What's Happening to Medicine: Autopsy Report (4)

2024 Author: Seth Attwood | [email protected]. Last modified: 2023-12-16 15:55

In a series of posts, I try to summarize what has been happening in medicine over the past few decades, and make assumptions about where it will develop next.

The fourth post is devoted to the following question:

What are the obstacles to the development of medicine?

It is impossible to predict the development of medicine both from the position of a simple user and from the position of a simple doctor. To see cause-and-effect relationships, you need to know from the inside the "kitchen" of medical ideology - where they come from and how new directions and approaches are being introduced. It is required to imagine how they relate to the needs and unsolved problems of medicine (and to know these problems), how to assess the prospects of a particular method (i.e., to know the principles of evidence). Much can be understood from the history of medicine and the relationship between "mainstream" and "unofficial" methods. It so happened that education and work experience allow me to navigate quite well in all of the above issues.

You can read about the author in the first note.

I am building my story from the answers to a number of key questions:

1. What are the needs and unresolved problems of medicine?

2. What are the advances in medicine over the past 50-100 years?

3. What are the real prospects for the "most promising" directions in "medicine of the 21st century"?

4. What are the obstacles to the development of medicine?

5. Where to develop medicine in the 21st century, taking into account the social, economic, scientific and technological context?

I try to adapt the text to the "skilled user" level - i.e. a person with common sense, but not burdened with many stereotypes of professionals.

I will make a reservation right away that there will be many controversial judgments and departures from the medical mainstream.

So, today let's talk about what hinders the development of medicineas an industry, the purpose of which is the preservation and restoration of human health.

In the answer to this question, I see several layers of problems:

- at the level of organization and economics of the health care system

- at the level of prevailing scientific concepts, theories, models

- at the level of the worldview of the professional and expert community

Let's figure it out in order.

1. At the organizational and economic levelthe health care system has conflict of long-term economic interestsplayers - first and foremost, health POLICY players. What is the conflict? Everything lies on the surface, it is enough to compare the declared goals of medicine with the goals of pharmaceutical companies and the real tasks of medical professionals.

The goal of medicine is the preservation and strengthening of health (as defined by WHO, the physical, mental / mental and social well-being of people). The goal of pharmaceutical companies as commercial enterprises is to make a profit. It is more difficult with doctors and other professionals. On the one hand, they may be sincerely committed to “high ideals,” but from the point of view of economic interests, doctors' income is proportional to the number of interactions with patients, and not to the level of health of patients. Accordingly, the improvement of the population in the long term threatens doctors … with a decrease in income and even loss of work.

On the other hand, in recent decades in medicine, the basic concepts, theories, standards of care and education have been formed with the direct participation of developers and manufacturers of those instruments that are used in medicine - drugs, new diagnostic and therapeutic technologies. If you look at the budgets spent by large pharmaceutical companies for the development and promotion of their drugs, they will be comparable to the budgets for science of entire states and even regions. Thus, government spending on research in the health sector in Europe averages 0.15% of GDP (source), which in monetary terms is about $ 25 billion. Now let's look at the capabilities of pharmaceutical companies: Johnson & Johnson alone has more than $ 70 billion in sales, and the total sales of the twelve largest pharmaceutical companies exceed $ 500 billion. Considering that these companies spend about 45% of their revenues on research, marketing and management costs (source), the financial capabilities of pharmaceutical companies to promote their drugs and ideology tenfoldthose funds that are spent on medical research ALL COUNTRIES OF THE EUROPEAN UNION - the second after the United States in terms of financial opportunities in the region of the world. Real levers of influence both on management decisions in the field of health care and on research organizations, educational institutions, professional associations, doctors, pharmacists are described in detail in a number of books: for example, Marcia Angell "The truth about drug companies: how they receive us and what to do about it, Ben Goldacre Bad Pharma: How Drug Companies Mislead Doctors and Harm Patients. and harm patients "). Pharmaceutical companies annually spend more than $ 100 million on lobbying decisions that are beneficial to them in the US Senate (source). A good overview of the manipulation of the pharmaceutical business in the field of evidence-based medicine is presented here.

Thus, within the framework of the existing healthcare system, managerial decisions at the state level, the opinion of the expert community, educational programs, diagnostic and treatment standards are formed under the influence and in the interests of the largest players - first of all, pharmaceutical companies. And since the main goal of pharmaceutical companies is to make a profit, it is not surprising that everything that happens in healthcare is somehow subordinated to this goal.

How exactly are the interests of the “commercial players” of health care integrated into the ideology of medicine? Let's take a closer look at this more long-term level of influence on "minds" - first of all, the minds of the professional community. This influence has a long-term aftereffect - several decades.

2. The problem at the level of scientific concepts, theories, models.

The cornerstone of modern biomedical science is the following postulate, formulated, for example, in one review on pharmacology:

"The regulation of physiological processes is reduced to chemical signals", It has been repeated many times in dozens of papers, for example, in this 2014 review:

“The cells in our body are constantly receiving signals from other cells. Most often these signals are chemical."

In my opinion, it is this thesis that is the main FALSE BASIS for all other "generally accepted theories" in modern biomedical science. Further logical construction is easy to restore:

The entire building of modern pharmacology and drug treatment of diseases is being built on the described model. This model, proposed in the late 1930s, defined the concepts of modern physiology and molecular biology. Why is it so beneficial? The fact is that if you can only treat it by introducing it into the body chemical compounds, then all new drugs can be to patent - i.e. monopolize their position in the market and sell these drugs at arbitrarily high prices. This is the basis for the basic model of obtaining superprofits large pharmaceutical companies. After the expiration of patents, copies appear on the market at a price many times lower than the patented "original".

What wrong in the described model of regulation in the body? Here's what. In reality, chemical signals are only SMALL the proportion of intercellular interactions in the body. Signals play no less, but rather a much more important role physical nature (biophysical). Why can we say this with confidence? Here are three main arguments:

(1) the structure of information exchanged between an organism and the environment is similar to the structure of information that a cell of an organism exchanges with its environment;

(2) the efficiency of information exchange (energy consumption, speed, etc.) by means of chemical signals in comparison with physical signals is incomparably lower;

(3) in the body, in all organs and cells, there are structures and mechanisms that ensure the exchange of physical signals during the regulation of physiological functions.

Each of these arguments needs a detailed presentation, which is unlikely to fit not only into the framework of this note, but also of a large scientific review. Right here I will try to explain each of the points using publicly available analogies.

(1) Similarity between cell and organism. In terms of the range of tasks that it has to solve for survival and functioning, each individual cell of the body practically does not differ from the whole organism. This question was described in detail by one of the founders of the systems approach in biology, American psychologist James Greer Miller; he also listed 20 most important functional subsystems present at each of the seven levels of organization of living systems. Let's imagine for a second that the organism in perceiving signals from the external environment is limited only by chemical signals: smell and taste. Are you ready to give up sight, hearing, touch, muscle sensitivity? Are you sure you can survive? And what is the fault of the cell, that it is denied the ability to perceive electromagnetic and mechanical vibrations?

(2) The effectiveness of chemical and physical signals. It is well known from biophysics that the perception of physical signals is based, first of all, on the mechanisms of resonance - the coincidence of the oscillation frequency of the signal and the natural oscillation frequency of the receiver. So, the rate of chemical interaction and resonance interaction was compared by the British physiologist Colin McClare in his 1974 article "Resonance in Bioenergetics". And what happened? The time it takes to exchange energy through the resonance mechanism refers to the time it takes for a chemical interaction, as roughly as 1 second to 30 years (1:10⁹). And this is without taking into account the time required for diffusion - and without taking into account the time and energy costs required for the production of a molecule, if we are talking about substances produced by the cell. What method of information transfer do you think the living system will prefer: a fast and cheap type of broadband Internet or golden tablets transported by camels? Tablets are probably also needed, but their role is very limited.

(3) Structural organization of the cell. The cell has structures that are unique in their effectiveness for the perception and transmission of electromagnetic and mechanical signals. The most studied of these signals are biophotons. Those interested can familiarize themselves with a selection of articles on this topic. By the way, in terms of the ability to conduct biophotons, the cell skeleton (microtubules) and connective tissues (ligaments, tendons, etc.) are very similar to fiber-optic cables, so the analogy with broadband Internet is quite appropriate.

Thus, the existence of structures and mechanisms that ensure the exchange of physical signals in the course of the regulation of physiological functions, science, at least, is known. So, what is next? How actively are these issues being researched? A search for articles in the largest biomedical database PubMed yielded a pitiful 5273 works on the topic of "electromagnetic intercellular interactions" over the past 38 years (by the way, from the short review recent articles I will recommend this one). For comparison: on the topic “interaction of a ligand with a receptor” there were more than 174 thousand works, “signal transmission from a receptor” - 213 thousand, “receptor antagonist” - 124 thousand, etc. As you can see, the scientific efforts and resources aimed at studying the most important regulatory mechanisms in the body are hundreds - if not thousands - times less than the study of chemical signals. Moreover, if you look at the content of the articles, it will become clear that these pitiful crumbs devoted to non-chemical mechanisms do not in any way develop MEANS OF INFLUENCING these mechanisms, methods of diagnosis, treatment or prevention of diseases. In short, these works have practically no APPLICATION SIGNIFICANCE.

So, we briefly discussed what is at the heart of modern pharmacology and physiology false postulate about the key role of chemical signals in the regulation of physiological functions of the body. The systematic study of NON-CHEMICAL signals - which, in fact, play a much more important role - is directed at no more than ONE THOUSAND effort in biomedical research. Accordingly, if some area is not explored, it will remain a blank spot. This begs the conspiracy question: "Who benefits from this?" The answer is obvious: those players in medicine who profit from the sale of patented chemical compounds as drugs.

Finally, let's move on to the last, third, deepest "layer" of problems that hinder the development of medicine.

3. At the level of worldview representatives of the professional and expert community there is no systematic approach to a person, to health and disease.

We have already referred to the WHO definition a couple of times: health is "a state of complete physical, mental / mental and social well-being." We said that just as a person cannot be reduced to a physical body, health cannot be reduced to normal physiological indicators. What happens in real life?

In real life, doctors, scientists, experts have worldview distortion: a person is not perceived systemically, as one of the levels of organization of living systems. Let me remind you that the founder of systems biology J. Miller distinguishes seven such levels: Cell, Organ, Organism, Group, Organization, Society, Supranational System. Without a systematic approach, it is impossible to understand human nature, including the physical principle (the organism and lower levels of organization), the soul - psyche (structures that determine interactions between individuals) and the spiritual principle (structures and principles that determine human interaction with higher levels of organization of living systems). The study of man is divided into disparate and often contradictory branches. So, biology and medicine are engaged in the physical body of a person. Psyche (soul) - psychology, a little psychiatry (a branch of medicine), a little philosophy, a little numerous religions, a little esoteric schools. Sociology, a little psychology, a little political science, a little economics are involved in the processes in society - a hierarchically higher level of human organization - and a little bit of economics … development, etc. As a result, each individual expert does not and cannot have a systemic vision of processes and problems, which means that there are no keys to finding solutions.

Meanwhile, the principles of functioning healthy living systems at different levels of organization are UNITED, these principles are quite well described, and without taking them into account in the organization of health care, it is hardly possible to achieve the declared goals of health care.

I'm not sure the question “who benefits from a false worldview? Is as appropriate as it is appropriate for a perverse the economy health systems and ideology health care (false scientific postulates). Nevertheless, distortions in economics and ideology cannot exist for a long time without stable distortions in worldview representatives of the elite of society, which includes the expert and business community.

What kind of worldview has replaced the holistic understanding of man as a living system? This worldview is individualism, the essence of which is the predominance of value, the value of the individual over the value, the value of society. From the point of view of living systems, individualism is about the same as the predominance of the value of an individual cell over the value of the whole organism. Sounds absurd. Each individual cell is valuable for the organism, but individualism at the level of cells threatens the death of the whole organism and all individual cells. And in the same way, individualism, as the prevailing worldview, threatens the destruction of the entire society and all its constituent people. Individualism is one of the most important components of the modern ideology of liberalism, prevailing in the so-called "economically developed" countries and being actively implemented in Russia. From the point of view of living systems, liberalism and individualism are the principles of organization and interaction that are most destructive for any living system.

In my opinion, the widespread dissemination of an adequate worldview poses a threat to modern power structures - first of all, at the level of supranational corporations and their beneficiaries. It's no secret that much of the world's wealth is controlled by a narrow circle of financial institutions (below is a picture from the article), not to mention consumer goods (link to the example of the United States).

Well, in this article it is impossible to do without conspiracy theories - or maybe this is just a consequence of a systematic approach?

Let's summarize and briefly formulate what is hindering the development of medicine? The promised Kashcheeva needle appears in the form of a three-headed snake:

1. Profit - as the true goal of the most powerful players in the health sector - poorly compatible with the goals of health itself. All management decisions, expert opinions, standards of education and medical care - all of this is easy to influence, having huge financial resources in your hands. So the pharmaceutical business - an industry that, in theory, appeared as an instrument of medicine - became a full-fledged master of health care.

Profit as the main goal displaces health preservation from the goals of activities. Or drastically reduces the priority of health in the vector (hierarchical set) of goals. And then health as a goal is considered according to the residual principle - this is exactly what is happening now, including in Russia. At the level of people and organizations, this problem manifests itself as conflict of interest … This is the main ECONOMIC factor hindering the development of medicine (medicine, not business for health). This factor is the most "dense", perceptible - and therefore not the most reliable for the beneficiaries: it is too clearly visible.

2. A close examination of the fundamental postulates of today's biomedical science reveals an interesting fact. It turns out that a brake is built into the ideological structure of medical science, a constraint that prevents the emergence and development of such new medical technologies for treatment and diagnostics, which a) are difficult to monopolistically control, b) are not profitable, and / or c) are difficult to monetize (on which it is difficult to make money). This brake - misconception about how regulation occurs in the body … The cornerstone of modern biomedical science is the following postulate: "the regulation of physiological processes can be reduced to chemical signals." All ideas about the mechanisms of diseases and approaches to their diagnosis and treatment follow from it. It follows from the postulate that without the introduction into the body of any chemical compound (a source of a chemical signal), it will not be possible to influence the regulation in the body. In fact, chemical signals hardly account for more than 10% of regulation in the body (the rest are signals of a physical nature), but this topic deserves a separate detailed discussion. The main consequences of the presence of this postulate for the beneficiaries: a) the ability to monopolize (patent) the use of drugs; b) the ability to sharply limit funding for the development and dissemination of competing methods "contrary to scientific ideas"; c) the ability to ostracize those who research or and use "unapproved" methods.

As a result of the action of the described brake, the effectiveness of biomedical sciences is sharply limited: in fact, researchers are searching not where a solution can be found, but where it is “allowed”. This unspoken prohibition on the study of biophysical mechanisms of regulation is duplicated by some ideological prohibitions in physics.

3. Finally, the development of medicine as the most important science of health is impossible due to the actual rejection of systemic perception man as a trinity of physical, social and spiritual principles. Unified system of knowledge about a person fragmented into unrelated and largely contradictory disciplines (physiology, psychology, sociology, etc.), representatives of each of which do not own the conceptual apparatus of the others. Because of this, neither fundamental science nor applied industries take into account and do not use the principles of living systems, which are the same for all levels of human organization.

The systemic perception of a person, especially among the elites, where managerial decisions in relation to medicine are made, has been replaced by individualism - the position "every man for himself", deeply contrary to both the principles of healthy living systems and the systemic understanding of human nature.

Thus, the source of problems in modern medicine is in the form of a three-headed snake:

1. At the level of the worldview of the professional and expert community: Individualism (and liberalism) as a worldview that contradicts the principles of healthy living systems and makes impossible a systemic and holistic understanding of human nature.

2. At the level of prevailing scientific concepts, theories, models: At the level of scientific ideology, false ideas about how regulation occurs in the body are artificially introduced into the expert community. This false scientific paradigm interferes with the search for effective solutions to medical problems and promotes the realization of the economic interests of a narrow group of key players in the healthcare system.

3. At the level of organization and economics of the health care system: The consequence of the described worldview is an insoluble conflict of economic interests among the key players in the health care system. As a result of the conflict, in accordance with the principles of individualism, pursuit of profit (enrichment of a narrow circle of people) becomes higher than the benefit for society as a whole. The preservation of the conflict is possible due to the preservation of a distorted scientific ideology.

Well, now that we have found out the key reasons for the deplorable situation in health care in general and medicine - in particular, it is time to answer the question "What to do?"

This will be the focus of the last, fifth article in the series "What Happens to Medicine: Autopsy Protocol."