Medicine, modern medicine, is blind to health. Diagnosis is blind by design.
Diagnosis requires medical blindness. The facts are gathered and studied to produce a yes/no decision, to separate patients into sick and not sick, into black and white. Shades of grey are ignored in diagnosis, until time for treatment. Your health insurance does not decide to pay or not pay, depending on ‘how sick’ you are. If you have a diagnosis on their list, they will pay. Your prescription medication is not controlled by ‘how sick’ you are. If you have a diagnosis, you can get a prescription.
Healthiness is best represented in color.
Healthiness has many factors, which can range from low to high. In this diagram, red indicates danger and green indicates healthiness. Each factor of health is on a scale, none are every likely to be perfectly healthy, nor perfectly unhealthy.
When we look at a number of healthiness factors in a single diagram, we see more complexity, as in the diagram below.
However, even when we look at many factors of healthiness, diagnosis is still a simplified, yes/no decision.
If specific health factors fall below the red line, you might be diagnosed with an illness. If not, you are ‘not ill’. If you don’t have a diagnosis, you are technically “not ill” – although you can be diagnosed retroactively. If your healthiness falls below the red line, but not in a pattern that is a recognized ‘disease’, you will not get a diagnosis, or you might get a tentative diagnosis, or an incorrect diagnosis. This happens more often than you might think.
A diagnosis is a yes/no decision. A yes/no decision often requires ignorance of some factors, or blindness towards some factors. Diagnosis is an art, the art of converting the colors of healthiness into a black/white decision. Visual blindness is when a person only sees blackness, there is no light. Snow blindness results from too much light, and we cannot see any black nor any shades of grey. Color blindness is when an individual can see shades of grey, but cannot see colors. Medicine is blind to health, it sees no colors of healthiness.
Diagnosis is also blind to health, it sees only black and white. Diagnosis is blind by design.
In diagnosis. facts are often not clear but a decision is required. The art of diagnosis is to arrive at a decision. Once a diagnosis has been made, the physician makes a prognosis and a plan of action. These require the physician to reconsider the grey areas to make more useful and effective decisions.
A similar situation with deliberate blindness is a powerful tool is in law. Opposing lawyers present the ‘facts’ and the judge must make a black/white, guilty/not guilty decision. When a guilty decision is made, the judge must use the arts of sentencing to account for the grey areas. This is why ‘three strike laws’ are ridiculous. They are designed to act on the ‘diagnosis’ of the courts, as if diagnosis arrived at truth. Diagnosis arrives at simple decisions. Truth is seldom simple.
Any time a medical professionals needs to make a decision, they can make use of specific medical blindnesses to guide them. Once the decision is made, two things are important. One, to see the grey area, and use them to guide future actions and plans. Two, doubt. When we use medical blindness to arrive at a diagnosis or treatment decision, errors are always possible, and doubt is an important tool in the arts of medicine.
Medical outsiders often confuse the black and white decisions of intentional medical blindness with ‘science’, or the results of a scientific investigation. Marketers, for example, seize a positive result and use it to boost sales and bash competition. The entire discussion of ‘alternative medicine’ is based on this type of blindness taken to excess. Some people believe that all alternative medical treatments are bad, black, refusing to see any white or recognize any grey areas. Others take an opposing view, that all conventional medicines are black, and only alternative medicines are healthy. This simplistic nonsense is perfect for advertisers on either side, and it is repeated by both sides, in deliberate attempts to drive purchasing decisions.
Where is the science in diagnosis? The science lies outside of the practice of medicine, just as the science of materials strengths lies outside of the field of engineering. The science of diagnosis is the work outside of the ‘practice’ of medicine, to identify patterns that can be named diseases. Much of this work has already been done, and as a result, the practice of medicine is very effective in these areas.
A disease that does not have a clearly defined cause, is a disease that needs more ‘science’. Many disease have very poor scientific definitions today. Think of chronic diseases. These are often diseases without ’cause’ and without ‘cure’. Chronic diseases are diseases where the science of disease has more work to do. We need to learn more about what causes arthritis, heart disease, diabetes, and more. The top causes of death are no longer diseases where the cause is clearly identified. Diseases like heart disease, cancer, stroke, Alzheimer’s, and diabetes, are incurable today. They are incurable because they are ‘diagnosed’ without identification of cause. Without knowing the cause, they cannot be treated, and cannot be prevented effectively.
You might think you know how to prevent these diseases. The heart association knows how to prevent heart disease. The cancer societies know how to prevent cancer. The stroke foundations know how to prevent stoke. The answer is always eat healthy, get lots of exercise. Live healthy. Does that seem strange? That health can prevent disease?
It is more strange that we don’t study health. We have thousands of tools and techniques to detect, diagnose and measure diseases. But we have no tools to measure healthiness. But heart disease, stroke, and cancers are not caused by parasites, nor by accidents. They are caused by poor health. Medicine is blind to health. When we learn to study health scientifically, when we learn to measure healthiness, we will have tools to cure these diseases, we will cure them with health.
We need to recognize that medical blindness is a tool, used to arrive at a decision in a specific case, just as legal blindness is a tool to arrive at a decision in a specific legal case. However, medical blindness as a general rule is nonsense. In law, every new case is recognized as such. We need the same standard in medicine to achieve a higher standard for health.
How can we achieve this? First, we need to recognize that all diagnoses are tentative, even diagnoses of death have been mistaken. Next, we need to recognize that every individual case of an illness, especially chronic illness, has a cause. We need to search for the causes specific to each case. The doctor needs to become a medical scientist and researcher, if we are to treat chronic illness effectively. And medical scientists need to study healthiness.
Also, we need to ensure that the patient, has freedom to choose, the right to make decisions about treatment. The patient deserves the truth, but the medical truths, like diagnosis, are often simplistic and sometimes wrong. The patient needs the right to decide.
When we study Healthicine, the arts and sciences of health and healthiness, when we can measure unhealthiness as effectively as we can diagnose illness today, we will advance the sciences of medicine, and the science of diagnosis.
to your health, tracy
Tracy is the author of two books about healthicine:
This post is part of a new book, currently in progress: “The Un-Sciences of Medicine”. But it’s not what you might think. The Un-Sciences of Medicine is not about ‘alternative medicine’ it is a book about medicine and healthicine.
