The Practice of Quantitative Medicine
The study of high energy physics has been compared to finding out how a watch works by throwing it against the wall to examine its parts. If you think of high energy colliders like CERN- the organization’s name is now used for the accelerator itself- that is pretty much how high energy physics is performed: accelerate sub-atomic particles to barely sub-lightspeed and then watch and measure the debris when that accelerated particle smashes into some other particle. While this is not very elegant it has proven to be a very useful way to understand sub-atomic physics. Historically and, of necessity, this process followed the development of a theoretical model proposed by everyone from Ernest Rutherford to Niels Bohr. Those early men engaging in atom smashing had a picture in their head; the picture was refined by subsequent ‘watch smashings’ and the enhanced picture led to even more fruitful ‘watch smashings.’
One problem with modern medicine is most of the research has been like that watch experiment but without the benefit of a picture previously in mind. Really. Examples abound: cholesterol was found in vascular plaque so the decision was made to get rid of cholesterol! And we were off on a 50 year quest to kill one of your body’s best friends. Did anyone stop and say, hmmm, maybe cholesterol is there for a good reason and being found at the scene of the crime does not make it a criminal? Surely someone did, but their voice was drowned by the howl of the mob. Something went awry from the microscope to the pharmacy. I can give you many examples of such errors in logic that could only happen with a mistaken and limited view of human biology.For now bear with me and I will give you a picture which, I hold, has a kind of inevitable logic to it and that creates a productive theoretical model for medical research and, for now, more importantly, for the day-to-day practice of medicine.
Fiat Lux. Let there be light. From the beginning of the universe through nucleo-genesis and stellar evolution to planetary evolution and biological evolution to social evolution there has been an unbroken chain of the possible that yielded the current estate of mankind. Whether or not you see a need for agency acting in all this- someone or some force acting or causing- it is clear that we are in the era of the agency of mankind. We think, we propose, we plan, we do.
Along that chain of the possible, key elements were formed- carbon, nitrogen and oxygen first come to mind- and certain planetary conditions – not too hot, not too cold- were necessary to allow early forms of life and certain geophysical conditions- the drift of the continents- were necessary to allow a broadly adapted human species to proliferate and certain social conditions- family, clans and tribes- were necessary to overcome predators and to allow breeding to create a progeny that would outlive famine, disease and planetary catastrophe like the Cretaceous–Paleocene extinction event about 66 million years ago.
While that is a very broadly brushed history of almost 14 billion years, properly understood it begins to paint a landscape in which to see and understand humans; even to see and understand how to structure the science and practice of medicine. The short lesson is this: “The Body Always Makes Sense.” Sense, logic, the chain of reason and circumstance that allowed emergence and survival is very precisely and tightly linked to the function of the body in all states of disease and wellness; the only difference between wellness and disease, most of the time, is the behavior that led an individual away from the inner and inexorable logic of its innate capacity to heal and adapt.
As long as medical science proceeds on the presumption that what-you-see-is-what you-get; that is, that the mechanisms of biological function in humans is right in front of us and that all we need do is elucidate the patterns and chemistry right before our microscopes and spectrographs, we will be incapable of seeing the actual level of complexity that reflects the human person.
Let me give you some simple and well known medical errors and you will see how they could have been avoided by taking a broader view of the human person. Ever since the agricultural revolution mankind has had a largely starch based subsistence diet. And since that time the incidence of heart disease and cancer has crescendoed. Without a picture, a theory of man, we have been scurrying around coming up with one disastrous solution after another for these diseases. Drugs to lower cholesterol, drugs to lower blood sugar, drugs to lower blood pressure. Each of these drugs targeted at some of the debris from metaphorically throwing the human watch against the laboratory wall. We attacked inadequate insulin production even as the body was making too much insulin in response to too much sugar, we attacked adrenaline even as the adrenaline was saving our lives just because it was part of the debris found on the floor of the lab where the human watch had been thrown when associated with high blood pressure. (How hilarious is this? Invent a drug that blocks the (marjuana)cannabinol receptors so people won’t crave food so they can lose weight. Guess what? They become depressed, sometimes suicidally so.) How about people overeat because they are malnourished? Makes more sense; might even be true.
You want some other examples? Fine. Take oxygen. The chemistry of oxygen, nitrogen, hydrogen and carbon are at the very root of human biology. So, can we know something from the picture in our head of human evolution that will guide us to know what to measure and change in the present that will save and change our lives for the better in the future?
You bet! From other of my posts you will know the history of eukaryotic cells and the symbiotic relationship they have with mitochondria derived from some long ago prokaryotic cell ‘eating’ another cell that could utilize oxygen when it produced biological energy; known as ATP. Bam! An important pivot point in the evolution of biological life provides a clear point to measure and know about our own health in the here-and-now. How much oxygen are you capable of utilizing? Whatever that number is reflects a very complex interplay between the genetics of that mitochondria and that of you and your parents and also describes your own biological power even as that measure of biological power determines how robust your immune system can be and thus your risk of cancer and heart disease.
Look, there are thousands of examples where this conceptual model of the human person generates behavioral, social and metabolic concepts to empower research and to provide information to guide your own changes and attempts at greater health.
Earlier in this post I wrote “We think, we propose, we plan, we do.” And, that is the problem and the promise. Personally I didn’t have much to do with ‘The Big Bang’ nor for that matter I was not the first prokaryote that ate that poor schmo that became our mitochondria. But I did have a lot to do with what I ate for breakfast. From ‘The Big Bang’ to yesterday, in evolutionary time, humans were not agents on the stage of the possible, we were mere actors and someone or something else wrote the script, and now that we are the agents we don’t really know what to do. As a result we have to step-up our game; we need to measure as many biological variables associated with health and longevity as we can and by altering the things we can- diet, exercise, spiritual discipline- map our way back to the peak health of the human person living free and strong in the world.
That is ‘The Practice of Quantitative Medicine.’ Measuring the knowable and crafting a path to a healthier and biologically younger state always guided by repeatedly quantifying the known health-linked variables is the future of medicine. It is the only way to leapfrog over all of the bad advice, and generic misinformation that several more generations of medical practitioners will inadvertently foist on the unsuspecting public. It is little wonder that no one really believes the ‘experts’ about proper diet and exercise because that advice changes every few years and each fad contradicts the previous one.
But if you measure it, the relevant variables are knowable and expanding, then you know your own true path. Not even genetics is precise enough to guide your day-to-day choices.
Put on your lab coat, you scientist you, and get well!