The Politics of Diagnosis
The greatest achievement would be to understand that everything factual is already its own theory. Do not look beyond the phenomena; they are themselves the teaching." Goethe Wilhelm Meisters Wanderjahre 1829
Metabolic harmony is by nature rhythmic. It conjugates contraction and expansion in the vital symphony of existence. The rhythm shows itself in the continuously alternating catabolic and anabolic coexistence. This rhythm is precisely co-ordinated in time - synchrony - and in action - synergy - with the vital transaction which the organism has established in a determined 'position and momentum'.
The organs are tissular structures ordered in a manner which permits the expression of the function for which they were created. The form is not only shape, but is actually a functional correlation of cells. The correlation expresses the intention of the function. Form brings individuality, but function demands inter-dependence. And the function is to live.
By metamorphosis, the creational process develops and forms one part out of another with particular completeness. It creates the most varied forms by the modification of a single organ. Metamorphosis is in fact a deeper continuity, the continuity of form, bringing with it an increase in quality and specialisation - delicacy and beauty. This is a process of intensification - Steigerung. It is sustained by the polarity of existence, as from seed to fruit.
The phenomenon which we are going to examine is the most important organic process of intensification from the physiological point of view, called inflammation. We will do it in a way which permits the phenomenon to show itself in itself.
The classical characteristics of inflammation are Calor, Dolor, Rubor, and Tumor.
Calor means heat, an increase in temperature.
Dolor means pain, an increase in sensitivity.
Rubor means redness, an increase in colouration.
Tumor means swelling, an increase in volume.
So the first thing we see about inflammation is that it is a phenomenon of increase, and the fundamental increase is in the creation of energy that in a generalised form appears as fever. We know from molecular biology that for this increase to happen two steps are necessary: the conversion of the exogenous nutritive principles into their basic molecular structures, and the metabolic oxidation of those combustible molecules whose basis is carbon. These steps are a catabolic phenomenon which involves the breakdown of proteins, creating ATP and making available the energy that held together the molecular union by means of phosphate bonds. We thereby obtain energy by the disjunction of matter. The energy provided in this way is used for the assembly of macromolecular precursors, and to build up proteins, nucleic acids, lipids and polysaccharides - and this is the anabolic aspect of the phenomenon.
Catabolism and anabolism have heat as a common denominator. The increase in heat therefore expresses a metabolic intensification, an increase in transformation. We can say then that inflammation is an extraordinary - out of the ordinary - process of intensification and metabolic transformation. It is an essential characteristic of the higher organisms that any new formation can proceed only on the basis of a preceding catabolism. Heat is the basic condition for transformation. Therefore growth and regeneration are directly related to the possibility of inflammation.
Digestion means to dissolve and it is the preliminary step to transformation. Through digestion, the organism carefully discriminates, it absorbs and excretes, it recreates life. Pepsis is the medical term for digestion, from the Greek 'pessein', to cook, and that is precisely what digestion is, a process of fermentation triggered by enzymatic catalysts which generate heat, which is in turn used for the reconstruction of tissue. We digest life by a process of discrimination.
Digestion is the ordinary transformation which takes place in the digestive tract. The food stuff acts as an irritant thus initiating the process. Inflammation is always a response to an irritant noxa and we could say that the mucous membrane of the intestinal tract is an organ in a state of permanent physiological inflammation maintained by bacterial flora. Therefore inflammation is in itself a transitory, parenteral digestive process concealed in the tissues. (Parenteral means outside the intestines.)
The function of the intestinal flora is to secrete enzymes. The enzymes are organic complexes which catalyse biochemical reactions. They have specificity of function and substrate. As well as in ordinary digestion, in inflammation - or extraordinary digestion - bacteria are present and also have a role of enzymatic production. Viruses only have the capacity to transport a metabolic code so they need cellular collaboration to unfold their enzymatic information. Bacteria and viruses are metabolic mediators in the extraordinary situation that expresses itself as the inflammatory phenomenon, and their increase is therefore justified. Leukocytes or white cells are part of the same phenomenon, having the role of mediator for enzymatic control, and their numbers increase during inflammation. But it is relevant that the blood rate of white cells is augmented also during the normal processes of digestion and pregnancy.
The way in which inflammation is observed always bears the imprint of the science of that age. The underlying theory of the creational processes forms the basis for the meaning of what is observed. Goethe's way was to look for 'an instance worth a thousand, bearing all within itself', but the experimental facts observed by means of microscopes do not bear their meaning within themselves.
We cannot enframe the presence of bacteria and leukocytes by the dialectical vision of aggressor versus defender. That is a question which has no meaning at this metabolic level and obliges bacteria to be classified into harmless and harmful. But the harmless intestinal bacteria essential for enteric absorption become harmful if human faeces contaminate the drinking water. So then harm becomes a geographical matter. What we see under this 'gestell' or enframing also puzzles us when the observed capacity of the leukocytes to destroy bacteria or cells occupied with active viruses, turns against healthy tissue and destroys it. For this apparent immunological error we have then to construct the concept of auto immune disease, which is in itself an abstraction based on the assumption that a leukocyte has a defensive role. A mechanism of immune defense exists as a potential, but not as a system. Leukocytes, bacteria and viruses all belong together to the phenomenon of the digestive process. Bacteria and viruses are carriers of metabolic possibilities, and leukocytes are metabolic controllers. Each one is an encoding of a set of potentialities.
When inflammation that should be transitory becomes permanent, we see a very interesting fact. The production of energy is diminished by exhaustion, the fever becomes sub-acute. The decrease in the creation of heat will also impair the digestive function of the inflammatory process, disrupting the cellular capacities involved in the phenomenon. These capacities are cellular growth and cellular differentiation. Chronic inflammation has an intense productive or proliferative character. An excess of granulation tissue (repairing tissue) is formed. This lack of control of growth will determine a tumor. When the other cellular capacity, that is differentiation, is also altered by the general weakening of energetic supply, two possibilities exist. There either appears a process of hardening, called sclerosis, where organs are penetrated by connective tissue, or an arresting of the process of cellular differentiation in the early stages, creating cellular atypia which, combined with over-proliferation, leads to cancer.
We see that a chronic inflammation will alter the form which in itself will impair the function. One way to create and maintain a permanent inflammation is by therapeutic procedures designed to counteract the inflammatory phenomenon itself, by means of blocking some of its metabolic components through the use of anti-inflammatories, antihistamines, antibiotics, immunoglobulins, interferon, steroids and vaccinations. Because this action will not modify the specific disease condition that creates the need for inflammation, the inflammatory solution will keep recurring, and metabolically failing to succeed.
Pathology is the science of pathos, suffering. It is this human suffering that moves our compassion and our intellects to look for a solution. The option to look in or to look out is political. Diagnosis comes from the Greek, 'dia', meaning through and 'gignosko', meaning to recognise. We recognise through what we look. But the microscope has been made to look deep within, and the telescope to look far away. But neither of them has been made to look 'there', the there of the being, the da-sein.
Diagnosis is a gestell, a way to look through and enframe the phenomena. This characteristic orientation has historically determined the therapeutic procedures of the twentieth century, and in so doing, allowed medical science to take the final step toward market medicine. During the American Civil War, for the first time, pharmaceutical formulae were patented and manufactured on an industrial scale. This process revealed the expansion of business opportunities that health care could provide, but it was also necessary to lay out the basis of medical theory in order to fulfill this economic purpose. To meet the needs of standardised industrial manufacture, medical science had first to be ordered in a way that would ensure the application of standard medical procedures. Therefore, pathology had to be looked at and defined in a standardised way. The scientific method derived from Newtonian mechanics, with its deterministic view of cause and effect, was the perfect, aseptic, scientifically demonstrable foundation. The goal was to create a scientific common agreement that would give to the scientific method the status of truth. This canonised scientific medical truth, as the practical branch of modern science (the emerging secular religion), had then to be taught in Universities, with strict control of the curriculum by the State-sanctioned research institutions.
The bodies through which the organisation of the medical monopoly was established were precisely the medical trade unions. As an historical example, in 1907, the American Medical Association (AMA) requested the Carnegie Foundation to conduct a survey of all the medical schools in the United States. This foundation was part of the Rockefeller Institute of Medical Research. By the end of the First World War, the number of medical schools was reduced from six hundred and fifty to fifty, and the number of annual graduates from seven thousand five hundred to two thousand five hundred. The Rockefeller General Education Board prepared a report on the advancement of teaching that was finally agreed by the AMA and put into practice. They did not restrict their educational activities to the US alone. In 1927, they formed the International Education Board which donated millions of dollars to foreign universities to enhance medical research and education. The Rockefeller empire also owned the largest drug manufacturing combine in the world.
Research gives the direction as to how to understand what we see in the phenomenon of illness. The understanding determines the therapy, and the therapy configures the medical practice. But the research in itself is already preoriented by the source of the funding. The above historical example shows us the intrusion of usury into medical science, a social virus carrying a code which forces the creation to order itself in a way that can generate continuous consumption in order to produce endless profit.
Thomas Carlyle has said that illness begins with the inquiry. The scientific inquiry looks beyond the phenomenon, ignoring the advice of Goethe, and in order to do this it has first to isolate it. Once isolated, the correlation between that which is seen and where it belongs is inevitably lost. Therefore the meaning is missed. In addition, the scientific assumption that the creational processes are flawed, has ensured that the outcome is a medical procedure that, in intervening, creates more pathology. The aetio of the pathos, that is the cause of the suffering, according to medical science, is inside you. This is no more than a means of distracting you from seeing that the source of the pathos is a social miasma, a set of specific disease conditions which reduce man to being a passive consumer, trapped by endless debt, worthless money, political impotence and the complete disintegration of human behaviour patterns.
The recovery of health is not primarily a medical issue. It is a question of how we live, how we trade, how we worship and to whom we submit.
Dr. Mohammed Dalmau