The Disease Problem

Modern medicine has a serious problem: disease. There is no clear definition of ‘disease’, so there can be no theory of disease. Disease is so poorly defined that diseases can and do appear and disappear, in patients and in medical textbooks, with astonishing agility – and little logic.  There are even names for the mysterious disappearance of a disease: ‘spontaneous cures’ and ‘spontaneous remissions’.

The definition of a disease, and the science of diagnosis is so weak that, if a patient is cured of a cancer, or AIDS, the question often raised is “did they really have the disease”.Cancers and AIDS are only two examples of diseases that are remarkably challenging to prove a diagnosis, thus even more challenging to prove that the disease has been ‘cured’. If a textbook contains a ‘new disease’ there is often little or no scientific basis to ensure that it actually defines a new disease. Symptoms are often confused with diseases – to the point that some of today’s diseases consist entirely of signs and symptoms. Many medical references to not distinguish between medical conditions that are diseases, and those that are not. The goal of modern medicine, is to move as soon as possible to ‘treatment’. Cures are often only forbidden ‘alternative’ medicines.

The problem is in the poor definitions of disease. Webster’s dictionary has a definition of disease, but it is simple and clear, but often wrong:

– an illness that affects a person, animal, or plant : a condition that prevents the body or mind from working normally
– a problem that a person, group, organization, or society has and cannot stop

It starts out good, although simplistic, “an illness that affects a person, animal or plant”.  A disease is an illness.  Too simple: Webster’s also defines ‘illness’ as a disease, completing the circle of nothing.  The further explanation is simply further nonsense: “a condition that prevents the body or mind from working normally”.  Eg.  A broken arm is a ‘disease’, being bullied, shot, or imprisoned is a disease? The definition is too weak to be useful. The second definition is just a mess: “a problem that x, y or z has and cannot stop”. Is global warming a disease? Is every ‘problem’ that some person, group, organization or society cannot stop a disease?

Does the field of medicine have a better definition of disease? No. The field of medicine has many definitions similar to Webster’s, most of them circular and simplistic, easily generalized to non-disease.

Our medical system has a unique solution to this problem: a “union contract”. Disease, in the medical system, is defined by diagnosis, and only medical doctors are allowed to diagnose disease. A disease is something defined and diagnosed by a doctor. You only have a disease if you have a diagnosis. And you only have a ‘valid’ diagnosis if it comes from a certified professional. If not, you don’t have a disease. It’s official. If a non-certified person claims you have a disease – they might be practicing medicine without a license. It is worth noting that you can be diagnosed with a disease retro-actively, even after death. It is also worth noting that, officially, you have a disease even if you have an incorrect diagnosis. You are eligible for insurance, for treatment, and can even be cured in some cases of an incorrect diagnosis.

Legally, or is it ethically, you cannot diagnose yourself, even if you are a licensed medical professional. And if you do, you cannot prescribe a treatment for yourself. This is an important, even useful definition of disease, but it is political, not scientific. I will not discuss it further.

Is it possible to create a clear, simple, scientific definition of disease? Several medical researchers have attempted to tackle this problem, and given up.

The research paper “The Concept of Disease: Structure and Change“, written in 1997 by Paul Thagard, concludes, after “Examination of historical and contemporary writings on disease” … that “disease concepts can best be viewed as causal networks that represent relations among the symptoms, causes, and treatment of a disease.” It’s an interesting diversion.

Thagard does not attempt to define disease, choosing instead to describe “disease concepts”. He tells us that “On the traditional, purely linguistic view, a concept is given by a definition that specifies necessary and sufficient conditions for its application. On this view, we should be able to provide definitions such as X is a disease if and only if ____, and X is tuberculosis if and only if ____. Like other concepts, however, the concept of disease has not succumbed to this kind of linguistic analysis (Reznek, 1987).” Reznek, who he references, argues that ‘disease’ is value laden. Perhaps they both think that it cannot be easily defined because it is value laden?

I will meet Paul Thagard’s conditions, to define the “sufficient conditions” for a disease and the definition will be value laden. The definition of disease is value laden.

Can we define a disease? Yes. Can you tell if you have a disease? Yes. It’s trivial, but yes – as Reznek advises, it’s “value laden”.

A disease is an ongoing progressive negative medical condition, that has an ongoing cause.

A disease is a medical condition.
It’s not  a disease unless it is ongoing: when it stops, it might be a handicap.
It’s not a disease unless it is progressing: it might be steadily progressing as the body tries to heal, appearing to not ‘progress’.
It’s not a disease unless it is negative: negative is value laden, what some see as positive, others might see as negative.
It’s not a disease unless it is has an ongoing cause: if the active cause has been removed or inactivated, the disease is gone, if the disease is not gone, then it’s because the cause was not removed, not inactivated.

You have a disease if you have an ongoing negative medical condition that grows and becomes worse, for some reason, some cause. There are lots of medical conditions that are not diseases. Pregnancy is a medical condition, but not negative, not a disease. A broken arm is a medical condition, but not progressing, not a disease. An amputated leg is not a disease, the cause is gone.

A cold is a disease. Cancer is a disease. Some diseases progress rapidly, others very, very slowly. Some diseases progress and then we recover. Some progress until they kill us.

The key to the definition of a disease is ‘a negative progression’. If it is not a negative progression, it is not a disease. Negative is value laden. Disease – the definition of a disease, is value laden. Is obesity a disease? Are Sumo wrestler’s diseased, or normal healthy Sumo wrestlers? It depends on your values. We might like to think that an external observer can make the judgement – but the closer we look, the more we realize that many diseases, even well known ‘diseases’ are defined using ‘value laden’, not scientific judgement.

Because the definition of disease is value laden, every disease has at least two, possibly different, ‘values’. The patient has one view, and the doctor has another view.  Those views, those values judgments, can be very closely aligned, they might in direct opposition, or they might be very divergent. When more doctors attend to the same patient, there is more opportunity for different values to be attached to the disease – even more so if different types of doctors attend.

Once we understand that a disease is a ‘negative progression’, we can take the next step, to understand the key underlying principle of disease:

Every disease has a cause.

Note: Every individual case of a disease has individual causes.

Causes feed the progression. If the causes are ongoing, the progression is ongoing, and the disease is ongoing. If the causes are stopped, the progression stops, and the disease is stopped. The disease is cured when the progression stops. Of course it may take longer to heal the patient, and it might not be possible to completely heal the patient.

Healing is independent of curing. Cured is not healed. If you have a flesh eating disease, and it eats your leg, and then you remove the cause, the bacteria – you don’t get your leg back. The disease is cured, the cause has been stopped or removed. Once the cause is stopped or removed, you don’t have a disease, but you might have a disability.

A similar example: Type 1 Diabetes. Is it a disease, or a disability? Type 1 Diabetes is not ‘progressing’. Your islet cells are ‘gone’, like your leg. Type 1 Diabetes is a disability. Like a missing leg, it might be a cause. It might lead to other medical conditions, other problems – but it is not a disease, because it cannot ‘progress’ any further. Modern medicine often confuses disability with disease.

Why is this distinction important?

You can cure a disease, but you cannot cure a disability. Type 1 diabetes is a disability that cannot be cured. Type 2 diabetes, on the other hand, has active causes, and active progression, and it can be cured. We can search for cures to a disease, but not to a disability. A disability might be healed, or fixed, but it cannot be ‘cured’. Only a disease can be cured, although we sometimes refer to ‘curing the patient’ (of the disease).

Modern medicine has classified many ‘diseases’ as incurable. This is defeatism; nonsense; a self fulfilling definition. If we are to find cures, we must define all diseases as curable. If it cannot be cured, it is a disability. If we claim it cannot be cured, we must prove that it is a disability, not a disease. If we are searching for a cure, we need to search for the cause.

Some animals can heal a disability. A lizard that loses it’s tail to a predator, has a disability for a while, until it grows a new tail. Then the disability is gone. If I crush my finger, I might have a fingernail disability for a while, until it regrows. But if I lose a leg, I cannot regrow another (today). If I lose the islet cells in my pancreas, I cannot grow new ones (today). I won’t have a disease – I will have a disability.

Jackie Leach Scully writing for the National Library of Medicine “What is a disease?” discusses the difference between disease and disability, but does not actually come to a conclusion. He asks an interesting and important question: “whether the carrier of a genetic predisposition should be considered ill or not“. If you have a genetic predisposition to a disease, do you have a disease? No. We might ask the same question about any theoretical cause of a disease. If you are a smoker, do you have ‘lung cancer’, and ‘mouth cancer’ and COPD? Clearly you are at risk, but you might have been smoking for years, even decades, with none of these diseases. A disease is an active negative progression, not just a ‘probable cause’. It is not a disease until the actual negative progression begins. Bacteria can cause many diseases – but they do not actually cause disease until their presence grows beyond your healthy ability to compensate and to fight the bacteria.

There are grey areas. What if the progression has begun, but it cannot be detected? Is it a disease? It might be healed before it can be detected or diagnosed. It might be a normal condition, where damage is occurring, but the body is healing at the same speed as the damage, or faster. But these are not as important as the times when disease is present. We can cure a disease, but we cannot cure a disease that we cannot detect and measure.

Sometimes the progression of a disease results in a steady, negative state. If you have an ongoing nasal infection, that you cannot cure, you have a disease. It might not be ‘progressing’ in the sense of ‘getting worse’, only in the sense of ‘persisting’. Your body is constantly fighting it, and it is constantly fighting your body. Both sides are progressing into the future, but neither side is ‘winning’. We can view obesity as a disease that progresses, then stalls at some point, but does not go away. The cause is still present. The disease is still present. It is not a ‘disability’.

Every disease has a cure.

Once we accept that a disease is a ‘negative progression, with a cause’, we can clearly see that every disease has a cure. Remove the cause, stop the progression, and the disease is cured.  Obesity is possible, trivial even (in theory) to cure. Stop eating. Of course that cure might be worse than the disease, and that simple cure might kill the patient, or cause other diseases. Some cures are better than other cures.

Many diseases have multiple causes, or long complex chains of cause. Identifying the main or key causes is not trivial. It requires specific, individual case analysis. Cancer has many, many causes. But a single case of cancer has a much smaller set of ‘active causes for this person’. There can be no ‘cancer cure’ for all cancers, because in theory – every cancer can have unique causes.

Every individual disease has causes unique to the individual. Some diseases have common causes, but even the common cold, and influenza, have dozens, even hundreds of ‘possible causes’. Of course the cure for the common cold is trivial, and has been known for centuries. Time. Wait a week or two. If it was not cured, it is not a common cold.

Conclusion:

As noted in the Theory of Cures:

A disease is an abnormal, active, negative, medical condition, with a cause, or causes and it is cured when those causes are removed, or stopped.

Every definition has grey areas, fuzzy areas, difficult to decide, difficult to judge. This definition of disease is no exception. There are conditions that are difficult to classify perfectly as ‘disease’ or ‘not disease’. This is to be expected. A good definition helps us to see the grey areas, and is useful in the exploration and study of grey areas.

If we don’t define ‘disease’ as a condition that has a cause, and can be cured, it becomes too easy to treat symptoms – and ignore the cause. Without a solid definition of disease – any disease can be classed as ‘incurable’. And that’s nonsense – but that is happening today. We have ‘progressed’ from the search for a ‘cure’ for cancer, to acceptance that ‘cancers cannot be cured’, and must be ‘survived’. We have progressed from the search for a ‘cure’ for diabetes, to acceptance that ‘diabetes cannot be cured’. Nonsense.

The ultimate measure of a definition is not defined by some academic discussion. Definitions are measured by their usefulness. The definition presented here is designed to facilitate disease cures.

to your health, tracy

 
Tracy is the author of two books about healthicine:


 

About Tracy Kolenchuk

Founder of Healthicine.org. Author of two books about healthicine; Healthicine: The Arts and Sciences of Health and Healthiness Healthicine: Introduction to Healthicine
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