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Although health is the main concern of medicine its exact meaning is not at all clear. Medicine is more concerned with non-health, known as disease. Yet not every disease may be regarded as non-health. Many young adults carry in their arteries arteriosclerotic plaques without any apparent health deterioration. Are these plaques non-health and should they be treated? Obviously health and disease are not complementary. How then to handle diseases that do not impinge upon health?
In the past, health and disease were complementary. The organism was either damaged or invaded by a disease; the distinction between health and non-health was simple and straight forward. Modern medicine continues to rescue the organism from disease, yet the nature of diseases changed. While in the past, sick patients felt sick or "dis-eased", many modern diseases are detected in patients that feel well and healthy. Sophisticated technology reveals slight aberrations that in the past were unknown, e.g., mild hypertension, or a slight morning hyperglycemia. Are these aberrations real diseases? Should a slightly elevated blood pressure be regarded as "essential hypertension"? or; should a mild morning- hyperglycemia be taken as diabetes mellitus? Is an adenomatous polyp, a cancer, neoplasia, or pre-neoplasia? Modern technology confronted medicine with a new problem, how to deal with aberrations in a patient that feels healthy?
Diseases evolve
Technology revealed also that diseases evolve. While ancient diseases fell upon the patient, modern diseases emerge. They start as small aberrations without clinical manifestations. During this pre-clinical phase patient feels healthy. Only when the first symptoms and signs appear, and patient feels ill, disease starts its clinical course. Advancing technology reveals more and more pre-clinical aberrations, and medicine lacks clear guidelines for dealing with them. To wait until they become more pronounced is generally regarded as malpractice. Medicine presumes that the traditional guideline "primum non nocere" results from ignorance and helplessness, and should not be practiced. Yet technological innovations endow this concept with a new meaning, e.g., "Do not harm, and don't interfere until the aberration ripens for treatment". Lacking clear criteria when to intervene, medicine tends to treat whenever an aberration is detected. Some treatments are clearly unnecessary, and yet the specialist cannot refrain from treating, since "primum non nocere" is forbidden. At best treatment is justified as a preventive measure.
Medicine reached a conceptual impasse. While competent specifying how to treat, it generally fails to decide correctly when to intervene in the evolving process. Which is the main source of medical iatrogenesis. In order to correct this impasse, we ought to specify when an evolving aberration turns into a disease, and when a process impairs health? The answer is given by the "Wisdom of the Body". A powerful concept that was applied by W.B. Cannon to describe complex physiological processes like homeostasis (1).
Wisdom of the Body
Wisdom of the Body is an attribute of live organisms. It directs growing plants toward sunshine, guides amebas to avoid noxious agents, and determines the behavior of higher animals, which is studied by Ethology (2). Wisdom of the Body is also wisdom of the species. It is inherited and ought to be distinguished from wisdom gained by experience and knowledge that are not inherited. It is essential for individual survival and was molded by Natural Selection. According to Darwin's theory of Natural Selection, each live being on earth is best qualified to live on this planet otherwise it would have been replaced by a more qualified. In other words the wisdom of today's live forms is most adequate for their survival under the present circumstances. From the medical point of view, since agents causing disease are part of the environment that "selects the best fitted organisms", during evolution Wisdom of the Body encountered all diseases and knows how to heal itself. It anticipates all diseases. According to Guyenot the human organism is "first among physicians" (3) which applies also to all organisms on earth (4). Wisdom of the body is essential for defining health and disease.
First, some definitions. All components of the organism are its norm. Most are not observable. Observable components are the state of the organism. Hostile environment is collectively called noxa. The potential of a norm to withstand a noxa is called tolerance. Noxa poses a threat to disrupt the norm, and tolerance is a measure of norm's vigor to withstand disruption. It is also a measure of norm's health. The higher tolerance the healthier is the norm. Since environmental threat changes, the norm has continually be adapted to meet the challenge, which is done by the healing force. Under the guidance of the Wisdom of the Body, healing force continually adjusts the norm so as to make it healthier as possible. In other words it continually maximizes tolerance. This property is called also normativity (5,6).
The norm of diabetes mellitus are the myriad processes operating in the diabetic organism. Since most cannot be observed, medicine deals with a small set of observable variables called diabetic state, e.g., blood sugar, insulin, nerve conduction, vascular condition, and apprehension. Healing force operates around the clock, continually adjusting all norm components so as to improve health, or maximize tolerance. While it may appear as if a meal affects mainly blood glucose and insulin, it actually affects the entire norm, that is reshuffled by the healing force to improve its tolerance. Diabetes mellitus is more than just blood glucose and insulin changes. Its hidden aspect is controlled by the Wisdom of the Body.
Diseases do not exist in nature
Diabetes starts with minute norm changes that initially are not observable. As the process evolves it is perceived by the physician as disease. In other words the set of norms that call his attention to the patient is called disease. Unlike health, disease is not an attribute of the organism. The notion of a disease is a way to describe certain norms that might interest the physician. It is not a real entity, and does not exist as such in nature (7-9). When planing to treat a disease, the physician should be concerned how treatment affects tolerance (or health), for treatment is allowed only if improving it. Since most norm components are not observable, while the Wisdom of the Body controls them all, in order to treat correctly the physician ought to consult the Wisdom of the Body, otherwise he may harm the organism. Which is summarized by the following guideline: "First evaluate the state of the organism. Then interrogate the Wisdom of the Body. Finally assist the healing force to improve tolerance". This approach was called previously Normative Medicine (10).
The language of the Wisdom of the Body
Throughout history, Wisdom of the Body recurred in different guises. It is known as the primitive or the beastly; it is irrational and selfish. In the arts it stands for the creative, and inspired our myths and legends. It accounts for the healing of Asclepius, shamans, medicine men, and other cults. It communicates with our own consciousness in various ways. First, it makes us aware when we become sick. We never experience health and are aroused only when losing it, when our tolerance declines. Leriche expressed it as follows: "Health is life lived in the silence of the organs" (11). Pain is its most prominent message, but there are many more, e.g., malaise, prostration, exhaustion, weariness, tiredness, lassitude, and weakness. While medicine regards them as synonyms, their meaning is deep and highly relevant to treatment. They are part of a rich language that conveys important information on tolerance. These and other feelings are considered by Homeopathy during treatment.
Part of the language repertory was revealed by Freud and Jung. Symbols, myths, and archetypes, are conscious interpretations of messages sent by the Wisdom of the Body. Dreams may convey information on tolerance, norm changes and adjustments. Wisdom of the Body communicates also with other live forms e.g., prior to mating. Without this communication, mating would be impossible. Simple live forms communicate by chemicals, while higher animals, by complex rituals (2). In humans such a behavior is known as non-verbal communication and body image; it conveys important information on health or tolerance changes.
The Wisdom of the Body concept provides the answer to our opening question, what is health and when to intervene in a disease process. Health is represented by a simpler concept, tolerance, that can be estimated by interrogating the Wisdom of the Body, or by measuring the healing force. Both methods will be explained in the next article. We have now a clear guideline when to interfere in a disease process; only if improving tolerance. Diseases do not exist as such, there are only patients. While medicine treats diseases, normative medicine is more concerned with the patient himself; particularly with his health.
References
1 Cannon WB. "The Wisdom of the Body". Norton, New York, 1932.
2 Eibl-Eibesfeldt I. Ethology, the biology of behavior. Holt Reinhart and Winston Inc. 1975
3 Guyenot in: Canguilhem G. Le normal et le pathologique. translated into English by Fawcett CR, Cohen RS. Zone Books New York 1991, p. 130.
4 Zajicek G. What is disease? Cancer J. 4:296,1991.
5 Zajicek, G. The Normal and the Pathological. Cancer J. 7: 48-49,1994.
6 Canguilhem G. Le normal et le pathologique. translated into English by Fawcett CR, Cohen RS. Zone Books New York 1991.
7 Zajicek G. Ludwick Fleck: Founder of the philosophy of modern medicine. Cancer J. 5:304-305, 1992.
8 Cognition and fact. Materials on Ludwik Fleck. Cohen RS and Schnelle T. Eds. D. Reidel Publishing company, Boston USA, 1986.
9 Lowi I. The immunological construction of the self. in: "Organism and the origins of the self". Tauber A.I. Ed. Kluwer Academic Publishers Norwell USA. p 43-71,1991.
10 Zajicek G. How to treat cancer? Cancer J. 7:132-133,1994.
11 Canguilhem G. Le normal et le pathologique. translated into English by Fawcett CR, Cohen RS. Zone Books New York 1991 p 91.