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The Democracy of Disease

Disease generally begins that equality which death completes.

Samuel Johnson

An enquiry into the essential nature of human diseasing, provides an insight into the unswerving impartiality with which diseases treat mankind. The equality inherent in man’s diseasing is a concept difficult to accept, but such difficulty need no longer allow man or medical science to deny its reality. The natural course of life exhibited by a human being, from conception to death, is similar the world over. Such similarity extends to that part of development called diseasing - be it heart attack or hypertension, cancer or diabetes. This Chapter is about the little but significant reading that we can make in the human body’s unfathomable book of diseases.

What are Diseases?
The number of diseases that makes up the medical lexicon is legion, but they can be broadly classified into two groups - interactional and intrinsic .

Interactional maladies arise as a consequence of the unfavourable interaction between a human being and his or her environment - nutritive (excess or deficiency), microbial (worms, bacteria, viruses), mechanical or allergic. All the interactional diseases lend themselves to control (antibiotics in infections) or prevention (no allergens, no allergy; no cars, no car-accidents; no tubercle bacilli, no tuberculosis). Modern medicine’s golden-lettered triumphs have been in the field of interactional diseases - malnutrition mitigated, infections averted or treated, consequences of trauma minimized.

Intrinsic diseases, as the appellation implies, are coursal ("course” with "al”–not causal), programmed in one way or another into a human being’s growth from the womb to the tomb, being the temporal signposts in the trajectory of an individual, and what is tellingly important, impervious to the march of modern medicine. The chief categories in this group are as follows:

Birth Defects
These diseases are a result of the defective formation and or functioning of some parts of the body, that an individual is born with. In medical parlance, these are called congenital malformations.

Metabolic or Constitutional Disorders
These result from an alteration in the functioning of the body systems and comprise such diseases as diabetes, high blood pressure, high acid secretion in stomach, autoimmune diseases, and so on.

Some cells in the body change their character, and by multiplication form cell colonies, called a tumor or cancer.

Vascular Diseases
With age, arteries throughout the length and breadth of the body harden, narrow, and even get blocked. When such a process affects the artery to the heart or to the brain, heart attack or stroke may result. In pathological terms, such vascular changes are also called arteriosclerosis or atherosclerosis.

Collagenous Disorders
The cells and the blood vessels of the human body are supported by a universal network of fibers made up of the protein, collagen. The progressive changes in collagen fibers produce wrinkling of the skin, stiffening of the joints, and contribute to the diseasing of the arteries mentioned above.

Except for birth defects, all the other intrinsic disorders are an expression of the preprogrammed ageing of an individual.

The Problem of Ageing
Ageing is the calendar of events that starts at conception, or more conventionally at birth, and ends only at death. Everything that lives ages with reference to starting point in time. Ageing is synonymous with the passage of physical time, and need not be made to connote an adverse state or event.

Consistent with the ceaseless dynamism that characterizes life, an organism exhibits changes as it ages - changes that promote its survival, and almost pari passu , changes that demote its survival. At any stage, the individual’s survival or otherwise is an outcome of the balance of these two sets of processes - the benescent ones and the senescent ones. A child that cuts its teeth so that it can bite better exhibits benescence; the same child if diagnosed to have diabetes or leukemia, exhibits senescence. A person aged 75, spontaneously recovering from an attack of pneumonia as a result of increased immunity against it, exhibits benescence. Senescence, then, is not restricted to the ‘aged’, nor is benescence a privilege only of the young; both can occur at any time from conception onwards. Ageing is a function of the calendar on the wall; benescing and senescing are functions of the changes exhibited by a growing organism.

These concepts and the concomitant insistence on clearer terminology, on ageing and senescence, have some illuminating implications:

  1. Ageing is an extrinsic, physically-timed event; senescence comprises intrinsic bodily-timed tissue-changes. The two are related but not always. That is how time travels, in diverse paces with diverse persons, making the not-aged look senile, and the aged look young.
  2. Senescence is co-extensive with the human lifespan. Etymologi- cally, senescence is expected to occur only in a senile individual. Such a fixation must change. The criteria of senescence are intrinsicality , progressiveness and deleteriousness . A child of 4 years with, say, diabetes or cataract exhibits senescence, for each of these processes fulfills the above criteria. The occurrence of diabetes as a disease with a wide age range - infancy to old age - during which it may manifest itself, should force us to revise our thinking on senescence. If diabetes or cataract in old age is looked upon as senescence consequent on ageing, why should the same in youth or even in infancy, be considered as anything but a form of senescence?
  3. The signs of senescence can be altered to suggest that the changes brought about by ageing have been somehow reversed. Many a senescent process can be camouflaged, compensated for, even mitigated - grey hair dyed, lost teeth replaced by dentures, cataracts removed, wrinkles smoothened out by face lifts, baldness covered by a wig, and so on. However, the course of time cannot be halted or altered.
  4. At a more serious level, blocked arteries, of the heart or brain, can be cleansed, bypassed or replaced, cancerous masses removed, altered blood sugar curves restored to accepted norms, and so on. All these measures go a long way to ease the dis-ease, but fail to add to the individual’s predetermined lifespan which is a function of ageing.
  5. Much of medical prognosing (forecasting) on the course of a dis- ease is judgement passed on mere appearances - an individual with altered EKG (ECG - Electrocardiogram), heightened sugar curves or blood pressure, or a cancer is given a ‘bad’ prognosis. On the other hand, a ‘good’ prognosis is given when a check-up reveals no abnormalities. On many an occasion, the prognostica- tor has been proved wrong: those given good prognosis die, those given poor prognosis, survive.

This medical predicament is rooted in the fact that diseased tissues and organs of the human body do not necessarily dis-ease, get worse, or kill, nor are healthy-looking tissues and organs any guarantee against these possibilities.

Genesis of Senescence and Disease It is a long leap from nematodes to humans.... many of the mechanisms that govern aging in nematodes have counterparts in humans.... This evidence has generated speculation that aging may well be governed by similar genetic mechanisms in all species, including Homosapiens.

Carl Elliott

A most popular suffix in modern medicine is - gen (from the Greek, gennen to produce). Its popularity springs from the idea that every disease - including senescence, and even death - has a cause. Hence the array of such specific terms as atherogen, cancerogen, diabetogen,gerontogen (or senescogen ), hyper-tensinogen , and such general terms as nosogen , (from the Greek nosos , meaning disease) or pathogen . It is a sobering thought that much as such terms have given both credence and direction to medical thought and action, the end result, unfailingly, has proved the nemesis of the -gen concept, and with that, of the -gen -based research, prevention, and treatment. At the heart of Burnet’s learned and devastating judgment against modern medicine - that the contribution of laboratory science to medicine has almost come to an end - lies the facts that as far as its genocentric (causalistic) approach to disease is concerned, modern medicine has summarily failed.

Rudolf Virchow, the father of modern pathology, first proposed around 1858 the theory that a disease is the effect of some cause, which he has expounded in his book Cellular Pathologie . All diseases are assumed to be the outcome of the ‘changes’ and ‘active processes’ that have taken place in the cells of the human body. From 1858 to 2010, medicine has vigorously searched for the causal changes in cells that breed diseases, and has failed completely. Of late, the thrust has not been so much on cells as on the molecules that make the cell - the new science of molecular biology. The outcome has been far from rewarding: the deeper insight into the nature of human diseasing, provided by such studies, has in fact underscored medical men’s inherent inability either to elicit the causation of, or predictably and favourably alter the course of, say, cancer or heart attack, arthritis or autoimmune disease, stroke or senility. One is compelled to agree with Nobel-laureate Burnet’s candor: ‘I have more than once expressed the opinion that so far there has been no human benefit whatever from all that has been learnt of molecular biology. I doubt if any other biologist has been quite so blunt in public but a few eminent biochemists have agreed with me in private.’ Summary failure on the molecular front has impelled the medical men to venture into the submolecular world, to no avail. The above assessment has a lesson - man is neither a molecule nor a mouse. Molecular biology has ended being Mole-ocular Science, as blind as a mole.

If the cells, and the submolecules and molecules that constitute them, have failed medical science, what of the substances that the cells themselves make, such as hormones? What of the loss of some vital hormones? The evidence so far does not support the idea that senescence is the result of decrease in the secretion of any single hormone, and castration in either sex appears neither to shorten life nor to alter the process of ageing.

While medical science has failed in its search for the specific causes of various maladies, its attempts to explain these on a general basis have not met with any success either, Gerontologists have been advancing the ‘wear-and-tear’ theory to explain senescence and diseases. While this theory is metaphorically most appealing, its mechanistic bias has failed to find any scientific evidence. Another general theory has it that the loss of reproductive fitness is tantamount to the loss of, in Darwin’s terms, fitness to survive, thus resulting in diseases of old age. While the linking of reproductive capacity and the ability to survive may be acceptable at, say, the insect level, it finds poor application at the mammalian or human level.

In all humility, it must be concluded that medicine’s search for a cause for many a disease that the human body is prone to has failed for want of any scientific support.

Why are Diseases?
The answer to the query "Why are diseases?’ may be traced to the fact that man and animals are basically binary units comprising cells and the web or cocoon of collagen fibers that the cells throw around to house and support themselves. The cells and fibers together form such varied structures as skin, bone, liver, blood vessels, or intestines. Our cells and fibers, ever alive, ever changing, exhibit time- bound alterations that are at the heart of much of human diseasing. The study of the changes exhibited by cells and fibers could be called Cytofiber(ki)netics, or simply, cytofibernetics. It is not known whether the kinetics of cells and fibers are causally related or are merely concurrent.

Our body cells have a finite capacity for replicating themselves. Admirably elegant studies on cells, employing their serial cultures in test tubes, have revealed animal cells to be endowed with species- specific doubling-capacity, proportional to the lifespan of the species. The cells from a human embryo can be made to double exponentially (in geometric progression) 45 (+/- 5) times, whereas those from the rat embryo can be made to exhibit only 15 (+/- 5) doublings. While the foregoing number, for human beings, appears minuscule vis-a-vis his lifespan of three score years and ten, its exponential nature makes it awesomely powerful. The entire human embryogenesis starting with one cell and ending up with many billions is an outcome of 32 exponential divisions.

What exact bearing does the finiteness of the doubling capacity of the animal cells have on the ageing and diseasing of the organisms is not understood. A cytologic feature is an indicator, however. As cells - having multiplied to meet with the normal demands of growing, living, and repair - approach the limit of their replicative capacity, they exhibit aberrations of chromosomes (gene-bearing bodies in cell nucleus) in number or structure, an in vitro (test tube) phenomenon probably occurring in the body as well. Cytologists and cancerologists tend to take chromosomal abnormalities as a prelude to, or accompaniment of, a cancerous change. Cancer, an eminently cellular phenomenon, underlies 20% of overall human diseasing.

Like cells, the collagen fibers senesce, the rate being species-specific, and inversely proportional to the lifespan of the species. Senescent collagen is degenerate collagen - drier, thicker, more rigid, shorter. Many of the ageing processes are apparently due to derangement in the structure of collagen. Skin wrinkles, joints stiffen, blood vessels thicken and harden. The coronary arteries disease to give heart attacks, the carotids (arteries of the brain) disease to give strokes, and the overall vascular disease to give high blood pressure, and this totals up to over fifty per cent of human diseasing. There is considerable truth in the saying that a man is ‘as old as his arteries’.

The balance is a group of human ailments that can neither be clearly ascribed to the ageing of cells nor to the ageing of fibers - these are diabetes, a growing number of maladies called autoimmune diseases, and that ill-defined entity called loss of vitality or resistance. But there are pointers. Cells and fibers, on ageing and senescing, lose their pristine self-identify and pose as foreign elements that are attacked by the body’s white cells much as these cells would attack invading microbes. The result is a civil war, called autoimmune (immunity turned against one’s self) diseases, that manifest themselves as diseases of joint, kidney, skin and so on. The aged white cells themselves may make the mistake of identifying the innocent self-units as foreign, unleashing an attack on them and breeding autoimmune diseases. The ageing white cells may also lose the ability to fight microbes, thus accounting for the loss of resistance in the aged.

It cannot be overemphasized that cytofibernetics and the ills that it breeds are no errors, no toll that we pay for the wear-and-tear of living, but a phyletic feature that cuts across the entire vertebrate kingdom, being an integral part of a genetically determined course that occurs independent of wear-and-tear. There are a thousand causalistic theories of ageing, senescing and (the consequent) diseasing, but each ends with the same refrain: So far there is little evidence for this theory . Ageing, senescence, disease and death are integral processes of biological maturation comprising a series of gradual changes that occur in the human body through time, from conception to death, as a part of the human life cycle.

Disease as a Herd Function
The term herd is synonymous with a group, community, population or an ethnic ensemble that, belonging to the same race and nationality, shares, what the geneticist calls, a common or corporate gene pool and through this, an interrelated pattern of diseasing, and death (See Chapter Three).

In any human community or herd, the distribution of cancer is in 1 out of every 5 persons. The occurrence of cancer in one person is thus a function shared by the other 4 who escape. Considering further the distribution of, say, the age at which cancer occurs, it is found that amongst those who have cancer, the age-at-diagnosis is distributed along a bell-shaped curve, so that someone gets it at 19 years of age, the other at 91, the rest in between. Such herd distribution , and thus herd control , of a disease and its various features is found in all forms of human diseasing. A particular person’s disease thus becomes an individual performance at the behest of the herd. The concept of herd (and herdity ) highlights the interrelatedness of an individual and the rest of the group, whose corporate genetic programme determines the occurrence of disease, (and death) in the individual.

Democracy of Diseases
Sir Thomas Browne, the English physician-philosopher, stated that the ‘Mercy of God hath scattered the great heap of Diseases, and not loaded any one Country with all.’ What Sir Thomas asserted in the seventeenth century, continues to hold good in the twenty first. Barring interactional diseases - worm infestations occur because there are worms and skiing accidents occur because there are skiers - the intrinsic pattern is emerging as very impartial both in its occurrence and behaviour, be it the affluent West or the indigent East.

What distinguishes one country or a group from another - Alaska from Australia and India from Israel, American Negroes from American Whites - is not the total quantum of intrinsic diseases as much as their types. In a given population, birth defects - congenital malformations - affect a more or less fixed proportion of newborns, for these are an outcome of multi-factorial inheritance, which is but the geneticists’ way of saying that the occurrence of such abnormalities is a function of the herd and not of the individual affected nor of his or her parents. Cellular disease - cancer - occurs everywhere; in excess, nowhere. If the Parsi women in India have a greater incidence of breast cancer, the Hindus compensate for this difference by having a greater incidence of cervical cancer so that all told, Parsis develop cancer and die with it no more nor less than their Hindu counterparts. Vascular diseases are universal and impartial. So is diabetes. To be human is to be endowed with one or more inherent, intrinsic diseases.

Stroke provides a striking example of the innate impartiality and universality of a disease. Stroke, medically called cerebro-vascular disease, is a disease-complex arising from the disorder of the arteries supplying blood to the brain. A global epidemiological study on stroke revealed that at all ages it equally affects both sexes in all lands and all regions of the lands, being unrelated to environment, and not exhibiting any racial predilection within a nation or between nations, regarding both its occurrence and behaviour. Such conclusions are equally relevant to other forms of human diseases. As the diseases caused by external factors - accidents, infections, malnutrition - are reduced, a greater number of human beings live out their natural lifespan. The longer they live, the more they exhibit diseases inherent to human ageing. This is universally true. Thus a curve describing mortality due to any intrinsic disease process closely compares with the age-specific mortality curve. The stroke mortality curve also describes such a pattern. If this is correct, then stroke may have to be classed as concomitant of ageing, and as such would seem to be preventable only to the extent one could reverse the process of ageing.

If one were to replace in the foregoing, just the word ‘stroke’ by ‘cancer’, ‘heart attack’, ‘hypertension’, or ‘diabetes’, the generalization would hold as true. Each of the above diseases is built into mankind, into the warp and weft of man’s genes. Being a herd feature that expresses itself at an individual level, a given disease affects a more or less fixed percentage of the herd, both as a herd certainty and an individual probability. All humans can develop, say, cancer or have a heart attack, yet only some do . It should not come as a surprise that carcinoma of the stomach, in the Japanese and Jamaicans, behaves in a very closely comparable fashion, despite the differing sophistry in medical care. So do heart attacks, hypertension and diabetes. For most diseases inherent to humans, one could paraphrase the Bible : Many (in fact, all) are called to disease, but, afew are chosen to bear the Cross thereof.

Human diseasing thus exerts its impartial sway on mankind irrespective of such considerations as age, sex, heredity, race, religion, caste or creed, asceticism or hedonism, lowest Gross National Product or highest Gross National Product. The occurrence of heart attack, or stroke, carcinoma lung or carcinoma cervix, even in infancy, regardless of national boundaries bears an eloquent testimony to the democratic demeanour of diseases. On a global scale, paraphrasing Sir Thomas Browne, it could be reassuringly said that the mercy of God hath scattered diseases equally the world over, and hath commended them to behave comparably the world over. God has been very just.

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