Process, Not Categories

In my view, progress in medicine will depend on a greater understanding of whole body processes and phasing out category-based diagnosis. A proper biological method of medicine begins by recognizing and solving problems in food, air and water supplies. A steady flow of molecules from the environment enters the body of each individual through the air breathed and the food and liquids ingested. This body-input determines health and disease in whole populations over the long-term and the moment to moment functional capacity of the individual. A person's performance can change dramatically with changes in this molecular stream.

While I appreciate that humans depend on categories to organize their interactions with each other, all categories are arbitrary and limit understanding. Thus, irritable bowel syndrome (IBS) and depression appear to be real things that are separate; but on closer analysis they are not real and not separate. At best, they are descriptions of packages of symptoms without distinct boundaries. These processes are also occurring inside and outside the bodies of symptomatic people. It is a mistake to believe that a symptomatic person owns the problem. The truth is a single patient manifests environmental conditions and group processes.

Here is a brief example of a process summary: Food processing is a whole body process starting in the digestive tract and emerging in all parts of the body minutes to days later. Food is a sample of the local environment and food choices are determined by groups of humans, not individuals. Some of our understanding of what happens to food inside a body involves digestive processes and metabolism. 

Usually missing in medicine is an understanding of the effects of xenobiotics and immune responses to food proteins. Digestive tract responses to food include signals that are sent to regulate digestive processes and to activate the metabolic activities required to utilize incoming nutrients.

Other responses are defensive and produce symptoms that warn that other problems will follow downstream.  Recurrent digestive symptoms suggest that disease may appear. When the digestive disease is not fully expressed, categories like IBS are used, just as depression is used as a placeholder for dysfunctions that are not fully manifest and not understood. Patients who are eventually diagnosed with celiac disease often spent years with a variety of wrong diagnoses, especially IBS. They accumulate other diseases that are seen as separate and unrelated.

A patient with "depression" first presented to his physician as a tried, sad man with digestive problems who had lost interest in all his activities; eventually, he progressed to further, more specific manifestations of brain dysfunction. The question for physicians is: When do you switch from a psychiatric paradigm to a neurology paradigm?  In other words, when to you realize that a collection of symptoms that you called "depression" are really symptoms of Alzheimer's disease or some other neurological disease that eventually the pathologist can diagnose? You may be able to prevent progression of early disease with diet revision and exercise, if you start soon enough. Physicians in general have no idea how to prevent the progression of dementias. They tend to ignore early manifestations. I present these arguments in more detail in the Book of Brain.