editorial
Secondary polycythemia - Carlos was seventy years old when he decided to
leave Buenos Aires to join his daughter's family in the Andes. The joy of reunion
was short. On the next day Carlos was overwhelmed by prostration and shortness
of breath. He remained in bed waiting for the physician to save him. Hitherto
he had enjoyed good health, and never experienced sickness. Was his suffering
a token of his advancing age? The doctor noticed tachypnea, anxiety, and a slight
hardening of the radial artery due to arteriosclerosis. He turned to Carlos: "You
lack red blood cells. Here in the Andes, the air is thin, and the body needs more
red blood cells to get enough oxygen from the lungs. Don't lose hope, soon their
number will rise, the tissues will get their accustomed share of oxygen and you
will feel better. Stay in bed until 'The healing force of Nature' (1)
fulfills its task."
By the following week Carlos could accompany his grandchildren to the play-ground.
After two weeks he nearly forgot the sad incident. There remained only a slight
and nagging shortness of breath, that he hoped will soon disappear. Yet it did
not. His condition worsened, he felt palpitations, and head throbbing. He took
refuge in his bed and waited for the physician to save him. "Your red blood cells
are fine", the doctor said, "but the blood has become viscous and your heart is
failing to push it through the tissues." In the following weeks the doctor attempted
to balance his condition but in vain. Although blood letting would alleviate the
burden on his heart, it would deprive his tissues of oxygen. Soon Carlos and his
physician realized, that the only solution for his ailment was to return to Buenos
Aires. And so he did. He recovered and remained healthy ever after.
What is the cause of Carlos' disease? - This simple narrative illustrates
the inadequacy of medical concepts when applied to Carlos' illness. By joining
his daughter, his normo-cytemia turned into a relative anemia. And when his blood
count rose, to the normo-cytemic level of the Andes, his arteriosclerotic heart
failed to cope with it. What was the cause, or etiology of Carlos' disease? Relative
anemia, reactive polycythemia, heart failure, or simply his decision to join his
daughter's family? And what would be the adequate cure for such an ailment? Blood
letting, digitalis, or simply the decision to return to Buenos Aires? Although
Medicine regards Carlos' ailment as multi-factorial it continues searching for
a single etiology. Yet most diseases lack an unique etiology. Even the concept
of cure seems inadequate. Was Carlos really cured? At best the patient regains
his balance, or remission. A real cure is only seldom attained.
Essential hypertension - Imagine Carlos in a different setting. At the
age of 40, he was a successful broker, manipulating stocks. Sometimes he awakened
at night concerned about their volatility. His recent checkup revealed a slightly
elevated blood pressure, yet Carlos felt good and continued his hectic life. At
the age of 50, Carlos started swallowing capsules despite their small effect on
his rising blood pressure.
A crisis in Eastern stock exchanges swept Buenos Aires like a storm. Carlos, who
profited mainly from Japanese equity, lost his fortune, and was broke. By then
he was 60. He still got a small pension, decided to see the world, and landed
up in India. He soon mastered the art of Yoga, and realized that his blood pressure
hadreturned to normal.
What is the cause of Carlos' disease? - Was Carlos the broker ill? According
to Medicine he was, since essential hypertension is regarded as "the silent killer".
On the other hand, a slightly elevated blood pressure might be a pre-requisite
for the life-style of some brokers, exactly as a slightly elevated red blood cell
count is for living in the Andes. By joining the brokerage, Carlos' normo-tension
turned into a relative hypo-tension and he had to raise it to a new level that
represents his normo-tension as a broker. His heart was strong, otherwise he would
have developed congestive heart failure, like his counterpart in the Andes. What
was the cause, or etiology of Carlos' disease? Relative hypotension or reactive
hypertension? Or simply his decision to become a broker? And what would be the
adequate cure for such an ailment; hypotensive drugs, sleeping pills or simply
going to India? Although medicine regards Carlos' ailment as multi-factorial.,
it is pre-occupied with blood pressure, regarding it as the sole cause, or etiology
of his condition, and claiming that the only way to cure essential hypertension
is by lowering it.
Prostate cancer - Carlos was always a believer in preventive medicine.
"One ought to overpower disease when it starts", he said to himself and sent his
blood to have his PSA checked. It was elevated, nourished by a small tumor in
his prostate. Suddenly he was declared sick, carrying a deadly illness.
Was Carlos really ill? According to Medicine he was, since cancer is regarded
as a killer. Yet this small nodule might be the pre-requisite for the life-style
of certain men in their seventies, exactly as a slightly elevated red blood cell
count is for living in the Andes. This might also be the reason why every second
male above the age of 65 carries an occult cancer nodule in his prostate (2)
(3). True, prostate cancer may kill, but not always.
Other factors seem to determine who will succumb. As in reactive polycythemia
that is generally not accompanied by heart failure. Yet medicine does not regard
Carlos' ailment as multi-factorial, and blames only the tumor for his condition.(4).
The tumor is only a single facet in a multi-factorial puzzle. Like an elevated
red blood cell count in polycythemia, or blood pressure in essential hypertension?
The search for a common pattern in seemingly unrelated diseases illustrates how
poor medical reasoning still is (5).
Gershom Zajicek
1. Zajicek G. Healing force of nature. The Cancer J
8, 4-5,1995
2. Zajicek G. Watch your prostate! The Cancer. J 10,
70-71,1997.
3. Zajicek G. Cancer in old age is more benign than
in young adults. The Cancer J 9, 64-65, 1996.
4. Zajicek G. Cancer starts as a systemic disease The
Cancer J 5, 28,1992
5. Root-Bernstein RS. Rethinking Aids: The Tragic Cost
of Premature Consensus. New York Free Press, 1993.
