Once upon a time, a very intelligent young owl wanted to become the worlds best doctor. She consulted the wise old owl.
“Many owls claim to cure in many different ways. How,” she asked, “can I learn the best…?”
“First,” The wise old owl interrupted strategically, “you must know that every disease has two names.”
“Two names? But I want to find the best cure. Why do I need two diseases?”
“Not two diseases,” the elder counselled, “two names for every disease.”
“I want to find the best cure for the disease, not two diseases.“
“A disease is not a thing. It’s just a name we assign to guide our treatments.” The wise owl continued, “Every case of disease, every illness, spans from cause to consequences. Sometimes, we name it after the cause. Sometimes we name it after the consequences… and sometimes we name it after the span. So sometimes, it has more names.”
“A disease with three names?” the smart young owl challenged, “Can you give an example?”
“It’s trivial once we understand the concepts. For example, Vitamin C deficiency is a disease. That’s the cause-name.”
“But,” the smart owl interrupted, “isn’t that called scurvy?”
“Scurvy is a consequences-name. A patient might have a mild, even severe Vitamin C deficiency for some time, but we can’t diagnose scurvy until the consequences become severe enough.”
“You said sometimes there are three names?” The young owl stepped back.
“Yes, of course. Sometimes a patient is only mildly deficient, or only temporarily – not severely enough to be diagnosed as scurvy, not even consistently enough to be easily diagnosed as Vitamin C deficiency.”
“So, what name do we give it?”
“When we don’t understand, we might give it many incorrect names. We might call it ‘poor healing’, or ‘aging’, or perhaps ‘weakness’. The name we assign might be more or less ambiguous, depending on the severity, the strength or weakness of the confidence of the physician – who might fail to understand either cause or the consequences. It might be called chronic something, a span-name, when we don’t know the cause and only poorly understand the consequences.”
“If an illness has two names, or three names – does it need two, three, or more cures?”
“You are quite smart. There is some truth in that analysis. Every cure of an illness must address the cause, the consequences, and sometimes the span, the connection between cause and consequences. In addition, sometimes, we must address the patient’s fear, or the physician’s prejudices, the family’s concern – or many other factors.” The old owl paused, and then continued, “As a doctor, we must recognize that health is the best cure. Most cases, and many aspects of an illness, are cured by health. To cure, we sometimes need only address a single name. But, take care – sometimes addressing only one name, or the wrong name – produces a false cure.”
“Like alternative medicines,” the young owl enthused, hoping to get something right, “which don’t actually cure.”
“Every cure is an alternative,” the wise owl cautioned. “Some alternatives cure, some don’t. Every illness has many potential cures. The concept of alternative medicines is a red herring, distracting us from cures. ”
“But, isn’t every illness cured by a true medicine?” The smart owl was puzzled.
“Curative medicines are mostly a myth. Most medicines are only caring medicines, making no attempt to cure. Most conventional medicines, and also most alternative medicines, only address consequence-names of illness. Very few illnesses are cured by medicines. Most cures come from health. Vitamin C deficiency is not cured by medicines – it is cured with a healthy diet. As James Lind noted hundreds of years ago, there are many names for scurvy, and many ‘alternatives’ that cure. Keep in mind that Lind was studying scurvy, not ‘cure’.”
“So… The cause-name is the cure-name?” The young owl tilted her head to the side.
“Usually, the cure-name is the inverse of the cause-name, yes. We often use the same name. When the cause is ‘absence of Vitamin C in the diet’ and the cure is ‘Vitamin C’ in the diet. But sometimes that’s just a care-name. Other times, the consequences-name is both the care-name and the cure-name.”
“How can it be both?”
“There is no cure for the common cold in medical theory. But in medical practice, the cure is care. When we care for the patient, when the patient takes time to care for themselves, the cold is cured.”
“Isn’t that just placebo effect?”
“You are confusing placebo treatments and placebo effect. It’s a common error. A placebo treatment is a treatment that the doctor does not believe can help the patient. But when we care for the patient, we expect our care to help them. Placebo effect, on the other hand, is simply mysticism. Every beneficial effect is a true effect, every true effect has a true cause. We can only call it placebo effect if we don’t understand the cause.”
“But, isn’t placebo effect just in the mind of the patient?”
The old owl looked down his nose, “A placebo effect is in improvement in the condition of the patient. You can look it up. The patient cannot bend spoons with their mind – and they cannot heal with the mind alone. We can never prove that an effect was caused ‘by the patient’s mind, or their beliefs’. So, placebo effect is simply unscientific. Every so-called placebo effect has a real cause. Once we understand the cause, it becomes a real effect of the cause. The placebo effect disappears. It was never there.”
The old owl continued, “Advanced Vitamin C deficiency, a more severe case of the same cause-named illness, is called scurvy. It requires a cure for the cause – the dietary change, and also a care-cure for the consequences – concentrated Vitamin C, perhaps lots of oranges, or a concentrated supplement. But, Vitamin C is not a curative medicine, it’s part of our natural healthiness. Oranges are not ‘alternative medicines’, even when they cure.”
“Isn’t it a medicine when the patient has the disease?” the smart owl challenged.
“Beware of medical chauvinism. When we believe it’s a medicine if we prescribe it, but not a medicine the rest of the time – we are inflating our own importance, often diminishing the importance of the patient, and of nature. You said you wanted to learn to cure. Take care that you don’t need to cure your ego,” the wise owl chastised.
“But, everyone knows Vitamin C supplements cure scurvy,” challenged the youth.
“Beware of what everyone knows. Most people don’t think. No medical reference suggests Vitamin C to cure scurvy, only to ‘treat’ scurvy, to care for scurvy. When we only give the patient a supplement, the cure never arrives. The diet doesn’t change, the supplement becomes a chronic medicine, necessary as long as the patient lives.” The old owl paused for a moment’s thought, and added, “This leads to the common mistake of telling the patient to ‘learn to live with their disease’ when we really mean ‘learn to live with the medicine that does not cure’, or perhaps ‘learn to die with your disease‘. To cure a severe case of scurvy, we must address both names – the cause, the faulty diet, and the consequences, the inability to heal.”
“So when we study the names of a disease, we find better cures.”
“Yes. But, sometimes, more is needed,” the wise owl counselled. “Sometimes, for example, scurvy causes damaged or loose teeth which cannot be healed. The only cure is dental surgery.”
“Advanced scurvy needs three cures?”
“Sometimes, yes. It has three disease-names, and each disease-name has many alternative cures. There are many dietary changes that can address the dietary cause of the illness. There are many sources of concentrated Vitamin C to address the healing consequences. And there are many dental surgeries that might be used to repair the damaged tooth.”
“This is so complicated – is every disease so difficult?”
“Every disease has the same basic aspects. Begin with the basics. Every cure is a change, a transformation of the patient. That’s the first understanding. To cure, we must change the patient in some way, perhaps their diet, body, mind, spirit, sometimes their community. Occasionally, a medicine changes the patient, but those cases are rare,” the wise owl paused.
“But, aren’t there millions of possible changes?” the young owl shook her head.
“And every disease is caused by a change as well,” the old owl smiled. “But, it’s not so complicated. There are exactly two types of life changes. So, there are two basic types of cures. We might cure by changing the patient’s life processes – their diet, their exercise or rest patterns, perhaps their body, their mind, their spirit, or any life process. Process cures must be maintained. When we fail to maintain the change, a new case of illness occurs.”
“Like remission and recurrence.” the smart owl agreed confidently.
“The concept of remission and recurrence is weak and flawed. Remission usually means the consequences-name was addressed. Remission can be a result of care that does not cure. A disease is not something that can go away and return. When we address the cause we don’t call it remission. We only say remission when signs and symptoms fade – but we don’t know the cause. When the cause is addressed, we call it a cure.” The old owl continued “When the cause has been addressed – and occurs again, it’s a new case, not remission and recurrence.”
“For example?”
“A person might suffer Vitamin C deficiency due to ignorance. When they are made aware of the cause, the illness can be cured. But, perhaps many years later – their life situation changes, they become old and senile, or perhaps addicted or alcoholic, and forget the lesson. They get a new case of Vitamin C deficiency. Their illness did not ‘go away’ and ‘return’. Any person who is deficient in Vitamin C will get scurvy. The presence or absence of a previous illness has no impact on the second occurrence.”
“But what if the dietary change was only temporary? Is it just a temporary cure?”
“Cured is a judgement. It is possible to have a partial cure by partially addressing a cause, or a temporary cure by temporarily addressing the cause. It is appropriate in some cases to judge a temporary cure, in other cases to judge a failure to cure.”
“But as a doctor, I can’t change the patient’s diet. Only the patient can change,” the smart owl shifted the conversation.
“You are beginning to understand,” the wise owl nodded.
“You said there were two types of life changes,” the young owl responded, “what is the second change that cures?”
“Sometimes, we need a process change, like diet. But other times, we only need to change some attribute of the illness. When a tooth is broken, it needs to be repaired or removed. Attribute cures are single cure actions, sometimes by the patient, sometimes by a doctor, sometimes by someone else.”
“But, pulling a tooth doesn’t cure the tooth!” the young owl challenged.
“Every illness has two names, the cause-name and the consequences-name. We don’t cure the ‘tooth-name’. We address the cause and the consequences.”
“But, we can’t address the cause of the broken tooth. That cause is gone,” the youth appeared frustrated.
“Of course, you are right. No cure can address a past causes. We study past causes for prevention – but they cannot cure.” The wise owl continued, “the broken tooth is the ‘present cause’ of the patient’s signs and symptoms. The illness spans from the present cause to the consequences. Past causes are of no consequence to the cure unless they are also present causes. Removing the tooth cures the illness. No cure is perfect.“.
“Hmmm…” the smart owl considered this for a moment. As her mind sped from one concept to another, she had an idea. “But, isn’t a dietary change actually an attribute change? It changes an attribute of the patient’s diet.”
“Yes, of course. Cure is not a trivial concept. We can look at it one way, and see an attribute change cure, or look at it another way, and see a process change cure. From the doctor’s perspective, we need only change the patient’s diet, a single change. But from the patient’s perspective, the change must be repeated every day. In addition, over time, the patient might not realize it is a change, the daily change becomes an attribute change.”
“So how do we decide if we need a change of process, or of attribute?” the young owl was worried about her future.
“We must choose. When we choose an action that must be continued as long as the patient lives, it’s a process change to their life. When we choose a one-time action, it’s an attribute change.”
“It’s muddy. Is there no true science of medicine?”
“We can discuss theory forever,” the wise old owl concluded, “Medicine is a practice, not a theory. The science of medicine is theory. In theory, theory and practice are the same. But, in practice, they are not the same. To cure, we practice, learning from our successes and our failures. Would you like a bite of this mouse?”
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This story is based on the concepts of illness and cure as documented in the book The Elements of Cure and explored in more details in the book A Calculus of Curing.
to your health, tracy
