LIVING, DYING

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The Trans-Science Aspects of Disease and Death

The big brag preceded the big bang as a human possibility.
Any demonstration that the earth revolves about the sun, while
offensive to the authorities in charge, did not presume that
we could reverse its course. Any proof of a natural law called
gravity did not presuppose that man could make apples fall
up; designers of supersonic planes, indeed, still take account
of the apple. To the frontiersmen of science the discovery of
natural laws meant no more than that we had explored certain
forces governing the dispositions of man. But for many a
hoi-polloi scientific settler who came after the frontier such
discoveries meant something quite different: Man could
master nature.
Robert Ardrey

The cardinal psychological prerequisite for accepting diseases, death
and their democracy is the realization that the denial of these lies in
the realm of the impossible. The task before us is to discover certain
natural forces and laws governing the nosologic ( noso = disease) and
the thanatologic dispositions of man. And such discovery reveals to
us the trans-scientific nature of human disease and death.

A word about trans-science: Weinberg, introducing this concept and
term, defines 'trans-science' questions as those that can be asked of
science, but cannot be answered by science. Epistemologically, these
are questions of facts presentable in the language of science but to
which science has no rational answers; such questions transcend
science. For example, about the 'why?' of the invariable variability
of a person, from birth through death, questions have been asked of
medical science, but have not been answered by medical science.
Modern medicine, in its ostensibly scientific optimism, has not
accorded due consideration to factors that are not only trans-modern-
medicine but trans- any -science.

At the root of medicine's failure in providing an answer to the
questions of what, when, how, where and who is an assemblage of
four independent biological factors; time , uncertainty , relativity , and
normality . These abstract principles govern all that appears concrete
in medicine be it laboratory research or the development of a person,
physiological parameters, disease, and death. Such an approach is both
an analysis and a synthesis, discussed in the order of time, relativity,
normality, uncertainty, and the overall implications thereof.

Time
Time is as fundamental as space and holds perhaps the essence of all
reality. If matter has been understood as but configured energy, then
life needs to be understood as configured time. Isn't man, from his
very start as a zygote, a calendar of timed events? Human
development, in the mother's womb, is charted with remarkable
precision in terms of weeks, days, and hours.

Lest the proposition that every life-form represents a unique,
individualized space-time entity appear preposterous, it is pertinent
to allude to Einstein's concept that regards matter as the expression
of an inner dynamic will that is natural, meaningful or even divine. If
matter can be assigned such individualized qualities as 'will' and
'inner essence', there should be no objection to assigning each
individualized life-form the status of a unique space-time unit. In a
symposium titled Man and Time , Portmann characterizes any life-form
as configured time, while Van der Leeuw pithily concludes: 'We are
time'. Burnet relates time to disease and senescence. He describes
senescence as assuming similar form in each species as evidenced by
the physicochemical changes in collagen, the incidence of vascular
degeneration or the high incidence of cancer, the whole gamut of
events being guided by a genetic 'programme in time' specific to each
species.

Van der Leeuw, talking in a similar vein as Burnet, states that we are
time, we are timed, we are the timer. 'We are temporal.... The man of
nine thirty is not the same as the man of nine twenty five.' The most
important point in the foregoing regarding man's disease and dying
is the apparently sweeping generalization that the man two and half
minutes ago is not the same as the man two and a half minutes later.
This bold generalization carries with it the ability to resolve many a
paradox witnessed in modern medical practice - the puzzle, for
example, of a person just dropping dead while full of life, or soon
after being given a clean bill of health.

Nelson Rockefeller, 'the richest man in the world,' dropped dead,
'working at his desk' at the age of 70. The press particularly added
that 'Mr. Rockefeller had no history of heart trouble and he used to
joke with his children that he was going to live up to a hundred years.'
Dean Acheson, the former American Secretary of State, died in a
similar manner: 'Full of years and honors, he slumped forward on his
desk, without a moment's agony or suspense.' Pope Paul IV suffered
a heart attack while resting in bed, and soon died. The deceased Pope
was replaced by John Paul I, who died a bare 33 days after his
appointment, probably from a massive stroke he suffered in his sleep.
Winston Churchill's wife died of a heart attack, at 92, while eating
lunch at her London home. Similarly, Charles de Gaulle: 'One
neighbor had seen him in the afternoon on business and had come
away feeling that le vieux was in superb health. At a few minutes past
seven in the evening, he was about to sit down and thumb through
some papers and perhaps play a game of patience. He merely had
time to clutch his side and gasp, "It hurts", before collapsing. The
doctor was summoned, as was the local priest who administered the
last rites. Less than two weeks before his 80th birthday, Charles de
Gaulle was dead from a ruptured blood vessel.' The fact that all these
deaths occurred to individuals who were resting, relaxing, or relaxedly
working gives the lie to the medical theory of some 'stress' as the
basis of such deaths.

It may be argued that the above group comprised aged people who
did not take enough exercise. Opie and others, in The New England
Journal of Medicine described the deaths from heart attack, in a boy
of 19 and a man of 35, both accomplished athletes in the peak of
physical fitness. LES, 49, a surgeon in South Dakota, died following
a cerebral hemorrhage while he was operating on a patient. SG, a
surgeon studying for his Fellowship in London, died of a heart attack
at 29.

The sudden, unanticipated death from heart attack of say, Rockefeller
at 70, and DLK, an orthopaedic surgeon, at 30, both fighting fit and
with no history of heart trouble, cannot be related convincingly to
any anatomical, physiological, pathological, or genetic factors. Many
a person with any or all the presumed predisposing factors, even to a
more severe degree, carries on admirably well, regardless, to
eventually die unexpectedly and inexplicably of something else.
Rockefeller died at 70, DLK at 30, incidentally of heart attack, both
ages falling well within the age distribution of heart attack and
resultant death, or of overall human mortality. A death hormone has
been postulated; a death mechanism obeying an individual's timer may be operative, doing what it wants to and when, and giving a
disease a bad name. In an analysis of the death-rates in four major
diseases by Zumoff and others, the startling finding was that the death-
rate was neither related to the severity of the disease nor to its earliness
or lateness, but to some undefined physiological systems governed
solely by the passage of time.

What really killed all these people, and would kill most of us, is not
this disease or that, but the fact, ascertainable only a posteriori , that
the time was up, as declared by a timer inside. The allegorical timer
inside is a pointer to the fact that, as of today, modern medicine can
talk about the time of death of anyone healthy, diseased or more
diseased, only after the death has occured. No list of predisposing
factors including the medical prognosis of doom nor the findings at
the anachronistic clinicopathological conferences allow a tenable
correlation between the medical data and the why and when of death.
It is the subservience of death to time alone as determined by the
timer inside that allows a Tito or a Karen Ann Quinlan to tick on and
on in the teeth of adverse opinion of medical experts, and a de Gaulle
or Acheson to slump down dead when medically least expected to do
so. We are time; we are ended by time.

Dobzhansky speaking from a biologist's point of view talks of death
as the climax of our proportioned and programmed development.
Ageing, diseasing, senescence and death are held as built-in processes
mediating biological maturation consisting of a series of gradual
changes through time from conception to death. 'To die, a man needs
no disease. When the time is up, he dies with disease or without,
regardless of full health and vigour. Like a ripened fruit falling off a
tree on its own, man passes away on getting the call from the inner
clock. People often wonder: "Oh, he was happy, healthy, active, and
yet he died!". (Bhave) Death reigns, indifferent to the thousand man-
made ifs and buts. The healthy may not survive, the diseased may not
die.

Vinoba Bhave's aphorism explains why people, in the pink of health
and in the prime of their life, die a 'natural death,' and people who
are manifestly afflicted with a major disease, or diseases not only
drag on, but even seem to thrive. Leonid Brezhnev ruled the roost
despite a rich assortment of chronic illnesses - gout, leukemia,
emphysema, cardio-vascular problems needing a pacemaker, and also,
possibly a jaw cancer, brain tumor, and chronic pneumonia. Golda
Meir, the 'tough maternal, legend,' already had a lymphoma when
she became the premier in 1969. It took her cancer 13 years before she succumbed to its 'complications' at the age of 80. Many a person
afflicted with medically certified 'killer diseases' survives long
enough to falsify the prognosis of doom, and to outlive the learned
prognoser.

The best example of the above is offered by an experimental study in
the United States. In order to study the development of major diseases
in relation to age in rats, Simms and co-workers created ideal animal
quarters which, because they offered the test animals board and
lodging, comparable to a Waldorf-Astoria, came to be known as the
Rat Palace. Visitors who had come in contact with other rats elsewhere
were strictly forbidden in order to preclude the possibility of their
transferring any contagious disease to the rats in the Rat Palace. And
yet in this rat-utopia, diseases and death occurred with predictable
timing and frequency. Comparing the findings of this experiment on
rats with those in man, the authors concluded that, barring the
differences in the time scale, the findings on rats were easily
applicable to man and that the factors that determine longevity (or
mortality) of the two species seemed to operate in a closely comparable
fashion. Needless to say, the diseases in rats bore the same relation to
death, as in man: death and disease occurred independent of each other.
This comparison between rat and man brings us to the next important
factor - namely, relativity.

Relativity
For several criteria of relative time , all mammals live about the same
span. All mammals, for example, breathe about the same number of
times in their lives. The problems of middle and old age that bother
man do not spare the animals. Most spontaneous cancers in animals,
as in man, occur in middle-aged or elderly animals. It is also true of
atherosclerosis, be it man, swine or killer whale. These realities and
the Rat Palace observations of Simms and his co-workers drive home
the relativistic nature of animal/human senescence and death.
Collagen, although physicochemically similar in man, horse, dog, rat
and mouse, exhibits maximal, and very closely comparable, age-
changes in these animals respectively at 70, 25, 12, 3 and 2 years.
Thus man, in terms of ageing and death, is a mouse whose time scale
has been enlarged 35 times.

The relativity that prevails at the collagen-level, disease-level, and
lifespan-level, is clearly reflected in the number of times the
embryonic cells can multiply - the upper limit of the capacity being
known as the Hayflick limit. Hayflick has demonstrated that the
duplicating capacity of the cells from the embryo of an animal relates
closely to its lifespan - the greater the lifespan, the greater is the
number of times the cells can serially multiply.

We now have sufficient information to reach an understanding of the
relativity of biological lifespan. Although the cells and the collagen
fibers of all mammals are very similar, they age at a rate that is inversely
proportional to their lifespan. Further, given the time-adjustment
between different species (that is 2 years for a rat corresponds to 70
years for man), both the cells and the collagen fibers reach the same
endpoint in all mammalian species. In terms of cells and fibers
(cytofibernetics), we are forced to conclude that man is no more than
70/2 or 70/12 times longer lived mouse or dog respectively. Man's
ageing is relatively slow, that of the dog less slow, that of the mouse
less slower still. The rates differ, but not the basic style. The problem
is, strictly, one of relativity, Jacqueline Susann, in a novel about her
dog Josephine presents this relativity in the most telling manner:

She said, 'That's a cute puppy you've got. How old is it?'
I said 'Six.'
'But she is forty-two years old,' the woman insisted. Who was
forty-two? Even Josephine looked interested. Josephine was
forty-two, the woman insisted. A dog's life is seven to our one.
At six, Josie was forty-two. A middle-aged woman.

Such differing rates of ageing are seen even within the human herd,
where, despite the genetic similarity of one man to another, one lives
for 19 years the other for 91 years, one grays earlier and the other
later, one woman gets cancer and the other escapes, and so on. The
basis of this differences lies in the bioforce of normality as governs a
given herd. While relativity explains the differences between species,
normality underlies the differences within a species.

Normality
To say what things are normal, one must know what is abnormal. Alas,
medicine has not been able to define what constitutes the normal, be
it the blood sugar or the blood pressure. It is high time that normal/
normality is accorded its pristine status of a field-concept that is
thoroughly irrelevant and inapplicable at an individual level.

The current widespread problem concerning the normal and normality
is traceable to carpentry, geometry, and arithmetic. Norma means the
carpenter's square, and hence in geometry, normal connotes perpendicular,
as also a line perpendicular to the tangent to the point
of a curve. By extension, normal implies the point at which this
perpendicular line intercepts the X-axis. Since in a Gaussian curve,
this point of interception falls on the arithmetic average on the X-axis,
normal is regarded as synonymous with mean or average and everything
to its right or left becomes deviation, error, or what is worse, abnormal .
The etymological errors multiply to equate 'normal' with 'sane, natural,
prevalent, regular, typical' and by virtue of all this, 'ideal'. In this jungle
of verbal distortions, what has been lost sight of is the fact that the
appellation 'normal' refers to a form of frequency distribution, also
called Gaussian distribution. Such a distribution provides a graph or a
curve that is bell-shaped, symmetrical, with its two ends stretchable to
infinity, thus allowing the widest variations of a parameter, say, blood
pressure readings, to fall within normality. The law of normality prevails
in the inanimate sphere with as much felicity as in the animate world.
Let the appellation NORMAL connote a N atural O rder R egulating
M atter A nd L ife.

Any biological characteristic that can be measured, exhibits normal
distribution. This could be human birth weight, under conditions
'normal' or 'abnormal', blood cholesterol level, or intelligence. Must
it not be for reasons of normality that the brain size varies widely on
either side of the mythical normal (that is to say average) brain, with
Anatole France enjoying a mere half of the brain size of Lord Byron
or Oliver Cromwell, with Einstein in between, near the average?
Again, would not the normality of distribution of intelligence,
independent of the brain size, account for the brightness of Anatole
France, the genius of Einstein and the mental retardation of individuals
with oversized brains?

If physiological features such as blood pressure or acid secretion in
the stomach exhibit normality in their distribution, pathological
features - even of the most serious nature - are no less normally
distributed. In any population, it is the normality of distribution of
the so-called pathological traits that determines the occurrence,
severity, age at diagnosis, post-diagnostic/post-treatment survival, or
the age at death, of such diverse diseases as congenital malformations,
peptic ulcer, hypertension, diabetes mellitus, cancer, heart attack, etc.
The discussion on normality can be concluded with the realization
that each of the many features, physiological or pathological, that
comprise a human being, is unpredictably and unalterably distributed
on the normal curve, independent of all other features. To the utter
chagrin of modern medicine and its specialists, such a 'normal' state
of affairs makes uncertain the what, when, why of every disease,
forcing modern medicine to be plagued by uncertainty at the level of
the individual patient. Let us now understand the fourth element,
namely, uncertainty.

Uncertainty
Uncertainty, the alter ego of Pascalian probability, is the child of
normality, the science of quantitative differences between human
beings. Modern medicine, without doubt, has spawned a gargantuan
technocracy, unmindful of the quantitative nature of all human
differences - anatomical, physiological, psychic, pathologic or
thanatologic. The seemingly gross differences between two persons -
one with elementary intelligence the other with creative genius, one
with high stomach acid and no ulcer the other with low acid and ulcer,
one surviving cancer, the other succumbing to it, and so on - are all a
matter of quantitative variations normally distributed throughout the
species.

In health and in disease, human beings differ, one from another, but
the difference that modern medicine can detect, given its most
sophisticated gadgetry, is not qualitative, but quantitative, not one of
character but of measurement. Human beings quantitatively differ very
widely, this being the nature of any parameter normally distributed.
And there is no way of telling which human being, healthy or diseased,
would show what reading, and why. This makes for the nagging
uncertainty that modern medicine can not dispel while dealing with
an individual patient.

It is the uncertainty principle which lends medical practice its
mysterious element of unpredictability that charms and challenges
the man of action - the medical man. It is uncertainty, backed by
temporality and normality that accounts for an esophagus declared
normal today but found cancerous tomorrow and ECG (EKG) being
assured as all right today, and worrisome tomorrow, the patient given
up as lost today, surviving to attend his physician's funeral, tomorrow.
But for uncertainty, medical practice would not have been half as
fascinating.

Summing Up
Time, Uncertainty, Relativity and Normality ( TURN) universally gov-
ern development, disease and death - concepts that allow an intellec-
tual ratiocination of both the trans-science and trans-medicine aspects
of disease and death.

These concepts have some wider implications for modern medicine.
They put modern medicine in its place, dismissing as naive modern
medicine's causalism - fat causes heart attack, coitus causes cancer.
These concepts further promise to cure modern medicine of its
characteristic obsession that every ill - congenital or acquired - is a
preventable outcome of some molecular, genetic or cytological
aberration. The borderlines that modern medicine has created stand
erased, for we realize that the difference between the 'normal' and
the 'abnormal' is not that between black and white but between shades
of gray, with no diving line anywhere. The phenomenon of death
acquires the status of an independent, physiological function: we are
purposely, unalterably programmed to die. All major problems -
congenital, cardiovascular, cancerous, or metabolic - that medicine
is claiming to be intensely researching upon, are, in essence,
unresearchable. Science etymologically means knowing , not doing .
Disease and death are not trans-science if we aim to understand them.
They are so only if we want to manipulate them. More correctly, aren't
they trans-technique?

The choicest implication of this chapter, however, may be its
integration of physical laws and biological laws, physicists and
physicians, matter and man. By hinting at the integral relationship
between time, relativity and uncertainty - hitherto only in the domain
of matter - and man, the borderline between the living and non-living
grows fainter. In the telling words of Ardrey, 'Time and death and the
space between the stars - these are the ingredients of the woman who
prepares your breakfast, or of the man who gets off the train as you
get on.' This chapter amplifies a poetic insight in order to put into
place laws that may govern you, the person who prepares your
breakfast, as also the men you meet in the street. It's but a peremptory
perspective on the democracy, the immense impartiality, the trans-
science temper, the Upanishad or the Tao of human development,
disease and death.

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