Acute infection

Sore throat is driven by microbes.  When infection starts, WOB  restructures processes to meet the threat. On the local arena it mobilizes an inflammation, manifested by  a locally elevated temperature, redness, swelling and pain. These classical signs of infection were known to the ancient Greeks and Romans like Celsus ( calor, rubor, tumor, dolor  et  functio laesa). They  actually have two meanings:

1. From  WOB perspective they are solutions to curb infection. WOB first increases local blood flow (vasodilation), raising  the supply of resources to combat infection. This accounts for  a local redness, swelling and warmth. Pain  stiffens muscles and makes them still. Unnecessary muscular activity like swallowing might promote the invader to other tissues. Fever, prostration, weakness, and the loss of appetite are (systemic) WOB solutions.  Some microbes thrive less in elevated temperature. Weakness and prostration force the patient to rest and save resources which are diverted to the throat.

2. These symptoms are also messages  from  WOB to the mind. Pain and discomfort, instruct the mind to seek help.  They are also messages to the physician, indicating WOB state.  As long as WOB does not complain and there is no pain, physician may watch and wait, since WOB still controls the new situation.

Treatment decision space

Physician has to decide when to interfere, and how vigorous treatment will be. Treatment intensity  and timing are two parameters in his decision space. A decision space consists of a set  of WOB signals and their  appropriate treatments.  The signal set consists of  systemic and local signals like those mentioned above. Each signal may be treated separately . Fever is reduced  with aspirin,  Gargles of cold water soothe the throat, and so on. Antibiotics are the most effective. With all these options at hand, physician has to decide when to start treating and  how intense treatment will be?

Decision space  = DS(i+1) = {[m( i ), t( i, p)]}  is the set of binary relations between WOB messages (m)  and appropriate treatments (t ). m:  WOB message t: Therapy p: intensity i: Now i+1 : Next

Infection is an experience

It seems reasonable to start treating an infection as early as possible since the microbe population (D(i)) continually grows. However such an approach ignores  that infection is an experience, which teaches WOB  how to cope with it so that in the future it will handle it better.  Immunology distinguishes between innate and adaptive immune system. The first is inborn, while the second learns from experience. However WOB experience us more than that. The entire body  learns from this experience and not only the immune system. WOB learns to respond more swiftly and efficiently. On the local arena, WOB learns to mobilize capillaries (angiogenesis)  more swiftly and brings more resources to the scene. It may learn also how to withstand infection  at a lower temperature.  Experience teaches WOB how to create better solutions. 

Infection trains WOB

Since infection trains WOB to handle future infections better,  an effective training requires to  delay  treatment. You might compare this experience with athletic training, when your will (mind) becomes the driver (D(i)) . The longer the daily training, the better the result.  Athletic training  is more than just muscle building. The organism learns  how to utilize resources more efficiently and this is also the essence of infection training.

You may notice that from WOB perspective the drivers (D(i)) of infection training and athletic training are the same. WOB is  unaware of the driver's nature.  It regards  drivers  as a challenge for which it creates an optimal solution. "Driver"  is a medical concept  to assist the physician in designing a therapy.

How  long should a therapy be delayed?  It  depends on the patient's condition. A strong youngster may wait, while a fragile elderly ought to be treated sooner.

Influenza experience

Each year a  flu epidemic sweeps  the globe and WOB has to handle an ever changing virus. Nevertheless it gets smarter, since flu experience is more than  an  immunological memory. Following every flu WOB becomes more efficient.

Resistance and tolerance
In order to decide when to treat we need a measure of the patient's reserves, which is called here tolerance, or resistance to a challenge.  The French philosopher Canguilhem   defines health as follows: . "Health is a margin of tolerance for the inconsistencies of the environment". "To be in a good health means being able to fall sick and recover". Tolerance is discussed in the chapter  on "Health measure". In the present discourse health is a WOB signal unrelated to tolerance.  The French physician Leriche said: 'Health is life lived in the silence of the organs' (1). Only WOB indicates to the mind when it is sick.  A silent WOB is healthy.

Tolerance is a measure for patient's reserves. The image below depicts schematically a tolerance of an untreated infection. Initially tolerance declines and when patient recuperates it raises.  Please note that health is unrelated to tolerance. Health is regained when WOB regains control and stops complaining.

The next image depicts a patient who was treated when infection began. His tolerance declines less and he gets healthy sooner, however WOB is not trained.

Mind disease

Training requires motivation to endure suffering, and  motivation is a property of the mind. Some patients  may suffer even their illness is negligible. When treating a patient the physician ought to consider also the mind which transmits to WOB how society regards its particular  disease. Mind's attitude to infection is called  mind disease, (here  mind infection). A negative attitude raises anxiety  which wastes resources and declines tolerance. Mind disease in AIDS is far more risky than in sore throat.

Early treatment  reduces  anxiety, and renders mind disease milder. WOB may gain more from an untreated infection, yet mind refuses to accept WOB solution and insists on a better  life. Physician has  to work out  a compromise between WOB solution and mind demand.

Therapeutic margin of a drug

Two processes determine the evolution of  an infectious disease: Driver, and WOB (solution).  Therapy has to consider both. Antibiotics treat the driver. When antibiotics slow down microbe proliferation, WOB needs less resources to  withstand  the invader.  Then come measures to support WOB, like aspirin  for reducing excess temperature. Driver treatment may be somewhat toxic to WOB, which will  require additional  supportive measures to avert driver toxicity.  Like over-hydration to protect the kidney.

The benefit or harm (negative benefit)  of a treatment  depends on its effect on  tolerance. The therapeutic margin of a drug, like an  antibiotic is generally  defined by the ratio   potency / toxicity. Here the therapeutic margin is defined by its effect on tolerance. If raising tolerance it is acceptable, and vice versa. A therapeutic margin of a drug may be raised by supporting WOB against drug toxicity. Like the above mentioned over-hydration which by protecting the kidney, reduces tolerance decline, and  widens the therapeutic margin of the antibiotic.

Antibiotic treatment is an experience

Let's return to the untreated patient mentioned above. By withholding antibiotics from the patient, WOB is protected from their toxicity. On the other hand, antibiotic treatment is a WOB experience which may assist it to handle future infections requiring  antibiotics. Such a  reasoning highlights the importance of tolerance and  WOB experience when planning therapy.

Chronic uneventful disease

In  most chronic diseases  the driving process is unknown. However its intensity can be inferred from WOB behavior.  The disease evolves from one WOB solution to another, always maintaining homeorhesis (homeostasis). At any instant WOB controls the disease, only its resources (tolerance) decline.  Since the driver is unknown and cannot be eliminated like in infections, therapy is directed to slowing down disease progression, which means to slow down resource depletion and maintain an adequate  body function

From the medical perspective, declining resources drive the chronic disease ( D(i) ) and  the formula describing disease progression remains the same. R(i+1) = {D(i), W(I), M(i)}. Each of the three components has to be considered.

1. Resource depletion  D(i)

The amount of resources in the body depends on their input (uptake) and output (utilization).

Input

Therapy starts with a balanced  diet. Some resources may be particularly vital. Other may be depleted at different rates. Medicine favors specific replacement of missing substances like vitamins and hormones which has two drawbacks: 1. Hormone replacement impedes internal hormone production. 2. The optimal dose  is generally unknown and may vary as disease progresses, so that even a small dose may be toxic. Like during a sub clinical kidney weakness which is not yet  an overt failure.

A balanced diet lets WOB  choose whatever it needs. Any other routes of resource replacement like injections, or infusions, ought to be postponed as much as possible. This approach is meant far an uneventful  disease progression. In acute conditions an aggressive and invasive approach might be necessary.

Output

In most chronic diseases many missing substances are unknown, and when they cannot be  replenished with food,  treatment ought to improve their utilization. Like in angina pectoris. (see also WOB boosting , when  the patient suffers from a relative (internal)  oxygen deficiency. Gradual and careful sport  activity  strengthens his  respiratory muscles, and improves oxygen input. Activity trains the body (WOB)  to utilize oxygen more efficiently.  Its output (utilization) declines and so does oxygen deficiency.

Resource diversion

When the above measures are exhausted,  one may attempt to divert resources from less vital organs to the more vital. Fainting is such a measure. WOB eliminates the mind (consciousness), patient faints, periphery requires less oxygen, and it is diverted to the brain. This is also the rationale of putting a patient to bed.  Or applying ancient  Chinese martial arts to forward dopamine to vital brain areas.
 
2. WOB boosting  W(i)

As disease progresses WOB learns to handle it better, and becomes more efficient, which is most pronounced in cancer.  Hazard rate is the epidemiological manifestation of tolerance. When tolerance declines, hazard rate rises and vice versa.  It is striking that as cancer progresses its hazard rate declines. The longer the patient lives the better his chances to survive. Since however his tolerance declines he ultimately dies. In other words, the outcome of cancer depends on two factors, WOB boosting, and tolerance.  Although WOB learns to slow down tolerance decline, by itself it is unable to replenish resources, and  patient dies.

A Cancer-Yogi  trains her WOB to save resources, and slows down  cancer progression, which may be expressed metaphorically that she puts  her cancer to sleep .

3. Mind  M(i)

Mind depends on how the society faces a particular disease (R(i)). The prevailing notion that cancer is a death sentence makes the patient with a minute tumor  miserable,  in spite of the fact that WOB is silent and  she is healthy.  Her misery  is called mind cancer. At this stage of her disease it poses a greater threat than WOB cancer. Now meditation or guided imagery are extremely efficient.
Placebo is an effective measure for many kinds of mind disease.

Etiology

The relationship between microbe and host illustrates how medicine views disease. A disease is caused by an agent, which is regarded as  etiology of this infectious disease. In order to cure infection  it suffices to treat its etiology. Unfortunately in most chronic diseases  etiology is unknown and medicine assigns to such diseases an arbitrary etiology. For instance, replication error is the etiology of cancer, or an  error in the control of  carbohydrate metabolism is the etiology of diabetes.

Despite such a narrow and linear interpretation of disease, the hunt after etiologies advanced medicine to its present state. Like the  discovery of vitamins, hormones and antibiotics.  Ultimately medical science hopes to discover  etiologies of other diseases like cancer. Treatment will be better yet the guidelines presented here will not change. While medicine regards the organism as a complex linear  machine, in reality it is  extremely complex  and non linear.  It cannot be reduced to its elements and has to be treated as a whole composed of a Driver, WOB and Mind.

Reference

1. Canguilhem G. Le normal et le pathologique. translated into English by Fawcett CR, Cohen RS. Zone Books New York 1991 p 91.

The complete model: R[i+1] = R[D(i), W(i), M(i)] W[i+1] =  W[D(i), M(i)] M[i+1] =  M[R(i), R(environment, i)] R : Resources D:  Disease driver. W: WOB M: Mind is the interface between WOB and  environment. R(environment) : resources supplied from outside. i:  Now i+1 : Next -------------------------- Initial conditions: R(zygote) = R(sperm) +R(ovum) During embryogenesis M is the placenta During the first weeks  after birth M is mainly the mother. WOB solution: W(i+1) = Max[R(i)] Disease-Yogi(i+1) = Max[R(i) + R(environment , i)] Therapy(i +1) = Max[R(i) + R(environment, i)] Death: R(i)  = 0

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