Medical science rarely undergoes revolutionary changes. Progress tends to be slow and steady, with new ideas undergoing extensive investigation before being implemented. This pace can be frustrating and every once in a while, someone comes along who thinks they have discovered The Secret to It All. Despite the apparent insanity of such grandiosity (or perhaps because if it), you can always rely on the Huffington Post to give it a platform. (Interestingly, most of these Ideas can’t be simultaneously correct, but that doesn’t seem to bother HuffPo).
The latest Revolutionary Thinker is Dr Frank Lipman who writes about what he calls “the myth of diagnosis”. Let me remind you what “diagnosis” is (paraphrasing liberally from an earlier post).
We have a couple of ways of going about defining diseases. One is pathophysiological where we can clearly see a disruption of normal function or anatomy. Another is genetic; if we can trace pathophysiologic changes to a specific genetic change, Bingo! Of course, genes are rather complicated, and the relationship between genotype and phenotype can sometimes be frustratingly variable. But no one said science would be easy.
The least satisfying way of defining a disease is syndromic. Humans are pattern monkeys, which is both a good and a bad thing. The earliest medical texts were descriptive, and defined illnesses by their outward manifestations, the inner workings being inaccessible to the ancients. We still are forced to resort to description from time to time in medicine. For example, in the 80’s a new disease emerged which didn’t appear to be any single disease but a grouping of different diseases and symptoms with some commonalities. We called this grouping “Acquired Immune Deficiency Syndrome” to acknowledge the fact that all the patients had immune dysfunction and all appeared to have “acquired” it rather than having been born with it. It was called a “syndrome” rather than a disease because it was more of a grouping of illnesses and the unifying pathology wasn’t yet understood. (Now, of course, HIV disease is one of the best understood illnesses in human history.)
Ultimately, the goal of defining a syndrome is to look for the disease or diseases that may underlie the symptoms. We realize that when we define a syndrome we may improperly include and exclude patients from our net, but we try to come up with rational definitions so that we may find the cause. “Syndrome” is more of a tool than an explanation but it can be a very useful tool.
The reasons that we diagnose diseases rather than taking some other approach to human disease is because it works. Generalization is important. Knowing patterns and causes of diseases allows us to intervene. Studying groups of individuals to find knowledge to apply to individuals is how medical science works. For example, a heart attack is (proximately) caused by the occlusion of a coronary artery. This knowledge has allowed us to study and implement ways of opening these arteries and saving lives. If we did not use this system and treated each presentation as a unique disease, we would have no way of generalizing treatments.
Of course, heart disease has more distant/ultimate causes as well, such as genetics, diet, cholesterol, and smoking, so we also have ways of preventing heart attacks. Understanding the proximate and ultimate causes of diseases, and being able to define them is what makes modern medicine work.
Diagnosing people with specific diseases does not preclude treating people as individuals; this is the heart of medicine.
But Dr. Lipman does not agree:
After 30 years of practicing Medicine, I have learned that for any chronic illness or ailment, treating underlying imbalances and dysfunctions is more important than making a diagnosis and naming the disease. Ultimately, asking the right questions is more important than giving a label to a set of observations.
What does that mean, doctor? “You learned that….” Did it really take you thirty years to learn that treating diseases involves more than naming them? Congratulations. So what is behind your revelation?
This is because most if not all chronic problems, from heart disease to arthritis, migraines to irritable bowel syndrome (IBS), depression to fatigue, usually have multiple factors that need to be addressed – this is called the total load. The total load is the sum of the factors that influence a person’s life and health, including diet, exercise, job stress, relationships, state of mind etc. Individually, each of these elements might not cause a problem, but their cumulative effect can overload our normal functioning and cause harm. Everyone’s tipping point is different and each of us manifests or experiences overload in our own unique way.
That’s clever! You invented a new word–“total load”. You also “discovered” that every patient experiences health and disease in a unique way. Good for you.
There are two types of idiocy going on here. First is the usual altmed co-optation of standard medical practice, in this case prevention. The recognition that prevention is important is not revolutionary—it’s standard of care. The second is the delusional belief that you have actually discovered something new and revolutionary.
It’s sad in a way, but also dangerous. Doctors who abandon the model that has served us well for so many years to adopt a new, made up, and invalid approach to practice are dangerous. There’s plenty in medicine that could stand some improvement, and smart, compassionate doctors are always needed. Cranks, not so much.