughout our life into what they are at any given moment. The immune system is a good example of this complexity. It changes dynamically through interaction with the environment and is very dependent on our intestinal health and emotional well-being. At any point in time, you are at a unique state defined by various characteristics of these systems. Health could be defined as a stable state where these adaptive systems work together within limits that ensure that the overall balance is maintained.
All systems of the body interact and communicate; there are all manners of signaling taking place via nerves or hormones. Gene expressions are turned on and off all depending on both internal and external factors. We are adaptive feedback-looped systems of almost infinite complexity.
I GET BY WITH A LITTLE HELP FROM MY FRIENDS
And there is more. We also have to take into account that we are harboring large amounts of bacteria that we interact very closely with. This does nothing to reduce the complexity.
In the intestinal tract alone, up to a 100 trillion inhabitants coexist, creating an ecosystem that interacts with our immune system, endocrine system, and our nervous system. These organisms help us digest food, and they manufacture vitamins and all sorts of important bio-chemicals in a remarkable anaerobic bioreactor. 1
The knowledge about these complex interactions in our intestinal tract is very limited. While we sit and pick our nose and play video games, these little critters could for all we know be performing operas and debating philosophy. Some of the noises that manage to escape are in fact very similar in expression to some human opera classics. Well, maybe that is just me.
I digress.
The point is: How could we ever expect to get a reliable and useful diagnosis when go to the doctor to complain about any collection of symptoms? In fact, a large part of visits results in a response similar to:
“Well, the results are back and we cannot find anything wrong with you.”
“You have an irritable colon. This is what we say when we do not know what really is going on.”
Some physicians like to pretend they have complete knowledge:
“We do not have a good explanation to this collection of symptoms. Our tests show nothing out of the ordinary. It must be all in your head.”
IS THERE A BETTER WAY?
You could wish for a more detailed investigation into how well the diverse systems work in our body so that a strategy could be devised that corrects any problems before an actual disease has manifested itself.
What we have now is a phenomenological approach, were you concentrate on finding a discrete set of facts that have been defined as representing a specific disease without delving any deeper into the actual causes of the disease for the specific patient. This must change into a more hands-on, real world approach where you acknowledge that there are shades of grey and more complex interrelationships where a patient can have several symptoms present that does not represent a well-known disease state, but rather a number of slightly malfunctioning systems that work together to create a disease state that is unique to the patient.
It could be argued that this would mean you would have to be the subject of a very thorough investigation, or a research project even that is several years in length.
Maybe there is some truth to that, but you have to wonder how health care would look today if mainstream medicine had been more concerned with understanding and mapping out the biochemical details of a well functioning healthy human with the aim of trying to maintain this state, correcting any fundamental imbalances long before it is too late. Instead, most research is aimed at finding patentable synthetic drugs that interfere with these systems when something already have gone awry.
Maybe there are several contributing factors to this state of affairs, not all necessarily involving the desire from pharmaceutical companies to profit from disease. It could be a simple consequence of the fact that medicine historically always have been busy with saving ill people from death and disease, and most efforts spent have been directed at achieving this as promptly as possible, regardless of the cause of the disease.
Researching life-saving drugs or procedures that alleviates disease is a much more profitable enterprise than the complicated and messy fundamental research that is needed if we ever are going to have a broader picture of the complex systems that keep us alive day in and day out.
Again, I direct your attention to the largely uncharted tubular territory that is at the center of our well being in many ways. Why isn’t it well researched?
Perhaps because most people do not want to spend their scientific career spelunking in the anaerobic tracts of these nether regions. Researching the complexities of the ecosystem in the human digestive tract will not present many opportunities for heroic deeds. And it may not be an activity that generates many suitable topics for polite dinner conversation.
Unfortunately.
PERSONALIZED MEDICINE
Wouldn’t it be satisfying to have your GP draw up a diagram that maps out how your immune status is along with your gut health and hormonal state and a detailed nutritional analysis along with the burden of toxins you carry and then explain how this works together to predispose you to future disease, and then go on to suggest a program of nutrition, exercise and other interventions that serve to correct each of the existing imbalances before your health takes a catastrophic nosedive?
You may object and say that the complexity I have been talking about make this kind of detailed analysis impossible. Also, with all the different populations of gut bacteria, it must be impossible to judge intestinal health.
I would say that it is eminently possible with modern DNA technology. Enter nutrigenomics and personalized medicine.
HEALTHCARE INFORMATION TECHNOLOGY
You could for instance use a DNA database of microbial populations that confer sickness or health and compare this data with samples from the patient. You could use data about gene expression, protein expression, and metabolism to create a personalized treatment plan to correct any imbalances through nutrition rather than using synthetic drugs. All this is entirely possible and represents a breakthrough in healthcare — if it is developed along these lines.
The problem is that the pharmaceutical industry will not benefit from such a development. Consequently, you can predict that they will use their very substantial financial muscle and influence to guide this development towards a focus that is all about disease and the pharmaceutical treatment of disease rather than being about health and its maintenance through nutrition.
Then we still will be stuck with patented synthetic pharmaceutical drugs that alleviate symptoms and interfere with, rather than support, normal biochemical processes, which guarantees that we later will return to the hospital in an ambulance for new profit generating treatments.
It is a failing and outdated paradigm; let your health deteriorate until a well-defined discrete disease manifests itself, after which you attempt to alleviate the symptoms by artificially manipulating a number of complex feedback looped systems through the use of synthetic chemicals.
The good thing about the new developments in modern DNA technology is that the increasingly advanced testing and detailed knowledge about disease processes provides not only useful information about possible targets for new synthetic pharmaceutical drugs: it is inevitable that this also will expand our understanding of the bodily systems that maintain our health.
A REVOLUTION
A new age of medicine is about to emerge. An age that is more concerned with understanding the processes that define individual health. It is also more about maintaining and optimizing this individual health rather than diagnosing discrete diseases that prompts one-size-fits-all pharmaceutical treatments. This will lead to efficient personal therapies based on nutrition rather than synthetic drugs. It is a simple but wonderful notion — maximizing health.
These new developments could serve to make our discrete stay in this continuous world a little longer and perhaps, if we are lucky, even less painful.
We are too much accustomed to attribute to a single cause that which is the product of several, and the majority of our controversies come from that.
– Marcus Aurelius
- 1 Fredrik Bäckhed et al, Host-Bacterial Mutualism in the Human Intestine, Science 25 March 2005: Vol. 307. no. 5717, pp. 1915 - 1920, DOI:10.1126/science.1104816 ¶
