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NATIONAL HEALTH

"It's better for everybody when it gets better for everybody." Eleanor Roosevelt

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* DISRUPTIVE PROCESSES

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. “

Maya   Angelou      ( 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 broader social cohesion within the community itself, an essential component of creating a healthy and resilient society.”  In effect, the thrust of healthcare reform must foster a steady improvement of each community’s  Social Cohesion  beginning, but not ending, with enhanced Primary Healthcare that is  equitably available  to each of the community’s citizens.

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 living that maintain each  person’s  survival in the absence of modern healthcare.

Given the breadth and depth of threats sustained by each person’s  Clusters of Human Capabilities,   baseline homeostasis,  and  innate temperament  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.   These causes are best understood as distinct  Disruptive processes.

 

 

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.  Besides armed conflict, the other principle  Disruptive Processes  encountered generally could be viewed a poor nutrition, epidemic infections, maternal mortality, accidental injury, and tuberculosis.    

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, you are not alone.

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 applicable disaster 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, although rapidly becoming more widely acknowledged.

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 both a person’s  innate temperament  and  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 measles and influenza; and  *) treated by medication to reduce or eliminate the reproduction where possible of a 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 Charles Darwin’s book was 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 at a later stage of life.  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  17.9%  in 2018 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 2018.  The most demoralizing attribute of this inefficiency is represented by our nation’s maternal mortality ratio.  It has worsened for nearly  30  years in a row through 2018.  We would need to reduce it by  70%  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 each community’s  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 Cohesion  throughout their 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 persons who develop 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 the basis for research analysis.  Our engineering colleagues probably have much to offer for an improved assessment of  Disruptive Processes  and how they can be assessed.

 

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