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GUEST EDITORIAL
Year : 1979  |  Volume : 25  |  Issue : 3  |  Page : 128-133

Time, uncertainty, relativity, normality and modern medicine


Department of Anatomy, Seth G. S. Medical College, Parel, Bombay-400 012, India

Correspondence Address:
M L Kothari
Department of Anatomy, Seth G. S. Medical College, Parel, Bombay-400 012
India
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Source of Support: None, Conflict of Interest: None


PMID: 529164

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How to cite this article:
Kothari M L, Mehta LA. Time, uncertainty, relativity, normality and modern medicine. J Postgrad Med 1979;25:128-33

How to cite this URL:
Kothari M L, Mehta LA. Time, uncertainty, relativity, normality and modern medicine. J Postgrad Med [serial online] 1979 [cited 2019 Dec 14];25:128-33. Available from: http://www.jpgmonline.com/text.asp?1979/25/3/128/42128


This year marks the birth anniversary of Albert Einstein, born on March 14, 1879. JBS Haldane [13] called him the greatest Jew since Jesus; scientists rate him as the greatest scientist so far. The reason is not far to seek: Einstein, "work­ing only with mathematical scribblings" [9] revolutionized scientific thought, and re­ordered the universe. This essay, a tribute to him, proposes, a la Einstein, a reorder­ing, of modern medicine on the basis of four simple concepts-Time, Uncertainty, Relativity, and Normality (TURN).

If a la Einstein, mass is configured, energy then a la Portmann, [22] life is con­figured time. A material object or an organism is identified by the space it defines, for a given time. Each object/ organism becomes, thus, a space-time unit. The time element is especially evident at the animate level, where the time-limit during which the organism-­unicellular life-forms to the biggest whale -will define space, is predictably and observably set. Burnet [5],[6] describes man as "the 4-dimensional clone in space­time." Over an individual's lifespan, the space-aspect of this space-time unit does not exhibit as many changes or attract as much attention as the time-aspect. It's as well that, through history, life has been synonymized with time. This synonymy is medically most interesting since it is time that foists senescence and diseases on an organism: "Senescence takes a generally similar form in each species, whether judged by the physicochemical changes in collagen, the incidence of degenerative changes in blood vessels or the high incidence of malignant disease. The essence surely is that there is a gene­tic 'programme in time' laid down for each species. There must be a biological clock and a means by which a series of processes can be made to occur according to the expediencies of evolutionary sur­vival" (Burnet [5] ).

Van Der Leeuw, [26] aphorises 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. We are time." The most im­portant point in the foregoing, vis-a-vis man's disease and dying, is the apparent­ly sweeping generalization that "The man of nine thirty is not the same as the man of nine twenty-five." This small statement carries with it the ability to resolve many a paradox witnessed in modern medical practice-the enigma, for example, of a person just dropping dead while full of life, or soon after being medically given a clean bill of health. Modern medicine has failed to understand, emphasize, or highlight the fact that death is being in­creasingly viewed as a physiological function [10],[16],[17],[28] [Figure 1] that owes allegiance only to time. No wonder, "Al­together death has nothing to do with health and sickness, it uses them for its ends" (Benn [2] ). Benn's [2] discomforting aphorism explains why people, pink and in the prime of their life, die a "natural death," and people who are manifestly afflicted with a major disease/s not only drag on, but even seem to thrive.

For studying the development of major diseases exclusively in relation to age in rats, Simms and co-workers [25] created animal quarters called for their sophistry the Rat Palace. "Visitors who had con­tact with other rats were strictly forbid­den." And yet, in this rat-utopia, diseases and death occurred with predictable tim­ing and frequency. Comparing the rat-­findings with those in man, the authors [25] concluded that "except for the difference in time scale," the findings on rats were applicable to man and that "the factors that determine longevity (or mortality) of the two species appear to operate in a similar manner." Needless to state, the diseases in rats bore as much relation to death, as in man: The two occurred in­dependent of each other. This rat-man comparison brings us to the next impor­tant part of TURN-namely, relativity.

Although the cells and the collagen fibres 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 mammalian species (e.g., 3 years for a rat is 70 years for man), both the cells and the collagen fibres reach the same endpoint in all the mammalian species. In terms of cells and fibres (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 aging is relatively slow, that of the dog less slow, and the mouse least slow. The rates differ, but not the basic style. The problem is one of relativity.

In a human herd, however, the genes of one man are exactly like that of another, and yet one lives for 19 years, and the other for 91 years; one woman gets cancer, the other escapes, and so on. To understand the basis of these differ­ences, one needs to appreciate the bio­force of normality as governs a given herd. While relativity explains interspe­cies differences, normality explains intra­species differences, between organisms.

Normal/normality, being fundament­ally a field/distribution phenomenon, is always applicable [14],[15] only 'to a group, herd, or a population. "Population think­ing denies uniformity and looks to the range of diverse individuals within a group. The range, not the average, is the reality .... Just as popular thinking ac­cepts range as reality, it dismisses as non­existent the `average man,' a being whom no one has ever met anyway." (Ardrey [1] ). Pickering [20] has searched for the dividing lines between hypo-, normal-, and hyper­tension, and found none. Cholesterol levels [3] exhibit the same Pickeringian puzzle of where does normality end, and abnormality begin? Let us paraphrase Ardrey, [1] to say, that The range, and not the mean or the average, is the norma­lity.

If physiologic features such as blood pressure [11],[20],[21] or HCl secretion [4] exhibit normality in their distribution, patho­logic features-even of the most serious nature [Figure 2] are no less normally distributed. In any human population, it is the normality of distribution of (the so-called) pathologic traits that deter­mines the occurrence, severity, age at diagnosis, post-diagnostic/post-treatment survival, or the age at death, of such diverse states as congenital malforma­tions, peptic ulcer, hypertension, diabetes mellitus, cancer, heart attack, and what have you [7],[8],[17],[18],[23] To take but one example, of cancer, [17],[18] it needs to be realized that every human being geneti­cally possesses the cancerability of tissues. Such cancerability, as a biologic feature, is normally distributed. All humans can, thus, develop cancer, yet only a fixed percentage (20%) of them does. This is dependent on the fact that to express cancerability, a human being must cross [Figure 3] a certain threshold [7],[8],[17],[18] World over, 80% do not cross this. Hence the global impar­tiality, nay the democracy [17],[18] of cancer. This discussion on the normalness of pathologic and lethal processes can be best concluded by considering the final end of all pathologies, viz., death. In animals inbred or outbred, and in hu­mans the world over, the age-at-death is normally distributed, and as was em­phasized earlier, this distribution is not dependent on the presence and/or the severity of some particular disease pro­cesses. Death, like diseases (to which even infections are no exceptions), is democratic. No wonder, death is held as the most impartial of all.

Often, diseases, such as cancer, heart attack, stroke are considered preroga­tives of the senile population. Not so, once normality is understood. The tails of the Gaussian curve stretch to inf­nity, [23],[27] an aspect of normality that ex­plains the occurrence of carcinoma of tongue in a newborn , [17] diabetes mellitus in a boy of 17 days, [19] carcinoma cervix in an infant, [17] carcinoma prostate in a child of 3, [17] heart attack in infants, [12] short survival despite mild disease, long survival despite severe disease, or a disease-free individual aged 105 years.

The discussion on normality can be concluded with the realization that each of the many features, physiologic or pathologic, that comprise a human being, is unpredictably, and unhelpably 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 every individual patient.

It is, however, the uncertainty principle that lends medical practice its mysterious element of unpredictability that charms and challenges the man of action [24] the medical man. It is uncertainty, backed by temporality and normality that ac­counts for esophageal mucosa declared normal today, but found cancerous to­morrow, ECG assured as OK today, and worrisome tomorrow, the patient given­up-as-gone today, surviving to attend his physician's funeral, tomorrow. But for uncertainty, medical practice would not have been half as fascinating. Thank God, for uncertainty.

In summary, we may state here the im­plications of the TURN concepts vis-a-vis modern medicine. TURN erases the hyper-hypo-cratic borderlines, that modern medicine has created, by show­ing that the difference between the "nor­mal" and the "abnormal" is not that bet­ween black and white but that between different shades of grey, with no dividing line anywhere. TURN rationalizes the overlap [Figure 3] of no-diabetes and dia­betes, [19] or of mere pathology (dys-is, as distinguished from dis-ease),merely symptomatic pathology, and presumably "lethal" pathology by showing that while these are symptoms of senescence, they bear questionable relation to the occur­rence of death. TURN thus accords to death [Figure 4] the status of an indepen­dent, physiologic function by highlight­ing that "we are purposely programmed to die. [10] TURN dismisses as naive, modern medicine's causalism-fat causes heart attack, coitus causes cancer. TURN promises to cure modern medi­cine of its errorism, the obsession that every ill-congenital, cardiac or cancerous-is preventable outcome of some molecular/genetic/cytologic errors. TURN exposes modern medicine's cure-­all-ism which is but ceremonial/essential palliative care of "killer" diseases which, regardless, chart their own course in a patient, often for the better, despite modern medicine. TURN is the new, and necessary, basis of physiology, pathology, and thanatology, and all that passes as modern medicine.[32]

 
 :: References Top

1.Ardrey, R.: "The Social Contract." The Fontana Library, Collins. London, 1972, p. 47.  Back to cited text no. 1    
2.Benn, G.: Quoted by Plessner, H. in, On the relation of time to death. In, "Man and Time." (Ed. Campbell, J.), Pantheon Books, New York, 1957, p. 249.  Back to cited text no. 2    
3.Best, C. H. and Taylor, N. B.: "The Phy­siologic Basis of Medical Practice." Wil­liams and Wilkins, Baltimore, 1961.  Back to cited text no. 3    
4.Booth, M., Hunt, J. Miles, J. M. and Murray, F. A.: Comparison of gastric emptying and secretion in men and women with reference to prevalence of duodenal ulcer in each sex. Lancet, 1: 657-662, 1957.  Back to cited text no. 4    
5.Burnet, M.: "Immunological Surveillance." Pergamon Press, Oxford, 1970.  Back to cited text no. 5    
6.Burnet, M.: "Genes, Dreams & Realities." MTP, Bucks, 1971.  Back to cited text no. 6    
7.Carter, C. O: The genetics of congenital malformations. Proc. Roy. Soc. Med. 61: 991-1000, 1968.  Back to cited text no. 7    
8.Carter, C.O.: Genetics of common single malformations. Brit. Med. Bull. 32: 21-26, 1976.  Back to cited text no. 8    
9.Cover Story: The year of Dr. Einstein. Time, February 19, 1979, pp. 48-55.  Back to cited text no. 9    
10.Cudmore, L. L. L.: "The Centre of Life A Natural History of the Cell." Quad­rangle Books, New York, 1978.  Back to cited text no. 10    
11.Emery, A. E. H.: "Elements of Medical Genetics." Churchill, Livingstone, Lon­don, 1975, p. 122.  Back to cited text no. 11    
12.Fox, J. P., Hall, C. E, and Elveback, L. R.: "Epidemiology-Man and Disease." Mac­millian, London, 1970, p. 156.  Back to cited text no. 12    
13.Friedberg, C. K.: Acute coronary occlu­sion and myocardial infarction. In, "Diseases of the Heart," W. B. Saunders, Philadelphia, 1967, pp. 770-795.  Back to cited text no. 13    
14.Haldane, J. B. S.: Quoted in, "The Pen­guin Dictionary of Modern Quotations." (Ed. Cohen, J. M. and Cohen, M. J.), Penguin Books, Middlesex, 1974, p. 91.  Back to cited text no. 14    
15.Hodkinson, H. M.: The interpretation of biochemical data. In, "Recent Advances in Geriatric Medicine. Number One." (Ed. Isaacs, B.), Churchill, Livingstone, Edin­burgh, 1978, pp. 101-108.  Back to cited text no. 15    
16.Isaacs, B.: Has geriatric medicine ad­vanced? In, "Recent Advances in Geria­tric Medicine. Number One." (Ed. Isaacs, B.), Churchill. Livingstone, Edinburgh, 1978, pp. 1-5.  Back to cited text no. 16    
17.Jones, H. B.: Demographic consideration of the cancer problem. Trans. N.Y. Acad. Sci., 18, 298-333, 1956.  Back to cited text no. 17    
18.Kothari. M. L. and Mehta, Lopa A.: "The Nature of Cancer." Kothari Med. Public­ations, Bombay, 1973.  Back to cited text no. 18    
19.Kothari, M. L. and Mehta, Lopa A.: "Cancer-Myths and Realities of Cause and Cure." Marion Boyars, London, 1979.  Back to cited text no. 19    
20.Kurtzke, J. F.: "Epidemiology of Cere­brovascular Disease." Springer-Verlag, Berlin, Heidelberg, 1969.  Back to cited text no. 20    
21.Malins, J.: "Clinical Diabetes Mellitus." ELBS & Chapman and Hall, London, 1975, pp. 54, 69.  Back to cited text no. 21    
22.Midwinter, R. E.: Smoking in pregnancy. In, "The Medical Annual, 1978-79." Wright, Bristol, 1978, pp. 114-116.  Back to cited text no. 22    
23.Pickering, G.: "High Blood Pressure." Churchill, London, 1968  Back to cited text no. 23    
24.Pickering, G.: Personal views on mecha­nics of hypertension. In, "Hypertension: Physiopathology and Treatment." (Ed. Genest, J., Koiw, E. and Kuchel, O. ), McGraw-Hill, New York, 1977, pp. 598-605.  Back to cited text no. 24    
25.Portmann, A.: Time in the life of orga­nism. In, "Man and Time." (Ed. Camp­bell, J.), Pantheon Books, New York, 1957, pp. 308-323.  Back to cited text no. 25    
26.Roberts, J. A. F.: "An Introduction to Medical Genetics." Oxford Univ. Press, London, 1967.  Back to cited text no. 26    
27.Robinson, D.: Introduction. In, "Patients Practitioners and Medical Care." William Heinemann Medical Books, London, 1978, pp. x-xiv.  Back to cited text no. 27    
28.Simms, H. S.: Longevity studies in rats. I. Relation between lifespan and age of onset of specific lesions. In, "Pathology of Laboratory Rats and Mice." (Ed. Cotchin, E, and Roe, F. J. C.), Blackwell, Oxford, 1967, pp. 733-748.  Back to cited text no. 28    
29.Smithells, R. W.: The prevention and prediction of congenital malformations. In, "Scientific Basis of Obstetrics and Gynae­cology. (Ed. Macdonald, R. R.), Churchill Livingstone, Edinburgh, 1978, pp. 275-299.  Back to cited text no. 29    
30.van der Leeuw, G.: Primordial time and final time. In, "Man and Time." (Ed. Campbell. J.), Pantheon Books, New York, 1957, pp. 324-350.  Back to cited text no. 30    
31."Webster's Third International Dictiona­ries of the English Language Unabridged." Ed. Gove, P. B., G. & C. Merriam Co., Springfield, 1971.  Back to cited text no. 31    
32.Zumoff, B., Hart, H. and Hellman, L.: Considerations of mortality in certain chronic disorders. Ann. Intern. Med., 64: 595-601, 1966  Back to cited text no. 32    


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  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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