Why is Medicine the way it is? Part 1/2
After the first episode of this blog you will understand why you feel your medical practitioner can only explain so little while being confident the proposed treatment is absolutely best for you.
As a science medicine is quite interested in how the human body functions and how diseases come about itself. But before anything else medicine is preoccupied with the question: “What is the most rational action one can take to improve healthiness in this particular patient?”
Probably most rational would be to act upon the cause of unhealthiness.
Every bit as rational would be to use experience from prior cases deemed equal to this new case.
However, since most causes and diseases remain largely unexplained some assumptions must be made to guide this rational action. To take back new knowledge from beyond the borders of what is actually known, one has to bring an idea.
The following phrase is probably the most important medical idea: “One cause, one disease”
In many ways this saying has contributed to the shaping of medicine. Now there is a lot one can say about “One cause, one disease”. First of all, what is actually meant by the words ’cause’ and ‘disease’? We will go into that in later posts. Let us take for now that neither ’cause’ nor ‘disease’ is clearly definable.
Back to the terms in the saying. More than just a number, ‘one’ is expressing something to be a whole, a single entity. We will explore this concept of ‘wholeness’ or ‘oneness’ by looking at what it means to be either identical, equal or similar.
Subsequently we look into how this applies to ‘disease’ in a series of cases of a specific disease and reflect on what this implies for the cause of this disease.
Then, we discuss how useful ‘One cause, one disease’ is in respect to different aspects of medicine. We show that disease and cause cannot be defined under the same set of rules.
In the end, to have a more comprehensive conception of how medicine works we will divide medicine into two domains. On the one hand medical practice responsible for crisp diagnostics and effective treatments but without any explanatory obligation. On the other hand the rest of medicine now fully responsible for the explanation of diagnosed diseases and their causes. In this process of separation this new part of medicine not only loses the obligation but maybe also the ability to clearly separate a cause from other causes and a disease from other diseases.
In future posts we will see how this separation enables the generation of powerful explanatory models that transcend the concept of causality.
Identical, equal or similar?
But first, how can equal things be distinguished from similar things on the one hand and identical things on the other? And what does this mean for cases of a disease and the attributed cause?
In brief, identical things are the same. Unquestionably, it might seem. However, when the slightest detail is utterly important, even identical things might no longer be the same. For instance two airliners of exactly the same make one of which has micro cracks in a vital mechanical part. Definitely these two planes are not ‘the same’.
Equal things are only ‘the same’ in respect to the purpose they serve. At a static show the two airliners will be equal and hence ‘the same’.
Similar things just look alike but are not ‘the same’.
Coming back to “One cause, one disease”, in what way are cases of a disease ‘the same’? Does the saying mean that disease is identical in each case?
Or is disease equal among cases?
Or just similar?
In the same way, must we perceive the cause of this disease as identical in each case of this disease? Or equal?
Or similar?
In the end, each case of a disease has its own unique presentation, development, test results, outcome etc. Therefore, it seems each case is unique in having the disease. Therefore, ‘disease’ is not ‘the same’ in every case. If ‘disease’ is not ‘the same’ in every case, than, the cause must be slightly different in each case.
Therefore, as seen from the perspective of their uniqueness cases are appearing to be nothing more than similar among them.
Meanwhile, there is a staggering amount of overlap in presentation, development and outcome of the individual cases. Way too much for the cases to be nothing more than just similar. This very same uniqueness of cases however, makes it difficult to plainly qualify these cases as equal. A conclusive argument for the cases being equal would be definite proof of cause and disease being one. This proof would in fact be nothing less than a full explanation of the disease and its cause. Therefore, let us qualify the extend of sameness of disease in a series of cases as somewhere in between ‘similar’ and ‘equal’. From the above follows that the respective cause of disease in each case of this series is not identical but somewhere in between ‘similar’ and ‘equal’ as well.
Back to ‘One cause, one disease’, as long as disease and cause have not been explained fully, how can we be sure any ‘one disease’ cannot result from two different causes?
Or, why should we exclude the possibility of ‘one cause’ leading to two separate diseases?
What would happen when finding out a certain disease actually does have not just one single cause but two different causes? In a quite mathematical way, from the proverb ‘One cause, one disease’ would logically follow that this disease was not one but two. This shows ‘One cause, one disease’ carries in itself some form of circular reasoning where cause and disease actually are like blending together. Analogously to a public address system where the output sound can re-enter back into the microphone: the output equals the input, the input equals the output. This merging of cause and disease is accentuated by the form of the saying. It actually resembles a mathematical equation:
“One cause = one disease”
cause = disease
In this blending of cause and disease there remains no place for the individual. Individuals have been cancelled out like in a real mathematical equation. The substrate for this cause and disease however remains the human body itself. Since there are lets say a thousand diseases, the human body is obviously more complex than any single cause or disease can ever be. This is why cancelling the human body out from this ‘medical equation of unknowns’ comes in especially handy. According to the saying the only unknown variables left now are ’cause’ and ‘disease’. Each of which is ‘one’. Even though they got blended together. Into one? How can cause and disease be ‘one’ if the one is to lead to the other?
Thus, the saying does not specify how cause and disease should be conceived. Unfortunately, the saying also remains unclear on how the word ‘one’ should be understood. How identical, equal or similar are cause and disease in every instance we might encounter them?Nevertheless, the circular reasoning built within ‘One cause, one disease’ boldly declares the saying itself to be unquestionably true. Here, the saying leaves no room for discussion. This however conflicts with the scientific proceeding of relentless questioning every instance of things being accepted as truth. There is no scientific method to prove our saying is true.
A generally accepted approach would be to make multiple observations. Ideally many observations agree with the supposed truth while no disagreeing observations are being made. Here our saying performs rather poorly. ‘One cause, one disease’ has been validated only for a handful of infectious diseases and an array of genetic conditions. Still, enough examples of infectious and genetic diseases exist where the infectious agent or corrupted gen are present in the absence of disease.
The cause of a disease therefore is obviously more complex and less ‘one’ than ‘One cause, one disease’ seems to suggest. In the same way we must conclude that there is more to a disease than being just one single invariable entity.