Yabluchansky M. My principle of the disease optimality. For doctors indeed. 2002.
The principle of disease optimality defines its norm, the optimal variant when a patient pays a little payment by his/her health for a qualitative recovery. “Whales” of the principle disease optimality are philosophy of health and disease, theory of optimal processes, and a principle of optimality in biology. The principle of disease optimality proves a strategy and a tactic of a treatment of a patient through its normalization by bringing to the conditions of an optimal variant. New clinic could be established on the principle of disease optimality.
This book writes for physicians and their patients and for everybody who care of the private health.
Instead of introduction
It is the beginning of the century. Expectations for the changes are being justified.
For me, as for a doctor, the most important part is a professional part. There are a lot of new things here. They are not in the trifles, but in the philosophy of the subject.
I became the participant of a doctor’s perception his/her role in medicine and the role of medicine in the society. It gave us a lot of useful things. The example, which I use not for the first time, is intervention of the ideas of the optimality to the clinics. I was lucky to summarize them as the “principle of the disease optimality”. The principle is the local application of one of the most fundamental natural phenomena, which is known in different spheres of natural sciences.
In the references one can find an incomplete summary of publications on this theme. The main works of the author in this important for me sphere are included there.
In spite of the locality of the principle, its sequences for the medicine I see as revolutionary in the real understanding of this word.
The principle intuitionally justifies corrected by the time and recognized by the medical society philosophy which is build on the trust to the nature, effective use of its constructive motive forces.
For me, the century we entered is the century of optimality.
In the furious pace of life there is a time deficiency. There is lack of it for the “other’s” ideas. Especially there are a lot of them in the thick books which are like anachronism on the stage of effused to the endlessness medical science. That is why it appeared an idea of my small book – distillation of my own thoughts on the topic of disease optimality.
The way how the philosophy of disease optimality is accepted is a question for me, its author, but not for the philosophy by itself. It already exists according to its own independent laws. I know many doctors, professionals, who not only like this philosophy, but this philosophy also helps them in their routine work.
Probably there are doctors who didn’t accept this philosophy because they didn’t understand it. However, there are more doctors who didn’t come across it.
I wrote this little book to promote faster dissemination of the philosophy.
You, not me, can judge this publication, but I did my best.
I will be grateful for your criticism and suggestions.
The theme of the disease optimality is important for me, and I will not leave your reaction without the answer.
You can write on one of the emails: firstname.lastname@example.org, email@example.com.
Prehistory of the principle
A clinic is in crisis.
The crisis is conditioned by many reasons. In the list there are economic, social, ecological, and, naturally, medical problems.
For me, the medical problems are concentrated in incorrect understanding of diseases. This incorrect understanding being out of the reality of modern life, leads to the false diagnosis and treatment decisions.
According to the faulty philosophy dominating in a modern clinic diseases are opposed to the norms of health, and the condition of a patient is evaluated by deflection from the norms of a healthy person.
By this philosophy the actions of a doctor are directed to the “normalization” of functions and structures of a patient in the sense of bringing to the norms of a healthy person. It doesn’t mean what a price is and if it is possible.
Endless line of tests and mistakes in the patient management proves that this philosophy is dead-end and defines the crisis of the clinic.
The example is the acute myocardial infarction. Its history is in “insistent” refusals from every time appearing new “promising” treatment methods.
We needed years to become sure that:
• Steroids limit the infarction zone but complicate its recovering
• Indirect anticoagulants (out of thrombolitic therapy as a compound link) increase the risk of thrombo-embolic complications.
• Non-steroid anti-inflammation means lead to the development of post infarction heart aneurism in a case of a wrong prescription.
• Coronaroactive remedies in systematic use “rob” the infarction zone.
As a result a prognosis and outcome of the disease becomes worse.
In majority we continue thinking that a disease is not a natural condition of a human life; and that only the norms of a healthy person have a right for existence in the world which we created.
I see a crisis of a modern clinic in this approach.
A Disease should be Normal
The reason of a clinics crisis is in wrong understanding of health. The sequence of these misunderstandings is a wrong approach to a patient, disappointment in the basis of a clinic.
Let’s analyze a formula “sanos-patos”. Everything is correct in it. Two measures are opposed – the measures of disease and health.
There is a trouble with the formula “norm-pathology”. Health is reduced to the norm. A disease is opposed to the norm.
I will explain my idea; it is clear.
In philosophy a measure – a category and a norm- is an idea connected with the measure. If we have a measure, we should have a norm as it goes without saying.
The norm is one of the parts of the measure which is rather limited defined by the aim function. Under the aim function we understand a norm. One aim is one norm. Unlimited number of aims leads to unlimited number of norms in the same measure. Moreover, every norm is concrete.
Let’s take an example from an engendering. A bulb. It can be used beginning from a part of a second until some years. There is a norm – a bulb is ok if it can be used during a certain period of time. There are a lot of bulbs. They are different. Even I know few dozens: from the torch bulbs to usual lamp ones. Each of them has its own norm.
Let’s take an example from sport. Sportsmen’s achievements are different in sprint, football and baseball,… if we make a champion in sprint to lift a weight, and a champion in swimming or chess… the result is not too difficult to predict.
Another example is from education. There are different educational standards in economics, mathematics, and medicine. Every standard is a norm. Two young people, who are twins, differ because they graduated from different departments. They had different educational standards. Everyone confirms his/her own standard, his/her norm of education. In all the examples the norms are connected with the aim functions. A bulb should work not less then…; sportsmen should run not more then…; a certain student should have an exact amount of courses, have a definite number of exams according to his/her specialty.
A measure of a disease cannot exist without norms even inductively; the same as a measure of health; the same as any measure. I formulate a norm of a disease as a variant when a patient pays a minimum payment by his/her health resources.
The idea of a norm of a disease is much wider then the idea of a norm of health.
There can be a variant of a particular disease with its particular characteristics in a certain patient, with concrete geno- and phenotypic determinants, with social, ecological and other conditions. These exacting diagnostic and other characteristics are typical for this moment of a disease development.
The aim here is a variant when a patient pays a minimum payment by his/her health recourses for a disease under certain conditions.
I want to stress that a local root of a mistaken approach of a clinic is partly in a fact that correct construction “sanos-patos” is opposed to the incorrect one “norm-disease”.
A strategy when parameters of a patient are brought to the norms of a healthy person is mistaken.
“Normalization” of a heart output and frequency of heart contractions in understanding of the norms of a healthy person in the case of a heart failure damages a heart and shortens a life.
Reasonable decrease heart output and increase of contraction frequency is one of the mechanisms of compensation of heart pump dysfunction.
Hyperthermic syndrome in a case of an acute pneumonia corresponding it severeness is necessary condition of a qualitative recovery of a patient.
Gastroenterology again got into trouble: now it is anti-helicobacter pillory therapy of a ulcer disease. I don’t know if it is good or not but the risk of oesophagus tumors and other complications increases. The world is excited. Not so long time ago it was inspired to forget everything that was worked out in its treatment before.
There is numerous numbers of examples.
I admire how the ancients understood health and disease: “health is natural in human under certain conditions; under other conditions a disease is also natural…” (Golbah).
“Remedy” for a modern clinic
Philosophical analysis of health and analysis predetermines spread of optimality ideas on clinic.
The problem of patient treatment according to this idea is formulated as a strategy of optimal management which provides the most favorable (optimal) from all other variants flowing of a disease.
The strategy of optimal management is a subject of a research of mathematical theory of optimal processes which is the most common instrument of an optimal solving of management tasks.
In the frames of this theory a patient management can be considered as a particular task.
The theory was created because of engineering demands and it became one of the most perspective directions of modern mathematics.
It gives methodology and methods of finding of optimal management:
A) Optimality in a meaning of getting an aim of a process for the shortest period of time;
B) Optimality in a meaning of getting an aim of a process with the minimum inputs of resources.
The tasks which a doctor solves in his/her work with a patient are management.
Diagnostic and prognoses are intermediate stages.
There is only one aim – to help a patient; to do the best to make a treatment or, in the other words, to make management.
That is why a mathematical theory of optimal processes is a “remedy” for a modern clinic.
Through principle to a new clinic
Natural spread of the theory of optimal processes on a disease in its philosophical understanding leads to formulation of a principle of disease optimality.
The principle states – the only variant is optimal which needs the minimum payment by the resources of health.
The principle soared hovered for a long time; but it isn’t and wasn’t understood in a right way.
G. Selye wrote: “is it possible to improve a natural defending mechanism? A theory “nature knows better” is seems to be rather applicable to adjustments. It is considered that… a natural selection … gradually developed the best possible defending reactions. But it is not so. We often can improve nature by suppressing the reactions which were developed for a defense but not necessarily useful under all the circumstances”.
There is a mistake here. Violation of optimality of a mechanism selected by nature is considered as its non-optimality.
I like the ideas of I. Davydovsky: “biological expediency of inflammation as natural spontaneous act doesn’t mean that this act in individual conditions is always necessary or that it conducts an absolute defense and “targeted” on it… a doctor faces a necessity not only to see spontaneous automatically developing processes of inflammation, but also to interfere before it starts”.
Please note; according to I. Davydovsky a doctor should interfere to an inflammation process only in a case of violation its natural (spontaneous) progression.
I think that the basis of the principle is fastened genetically as a mechanism of recovering. This is the way how nature selected them.
The aim of a doctor is to help a patient to go through a disease with the minimum losses. This is a real philosophy of family doctors.
The principle makes basic changes into the methodology of patient management. Its main point is optimal management. The sphere of the use of optimal management in the sense of fast actions is mainly in urgent conditions and in the sense of losses minimization is in a whole clinic.
An optimal progression of a disease provides:
1) Qualitative recovering in a case of acute forms;
2) Stable remission, less often and not severe complications in chronic forms;
3) The best possible quality of a patient’s life.
“Arrow of time” and reversibility of a disease
Aspiration to improve is always present in the world.
G. Selye, whom I quote in the previous paragraph, is not the only one.
Our post soviet space in contrast to the others accumulated a lot of experiences of planetarium size. It is easy for us “to make a fairy tale a reality”. It doesn’t matter that it is a fairy tale. The problem is we have to pay for it. And sometimes it is too expensive.
Normalization of a patient’s condition in a sense of bringing his/her functions to the norms of a healthy person is equal to the nature improvement, because a priory is allowed, it is axiomatized that nature is not perfect.
I want to insure you that this theme is more serious then just thinking about imperfectness of nature. Our (western) philosophy was built under a pressure of deterministic ideas. Of course they have a lot of clever things, but the most important ones go from classical (Newton) mechanics.
Deterministic ideas which are realized according to abstract mathematical tools, which were fixed for this mechanics, allow the existence of reversibility of time.
A representative of an exact science who is based on a deterministic platform would say: “give me a law and a reference point and I will predict the future and the past”.
It is right. He will do it. But this prediction in our real world doesn’t worth a pin. Real world is not deterministic, but it could be. Deterministic world is a rude idealization of a real one. Deterministic world is not alive; it is dead, and it doesn’t allow development.
Human nature more then a real world despises deterministic per se. The same related to the reversibility as well as in a narrow medical understanding.
The ancients said that it was not possible to come into the same river. I understand it in a meaning of impossibility of reversibility.
It is not understandable how we could loose this divine philosophy. East is wiser. From the ancient times they accept nature as a spontaneous harmony and put it into the deterministic frames is the same with subordinating it to the external power. Get know the Chinese pulse diagnostics. The problem is if the characteristics of pulse are disharmonious with the health condition of a patient. It is a catastrophe when a sick person has a pulse of a health one.
Making a research about order and chaos, definiteness and indefiniteness I. Prigozhin comes indisputable conclusion about deterministic – probabilistic world organization and the existence of the “arrow of time”. In the other words he confirms one of the most ancient philosophies of the irreversibility of a developing world.