Finding Health: The History of an Elusive Goal (part 1)

Health is a state of complete mental, social and physical well-being, not merely the absence of disease or infirmity.” – World Health Organization, 1948

When you look in the mirror, do you ask yourself if you are as healthy as you can be?  Like me, you might find yourself searching for ways to get healthier – maybe through a new exercise regimen, a personal trainer or a healthier diet.

Maybe during your last physical, your doctor told you that all of your blood-work checked out “normal” and there were no obvious concerns found on the examination. Nevertheless, you don’t feel the way you used to and are struggling with fatigue. Does normal blood-work mean you are healthy and it is all in your mind?

Maybe your doctor diagnosed you with a health condition that is linked to a behavior and wrote you a prescription for a medication — or maybe a few?  Do these make you healthier if you take them? 

Where is the cutoff point to “healthy,” “healthy enough,” and “unhealthy”? What can get us closer to the ever-eluding state of “healthy”?

This chapter is divided into two blogs given the length. I will discuss a brief history of anatomy and physiology and the use of medicines and its implications. In the second section, I will describe reductionism and holism, models in which to view health, and attempt to articulate a wellness concept.

A Brief Overview of Medicine

Understanding the mechanisms of the body has been one of the greatest challenges and accomplishments in human history. Early medical practice solely relied on observation, history-taking and physical assessment. In those times, physicians used all of their senses – including smell and taste (!), to gain a greater understanding of the inner workings of the body and understand the disease state. Egyptians studied anatomy from the cadavers that they embalmed at least as far back as 1600 B.C.E., the dating of the Edwin Smith Surgical Papyrus, which catalogs multiple injuries of the body in anatomical fashion. These observations became the tenets of early medicine, such as Chinese medicine, Ayurveda and practices in Egypt, Persia, Babylonia and Greece. It is interesting to think these disciplines were developed thousands of years ago without in-depth scientific understanding of human anatomical structure and function (physiology).

An attempt to explain the physiology of the body was made as early as in Ancient Egypt or Mesopotamia: Humorism. This was further constructed by the Greek Empedocles. The theory accounts for liquids found in the body (blood, yellow bile, black bile and phlegm) and how they control body function and even temperament. In the 2nd century, Galen contributed extensively to the study of anatomy by performing animal dissections and vivisections. His observations on the physiology of the circulatory system were influenced by Humorism. His writings became the foundation of anatomy for centuries after. In 1205, the Persian Avicenna in his “Canon of Medicine” fleshes-out further the theory of Humorism. The four humors, as they were called, became the paradigm of understanding physiology and behavior for millenia, until it was disproved around the mid-nineteenth century.

The Four Humors. Taken from Wickepedia.

Italy became a thriving center of anatomy during the middle ages and beyond. In Bologna, Italy, the writings of Mondino de’Luzzi in “Anathomia” in 1316 became a text book for university students of anatomy for more than 200 years. Anatomical theatres became a popular form of human anatomy instruction at the University of Padua during the 16th century. In these theatres, students gained knowledge on the procedure of human dissection and anatomy.

Physicians honed their understanding of physiology and the development of the clinical research method in the 17th and 18th century. An important advancement to physiology was the development of the high-powered single-lens microscope by Anton von Leeuwenhoek in 1666, fashioned after earlier models originating back in the 1590’s by Jannsen. Early microscopists described cellular structure, sperm, red blood cells and anamacules, or “little animals”, the name given to protozoa by Leeuwenhoek. Knowledge of the smaller components of anatomy began to shape modern understanding of physiology, which was further defined as tools became more precise.

In modern medicine, we are truly at the crossroads of anatomy and physiology – where electron microscopes are better defining structure down to the detailed structure of the genome and its function and targeted therapy is now a possibility.

A Brief Review of Medical treatment

“Let food be thy medicine and medicine be thy food.” Hippocrates

Humans have looked to nature as an aide to health and treatment of illness. Herbal medicine became the basis of much of early medical practice, dating as far back as 5,000 years ago in recorded history, for example with the Sumerians, Egyptians, Romans, Greeks and Chinese, and was a part of a much more ancient oral tradition dating possibly 60,000 years earlier. Some of this herbal history has even been implemented recently as a treatment for important illnesses. Hippocrates referred to the willow tree (salicylate containing) to treat fever in 400, B.C and it was referenced in Sumeria and Egypt, long before Bayer synthesized and manufactured the chemical in 1899. The Chinese use of Wormwood herb (Qing Hao) for the treatment of fever dates back to the 5th century, long before its anti-malaria compound artemisinin was isolated and manufactured on a large scale (1972).

Wormwood: A Treatment for Malaria

With the success of mass production of pharmaceuticals from factories, herbal remedies shifted to medication productions, many of which are derived from natural ingredients (e.g. aspirin, digoxin, antibiotics, etc).   Still today more than 50% of approved medications are either directly or indirectly derived from natural substances.  

Antibiotics and chemotherapy give many more hope for survival and a full lifespan.  Life expectancy increased through improved prenatal and postnatal practices, clean drinking water, and public health measures.  A generally longer lifespan brought an increase in heart disease, diabetes and other conditions.  With these conditions, there was a drive to mass-produce  medications by businesses in an attempt to mitigate health risk through pharmaceuticals –  and the businesses profited.

Today “Big pharma” is a multi-billion dollar industry.  The pharmaceutical industry has mastered the production, assembly and marketing of these products.  There are treatments for every ailment. If you have a problem such as diabetes, high blood pressure, high cholesterol, acid reflux – and even erectile dysfunction – there is a “pill for every ill”. If you even have coronary artery disease, you have multiple medication and intervention options, including stents and coronary artery bypass graft surgery (CABG). With these options though, some people with multiple medical problems face bankruptcy as they manage their medical problems and high medication costs. Sadly, the medications are not without their side effects. Several medications are known to increase the risk of diabetes, including statins, some psychiatric medications and blood pressure treatments (beta-blockers and thiazide diuretics). These medications create an effect by inducing an imbalance – side effect. After all medications are absorbed from the gut, get metabolized by the liver and then circulate through the whole body.

Medicine has had an incredible role in treating infectious diseases, cancers and autoimmune conditions. In the field of infectious diseases, I am astonished that we have a cure for hepatitis C and a treatment that is life-extending, if not life-saving, for those with HIV – both of which were developed in little more than a decade after discovery of the conditions! However, for chronic diseases such as hypertension, diabetes and atherosclerosis – all linked to behavior and obesity – medications come short to providing a significant benefit. In the midst of a worldwide obesity epidemic, with more than one-third of world’s population affected, actionable measures to approaching behavior change and prevention are paramount. The world is in great need for a panacea, and it will not be packaged as a pill.

The next post will describe the concepts of Reductionism and Holism and merge the understanding of the human body with a potential framework for viewing health and wellness.

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