t e m p e r a m e n t & h o m e o s t a s i s
D I S R U P T I V E P R O C E S S E S
root causes of Disease
INTRODUCTION
” To create long-lasting social change,
organizations and the programs they create
must in one way or another
become embedded in the local community. “
Eric Nee ( 1954 – )
” I’ve learned that
people will forget what you said,
people will forget what you did,
but people will never forget
how you made them feel. “
Angelou Maya ( 1928 – 2014 )
The opening citation, written by its Editor, appeared in the Spring 2016 edition of the Stanford SOCIAL INNOVATION Review. The “Editor’s Note” ends as follows. “Is community engagement a magic bullet? No. But it’s clearly an important component of creating programs that work. And the engagement that is created by one program can have spillover effects into the entire community, strengthening other social programs and creating greater social cohesion within the community itself, an essential component of creating a healthy and resilient society.” In effect, the thrust of healthcare reform must be its contribution to the Social Capital of each community beginning, but not ending, with equitably available enhanced Primary Healthcare.
This Sub-Page represents an expanded explanation for a key element in the definition of HEALTH that appears on the GLOSSARY FOR HEALTHCARE Sub-Page. That definition of HEALTH represents a global view for the origins of each person’s Well Being. In one sense, the definition identifies the dimensions of life that maintained a person’s survival in the absence of our contemporary healthcare.
Given the breadth and depth of threats sustained by each person’s Clusters of Human Capabilities, this Sub-Page represents a connection with the scientific systems of thought that underlie the various HEALTH Conditions of Unstable HEALTH that may be expressed by any person. Specifically, this Sub-Page attempts to identify the fundamental ‘Causes’ of unstable HEALTH that can be identified by contemporary healthcare as a Disease.
H E A L T H
The Disruptive Processes that underlie Unstable HEALTH have been substantially identified over the last 200 years, especially during the last 50 years. Historically, a HEALTH Condition has been most easily recognizable by the sudden occurrence of injuries associated with armed conflict. Since the beginning of recorded events, the sudden effects of armed conflict have been repeatedly described for the involved participants.
In addition to injury, the scientific attributes for defining the root causes of Disease began with the measurement of weight and time, then temperature around 1600 and the stethoscope in 1819. The pace of improvement in the KNOWLEDGE about HEALTH has now reached the level of various genetic and epigenetic anomalies, including the various combinations of these anomalies. Lurking behind the genetic and epigenetic processes, each person forms a unique innate temperament and baseline homeostasis during their immune tolerant, maternal gestation. If you are now overwhelmed by the level of complexity, join the chorus.
The ethical issues surrounding healthcare that are associated with its RESOURCES and HUMAN DIGNITY as well as its KNOWLEDGE will increasingly characterize the frontiers of healthcare reform. From genetic anomalies to the scarcity allocation of healthcare resources during a regional or national disaster, there is no current strategy to consider each community’s considerations for their nation-wide, locally uniform preparedness.
The root causes of DISRUPTIVE PROCESSES, aka root causes of disease, may be described as outlined below. The medical formulation supporting a Diagnosis becomes more clearly definable for healthcare when there is a predominant cause that is related to a clearly definable treatment plan. Usually, the treatment plan related to a Disruptive Process is similar to the treatment plans for the other HEALTH Conditions associated with the same predominant cause. They are as follows.
I. HEREDITY refers to:
The genetically determined, minor to life-threatening adverse effects occurring from a genetic or epigenetic abnormality that affects one, or more than one, Cluster of Human Capabilities for which the changes are present *) at birth (such as Down’s Syndrome, Sickle Cell Disease, or a heart defect) OR *) at various developmental stages of life (such as schizophrenia, Hemochromatosis, sudden athletic death from a hereditary Cardiac Disorder or certain forms of Senile Dementia). The range of abnormalities is quite large, and our current research efforts will open many new frontiers, such as, the newly definable arena of epigenetics.
One indication of how precarious the first trimester of a pregnancy can be, is represented by certain medications given to the mother during a pregnancy. There is a medication that when given during a pregnancy, a fetal daughter will eventually be at high-risk for developing vaginal cancer during her subsequent years of fertility. The medication is Diethylstilbesterol. This effect has been further reported in 2018 as occurring for the grand-daughters of women treated with the Diethylstilbesterol during a pregnancy.
Uniquely, a person’s innate temperament is not totally related to a person’s genetic endowment. This is also true for a person’s baseline homeostasis characteristics. Furthermore, the functional characteristics of a person’s homeostatic control can be more or less inter-connected with the person’s innate temperament. Common observations about these connections are borne out by the personalities of identical twins, with alternate personality traits. The biology of epigenetics may apply. When a sperm and an ovum unite, the person’s cytoplasm originates initially from the person’s mother including its governing RNA. How this affects the initial developmental boundaries of the evolving fetus is largely unknown?
The definition of HEALTH for this Blog clearly separates the fundamental genetic endowment for the Clusters of Human Capabilities as largely, but not completely, separate from the resilience of a person’s innate temperament and its baseline homeostasis. We would offer the hypothesis that this axis for early, pre-natal development should also account for the state of immune-tolerance that exists within the mother’s uterus during a pregnancy. The studies evaluating personality characteristics to a person’s maternal, birth order may also apply to understanding the origins for a person’s innate temperament.
II. CONTAGION refers to:
A contagious HEALTH Condition, i.e., an infection, occurs from self-replicating organisms that can be *) transmitted between persons as in tuberculosis, measles, polio, tetanus, influenza or gonorrhea; *) prevented by immunization for certain infections; *) spread by food preparation, bodily fluid contamination (most commonly by a cough or sexual intimacy) or touch between persons; *) controlled by quarantine as in tuberculosis and influenza; and *) treated by medication to reduce or eliminate the reproduction where possible of the self-replicating organism.
The evolution of infecting organisms has occurred over billions of years before the evolution of terrestrial animals. This has occurred as other animals have adapted to their presence. The current evolution of bacterial resistance from the wide-spread use of antibiotics, particularly in the small animal food supply, is not alone as the cause for antibiotic resistance. Resistance represents a normal attribute of infectious agents as a means to continue their survival.
During human existence, our world has experienced the disappearance of small pox. At the same time as the elimination of small pox, we now have the Ebola virus and human immunodeficiency virus. One reason for greater border security may be to have better control from the future existence of world-wide pandemics. Remember, our world-wide population will grow by 2 Billion people during the next 30 years.
III. GROWTH and DEVELOPMENT refers to:
These HEALTH Conditions occur because of multiple interacting disruptive processes that are more likely to induce adverse effects at a certain age during a person’s lifetime. The potential expression of a person’s Clusters of Human Capabilities unfolds with the continued multiplication of multiple individual cell lines that slows as the genetic endowment for its homeostatic control processes unfolds. Some cell lines slow down during this replacement process in ways that reflect the normal aging process. Whether or not this a reflection of entropy according to the Second Law of Thermodynamics is still not clear. During the last 5-10 years, this concept is no longer commonly cited.
More than likely, a new concept of Dynamic Kinetic Stability (DKS) will take the place of the concept of Entropy. Addy Pross, Ph.D., described this in his book titled “WHAT IS LIFE How Chemistry Becomes Biology” published in 2012. It could become the most important explanation of the basis for LIFE since the Charles Darwin’s book published in 1859 as an explanation of evolution: “ON THE ORIGIN OF SPECIES.” Think Addy Pross, future Nobel Prize winner.
Examples of GROWTH and DEVELOPMENT induced HEALTH Conditions include: *) congenital problems that are present at birth, related to a problem arising during the gestational process and unrelated to any specific genetic defect of the fetal person, such as, amniotic band malformations causing a child’s absent fingers; *) fertility such as contraception, infertility, maternal health and menopause; *) life-style stressors such as relationship betrayal, harmful habituation, vocational responsibility transitions and family neighborhood transitions; *) aging as in osteoporosis, degenerative joint disease and atherosclerotic vascular disease; and *) child neglect occurring as a substantial mismatch between the needs of the child and pervasively deficient capabilities of the child’s parents to provide for these needs. The deficient capabilities may begin prior to birth, begin at birth or occurring at a later time. The deficient capabilities represent patterns of parental Caring Relationships injurious to the dependent person’s future development to become an independent person. Child Neglect should be considered a congenital HEALTH Condition. Child Abuse is a form of assault. Child Neglect may be a precipitating event, but not always. The precipitating factors for Child Abuse are substantially different as compared to Child Neglect.
IV. HEALTHCARE refers to:
The adverse effects occurring while receiving health care as in *) medication hypersensitivity, i.e., both immunological (allergic) and non-immunological reactions; *) institutional environment (i.e., an unattended fall in a hospital bathroom causing a fractured hip); *) continuity of care, e.g., inadequate monitoring for the coordination of a persons prescribed, multiple medications ( especially when >5-10 ), each taken at least once a day; *) variably available and accessible medical Triage; and *) deficient universal health insurance that is offered based an a person’s level of disposable income (e.g., financial debt from healthcare that is the leading cause of personal bankruptcy).
Most importantly, there is no commonly understood acknowledgement for the attributes of Caring Relationships. Many years ago, a Pediatric Hospital examined the effects of dominant parental presence or absence on the characterization of matched hospitalizations. Chief among several observations, the hospital duration for similar health needs was shorter when parental presence was prominent. Putting aside the advocacy presence of the child’s parents, the study described a likely stress reducing benefit of their presence.
V. TRAUMATIC EVENTS refers to:
An isolated, time and date definable, sudden occurrence of an external force, as in trauma, that causes, or could substantially have caused, a major physical or emotional injury as in: *) war-time service, homicide, sports, motor vehicle injuries or accidental falls; *) dependency relationships as in human trafficking, child abuse, rape, or torture; *) vocational or avocational circumstances as in motor vehicle accidents, laceration at work, or sports; or *) sentinel events and their associated halo adverse effects, such as, divorce, death of a person’s long-enduring Caring Relationship (parent, child or spouse), or a Family move to a new neighborhood that is distantly located within a community with substantially different cultural and ethnic traditions.
The other dimension of TRAUMATIC EVENTS is represented by a clustering of multiple root causes with no evidence of Unstable HEALTH demonstrating their occurrence but eventually occurring over time in apparently random order to produce either temporary or long-lasting Unstable HEALTH. The unique connection among the contributing factors of time, infection, traumatic events, temperament, baseline homeostasis or environment are probably more complex than we are currently able to evaluate, such as, for the onset of cancer or an immune tolerant disease.
“Repetitive Trauma” has also been identified for certain specific work conditions, such as the carpal-tunnel syndrome. Also, the onset of Acute Depression in a person with no expression of Unstable HEALTH might be an example, especially if there is a recent occurrence of highly stressful events. The associated Ecologic factors such as Family Traditions, neighborhood social cohesion, community levels of Social Capital, and long-enduring Family based Caring Relationships then can become either preventive or causative by their presence or absence.
VI. NEOPLASIA (“Cancer”) refers to:
Uncontrolled cellular growth originating from a single Functional System such as cancer of the lung, breast, colon, prostate, or blood (leukemia). The sequence of interacting biologic events that eventually conspire to initiate a progressively harmful cancer are largely unknown. Eventually, the associated level of Unstable HEALTH is determined by a cancer’s location and the specific attributes of the uncontrolled spread from its originating location. The sequence of interacting biologic events becomes complicated by certain observations, such as breast cancer. The onset of breast cancer will rarely occur in both sides simultaneously. Evidently, the time-dependent cascade of possible interacting factors is very complex from the effects of age, heredity, the occurrence of certain infections, gestational exposure to maternal ingested chemicals or personal exposure to certain chemicals (skin, respiratory, gastrointestinal) and weight.
VII. HUMAN ECOLOGY refers to:
Living Space
The adverse effects occurring from a person’s living space as in *) pollen concentration, humidity changes, or outside temperature variability; *) good food accessibility; water, sewage and garbage sanitation; *) work place safety and cultural tolerance; *) highway safety; and *) neighborhood levels of noise, access to parks and sports facilities, and community infrastructure maintenance.
Institutional Governance
The continuing deficits in the level of Social Capital within cities, states and Federal governments have led to a failure of our nation’s healthcare reform. The worsening of our nation’s health spending has evolved from 5.0% in 1960 to 18.0% in 2016 of our nation’s economy, its gross domestic product (GDP). In contrast, the other 34 OECD nations of the world are mostly clustered around an average of 10-12% or less of their GDP for their nation’s health spending. The excess health spending between 13% and 18% for our nation’s healthcare represented nearly $1 Trillion in 2016. The most demoralizing attribute of this inefficiency is represented by our nation’s maternal mortality ratio. It has worsened for 25 years in a row through 2015. We would need to reduce it by 75% to rank among the 10 developed nation’s of the world with the lowest maternal mortality ratios.
Survival Commons
There are many factors that contribute to our nation’s high level of health spending. Probably 1/3 of the excess health spending is related to the highly variable levels of equitably available Primary Healthcare that is offered within and among our Nation’s communities. A second 1/3 is related to a very inefficient means of paying for our nation’s healthcare. The final 1/3 is related to the absence of a nationally sanctioned and locally managed process to assure a local commitment to the quality of each community’s Survival Commons for its citizens. Institutional Governance will need a means to support local initiatives for the improvement of its Social Capital.
Many adversities entangle the Unstable HEALTH of many citizens and thereby excess health spending is subsequently required. For a homeless person with a high level of risk factors, annual health spending for the person will decrease by 80% once the person enters supportive housing. The GLUE to improve a community’s Survival Commons occurs based on their ability to mobilize its level of Social Capital throughout the community. For perspective, it is a generational project and requires many years of commitment to adequately build and sustain.
VIII. IMMUNE–TOLERANCE refers to:
The unexpected onset of a serious health condition with a DIAGNOSIS leading to substantial impairments of multiple System Functions from multiple chronic illnesses. These include: *) Insulin Dependent Diabetes Mellitus with onset that clusters around the pediatric ages of 2 years, 5 years and 12 years; *) multiple sclerosis with onset in early mid-life and expressed by many forms; *) chronic inflammatory bowel disease with multiple forms and severity; *) Chronic Lung Disease; and *) atherosclerotic vascular disease. Of note, all of these diseases are associated with the absence of sensitive and specific diagnostic or monitoring tools that prevent the implementation of preventive care plans during the early phase of an associated disorder of immune-tolerance.
We currently refer to these as auto-immune disorders, as in the person develops antibodies for their own bodily structure. It is possible to consider it as a condition whereby there is a loss in the ability to ignore certain immunological events. A Pregnancy represents the most common example of this. Maternal gestation represents a state of immune-tolerance of the newborn’s unique set of antigens. Presumably, labor starts when the immune tolerance begins to end and induces a rejection of the child’s source of foreign antigen by the child’s mother. Life-threatening, immune-based diseases can occur at the end of a pregnancy, frequently with a precipitous onset.
IX. CHRONIC DISEASE refers to:
The previous CAUSE of Unstable HEALTH, IMMUNE-TOLERANCE, includes a group of persons with a very high burden of disability, often associated with chronic pain. Each of the other CAUSES, either alone or in combination can affect a certain number of persons with similar characteristics of pain and disability. Given the diversity of factors contributing to the resulting needs for Complex Healthcare, it is appropriate to ask how it is that a given HEALTH Condition could become so complicated. One possibility might be to postulate the idiosyncratic occurrence of disruptive processes as noted above within the TRAUMATIC EVENTS Section above.
This concept for the occurrence of a pervasive and disabling chronic illness has not been verified by the usual medical research processes. There are isolated research projects that have shown the possible role of emotional stress as augmenting the pre-clinical, asymptomatic phase of a chronic illness. I recall that this research has identified a time interval of two years between the occurrence of new emotional stress and the clinical identification of certain cancers. As of March in 2016, this multi-factorial Cause for the onset of a burdensome, complicated health condition is not widely acknowledged or recognized within the healthcare industry. The tools to assess or monitor the presence of a possibly evolving chronic illness do not exist. Most importantly, the character of long-term healthcare with a goal of achieving Stable HEALTH is also largely unrecognized. This has occurred since we lack a predictably reliable test to assess the stability of a person’s baseline homeostasis and its resilience.
The attributes of this Section often involve multiple medications taken at least once a day, commonly more than 15-20. Chronic Pain, disability, illicit substance dependency, obesity and depression often co-exist irregardless of the contributing disruptive processes. Multiple hospitalizations occur that occasionally are associated with complicating surgical procedures.
FINAL COMMENT
As of April 25, 2018, this is very preliminary effort. I would invite anyone to contact me who has a thought about the concept of Disruptive Processes. The AUTHOR BIOGRAPHY Sub-Page provides enough identifying information as a means to contact me.
My view is that the current status of healthcare research does not recognize the Frequency Domain as a means to evaluate patho-physiologic processes. We continue to remain in the Time Domain as a basis for research analysis. Our engineering colleagues probably have much to offer for an improved assessment of Disruptive Processes and how they interact.
