17 May 2016

The Tragedy of Treating Conditions

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We get so used to naming conditions, we end up thinking of them as entities when they are not.

A condition is a description of the state of the host, not a description of something that is independent of the host.

Take a simple condition, like bruising. Bruising is a condition found in fruit as well as humans.

A bruise cannot exist outside of its host. It’s a bit like a government. A government doesn’t exist outside of a society, it can only exist because of a society, yet often we think of Government as a thing, an entity. Likewise, a bruise cannot exist outside of a body.

A brick is a thing. A chair is a thing. A condition (a set of signs and symptoms) is a normal tissue response to a failed attempt to resist an external force. Yet, since the advent of antibiotics, we are “conditioned” to believe that diseases are singular, that they have a (single) cause and therefore an ideal (single) treatment.

Thus we are looking for “the cure” for cancer when there are over 120 different types of cancer. How do we know that any of those types have just once cause?

We look at research into “low back pain” but anyone in practice knows that very few patients complain of only low back pain. Within that group there are patients with concomitant sacroiliac pain, leg pain, mid back pain, shoulder pain, hip pain, neck pain, headaches and constipation or any combination of the above. What if the dozens of different types of low back pains all have dozens of different causes, how can we be confident that the research comparing one type of treatment of “low back pain” to a placebo actually applies to our patient? The truth is, it can’t.

This paradigm gives us the “pill for ever ill” phenomenon. The idea that as long as we can label a set of signs and symptoms, we can know the correct treatment for it. This is a failed and broken paradigm and it is important for those of us at the cutting edge of patient treatment to reject it outright. It hasn’t worked because it can’t possibly work.

The paradigm also gives us the science of randomised controlled trials. This is highly problematic because the nature of a controlled trial is to keep all other factors the same (or randomised between groups) and then change ONE variable at a time. It is therefore nonsensical to subject any “condition” to a randomised controlled trial of any one “treatment” as any condition could have one or two dozen unique contributory causes and therefore the ideal treatment may be different for every person in that trial.

Even if we do stumble across a treatment that reaches statistical significance, if it is not removing a cause or strengthening the person’s ability to withstand the external force, then we are condemning the patient to living with the condition as well as being dependent on the treatment.

The alternative paradigm is to recognise that it should never be conditions (or treatments) at the centre of research, it must be patients, and specifically, one patient. The standard of a successful treatment should not be its ability to treat a specific current condition, but its ability to prevent all future conditions.

This alternative paradigm recognises the adaptability and reserves built into human function and sees all conditions as the normal physiologic expression of the limits of resilience and resistance. If we are going to intervene in a normal physiologic response to an external force we  have only two alternatives. The first is to lessen or remove the external force and the other is to strengthen the ability of the organism to resist that force. No other approach will be useful, except in the very short term.

Whether a person develops one or more conditions will then depend on only two things

1) the magnitude of the external forces (physical, chemical, emotional or biological)

2) the ability of the body to withstand those forces (eliminating weakness or improving strength).

Strengthening can be achieved by providing more of what the body needs in the way of inputs that are essential or enhancing, or less of what it doesn’t need by removing inputs that are neutral or harmful.

This is the paradigm of the Afferent Input Practitioner. We recognise that every patient is unique but all are governed by the same laws of physiology, of deficiency and toxicity. By testing every patient’s ability to withstand an external force and via this mechanism, uncover their weaknesses, we can reverse-engineer the most appropriate solution to make them stronger and therefore healthier.

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