THEORY OF DISEASE = ТЕОРИЯ БОЛЕЗНИ

A.I. Gozhenko THEORY OF DISEASE 2017 A.I. Gozhenko THEORY OF DISEASE Monograph Odessa - 2017 UDC: 616-02.001.1 BBC: 52.522 G 57 Recommended for printing Scientific Council of the Ukrainian Research Institute of Transport Medicine of the Ministry of Health of Ukraine (Protocol No. 1 January 15, 2017) Reviewers: Trakhtenberg I. M. , Corresponding Member of the National Academy of Sciences of Ukraine, Academician of the National Academy of Medical Sciences of Ukraine, Doctor of Medical Sciences, Professor Ataman A. V. , Doctor of Medical Sciences, Professor Gozhenko A.I. Theory of disease: monograph / A.I. Gozhenko. - Odesa: Phoenix , 2017. - 144 p. The monograph summarizes modern ideas about the theory of the disease, which are presented on the basis of literature data and many years of research by the author, argues a number of methodological provisions that are subject to scientific discussion, contains conclusions that can be taken into account by practitioners. The main provisions of the theory of disease can be useful both for medical scientists and hygienists, specialists in the field of epidemiology of non-communicable diseases, clinicians, teachers and students of medical universities. DOI https://doi.org/10.5281/zenodo.7738767 Foreword The appearance of a new book by Professor A. I. Gozhenko "Theory of Disease" pleased readers who are interested in theoretical works in the field of medicine. Firstly, because there was another opportunity to get acquainted with the opinion of the leading theoretician-pathophysiologist on the modern understanding of the main theoretical issues of medicine. Secondly, because this is already the third work in which the ideas and provisions previously expressed in the works “Essays on the Theory of Disease” (2010) and “Basic Constructions of the Theory of Disease” (2015) are preserved and developed, which the author consistently supplements, clarifies, details his ideas and judgments, presenting the following work to the reader. However, the third book of A.I. Gozhenko, along with the deepening of the previously stated provisions, is characterized by the appearance of new sections, for example, "Sanogenesis", "Teaching about death - thanatology", "Models of medicine", "General theory of disease and prospects for the development of modern medicine", significantly revised sections "Theoretical foundations and prospects for improving diagnostic and therapeutic technologies”, etc. Moreover, the author not only formulates the principles and puts forward his judgments about the theoretical foundations of illness and health, but also demonstrates them on a much larger number of examples. In fact, it becomes clear that these are not individual examples, but a system that indicates that each theoretical position not only arose, but also “works” in medicine. Ultimately, the "Theory of Disease" presented to the reader becomes a significant part of the modern theory of medicine. Moreover, although the author does not set as his goal, but briefly but quite clearly in the new section presents a fundamentally new understanding of the models of medicine. This is especially important in our turbulent age of the development of medicine, which successfully develops based on biological principles, but already today steps further both technologically and philosophically. Indeed, at present, medicine, as a field of knowledge and practice, is the most important component of the civilizational process. Therefore, the history of medicine, which has not yet been written in such a context, is the history of mankind in the philosophical understanding and development of its practical direction - public health. In the last section, the theory of disease is the theoretical foundation. To present it in a historical aspect, a huge number of opinions, achievements and ideas should be analyzed. Meanwhile, understanding the complexity and scale of the task, the author presents his own approach to the presentation of the problem, which is based both on the main historical milestones and existing knowledge, and on his own idea of the development of the theory of medicine. Moreover, it is important that the author's task is to present the theory in a format accessible to a wide range of physicians - from a student to a scientist, which is not only understandable, but can also be used as a working tool - theory for medical practice. Theoretical ideas about the disease are addressed to everyone in medicine: from a student standing on the threshold of the temple of science and practice, a doctor and even a researcher, each of whom can use them both to form a methodology and a technique in medicine. And, indeed, it becomes clear the usefulness and significance of general biological, even philosophical approaches for medical science and practice. In general, one should agree with the author's opinion that understanding and, especially, the use of general theoretical approaches in medicine can significantly increase the efficiency of the modern diagnostic and treatment process, especially at the present time of rapid progress in medical technologies. Corresponding member of NAMS of Ukraine, Professor A.I. Gubsky Dedicated to Pathophysiology and Pathophysiologists Author AUTHOR'S FOREWORD The rapid development of science is now the basis and condition for the development of civilization. This fully applies to medicine, the progress of which is obvious. At the same time, humanity sets new and new tasks for medical practice, which is designed to ensure the preservation of health and the maximum extension of human life. Moreover, the idea and understanding is being strengthened in society that it is the life of each person that is the goal and measure of civilization, because there is nothing more morally significant than this. The scientific and technological achievements of civilization are largely measured and implemented by the success of medicine. It should be noted another global eco-ethical direction of the philosophy of civilization: the interaction of mankind with the environment, space, can also be measured by the interests of man, as an integral element and part, and one of the most complex - nature, at least on planet Earth. Thus, the humanization of science becomes the main direction in the development of modern civilization. The latter puts medicine, with its practical tasks of ensuring human health, to the very forefront of the development of science and technology. As a result, today there is a tangible progress in medical technologies, which are increasingly based on the achievements of fundamental sciences and, moreover, this connection is organic and quickly implemented in time. The most important problems of modern medicine continue to be the prevention and treatment of human diseases. Undoubtedly, the prospects for progress in medical technologies depend not only on the achievements of fundamental sciences, but especially on understanding the essence of human life in its two main states - health and disease. In this regard, health, its maintenance, especially through its management, has recently become the main direction of medicine. The need to deepen our understanding of the essence of the disease is also determined by the fact that many modern medical technologies use intensive methods of influencing a person. Transplantation of organs and tissues, the use of stem cells, genomic medicine, on the one hand, expand the biological capabilities of the body, but on the other hand, significantly change the evolutionary patterns of development of pathological processes and the formation of adaptive reactions that provide adaptation to the environment, and therefore determine human life and health . These and other issues that are associated with the emergence of modern medical technologies urgently require understanding and progress of our knowledge in the field of the theory of disease, the state of which has always been the basis for the development of medicine, the creation of its modern model. Meanwhile, in recent years, predominantly analytical approaches to the study of human nature have triumphed in the biomedical sciences. Of course, it is the deepening of our knowledge about the elemental nature (structure, function, biochemistry, biophysics) of a person that is the basis for the creation of new medical technologies. However, one should also clearly understand the need to understand the behavior of individual elements and mechanisms in an integral biological system, which is the human body, the degree of self-organization of which forms the basis of its health, including the ability to recovery from illness. Today, the classical ideas that it is necessary to treat the patient, and not the disease, should be filled with new theoretical content, it is necessary to create a new modern theory of the disease. Clearly realizing that it can be created only when a person as a biological system is fully known, we, at the same time, affirm that today it is possible and necessary to start building it, at least, forming the foundations of its creation. The author devoted his work to this task in the hope that the attempt to create a theory of disease will be used as the most important and necessary element of the foundation for building a modern theory of medicine. Along with this goal, no less important is the task of equipping every doctor at the present time with modern ideas about the theory of disease, which are extremely necessary in a huge flow of medical information, especially in connection with the rapid progress of pharmacology, opening up new possibilities for managing the body in a state of health and illness. The author is grateful to colleagues in science and medical practice, and, first of all, to pathophysiologists, communication and discussions with whom helped to formulate and present to your attention our ideas about modern problems in the theory of disease, which complete the cycle of work in this direction of the theory of medicine. INTRODUCTION Despite the validity of the statement of academician I.M. Trachtenberg about the complexity of formulating definitions, fundamental concepts are needed, because it is on them that knowledge is based, which is formed in a particular field of knowledge, to one or another historical stage in the development of science, including medical science [62] . In turn, fundamental concepts are also the prospect of improving the practical activities of mankind. Therefore, fully agreeing with the statement about the relative and complex nature of concepts that exist, including in medical science, we consider it possible and even necessary to present to the reader our vision of the modern understanding of the theory of disease - the totality of basic fundamental concepts in medicine. They are derived by biomedical science on the basis of the vast historical experience of medicine and form basic theoretical concepts that are constantly changing in connection with the development of science, and not only medical. Knowledge about the essence and manifestations of diseases is so numerous and, at the same time, constantly replenished that it is very difficult to solve the problem of their complete analysis and generalization, but this is precisely the basis, the theoretical (methodological) basis for the development of modern medicine. The need for modern methodological concepts is especially felt at the present time, when there is a rapid development and introduction of new methods of diagnosis and, especially, treatment and rehabilitation. This allows not only to ensure recovery by influencing the mechanisms of the body, but also to significantly influence, influence and supplement them. Examples are methods of treatment using stem cells, transplantation of organs and tissues, genetic engineering. In these cases, the biologically formed mechanisms of illness and recovery are changed (completed). Therefore, the proposed methods and technologies should be based on a new methodological base, i.e. general theoretical understanding of the disease. Moreover, the more data on morphological, biophysical, biochemical and physiological changes in pathology accumulate, the more obvious the need for their synthesis in the system of general ideas about the disease becomes. Of course, the improvement of our ideas about the elemental components of the disease at the same time often moves us away from understanding the state of the whole organism. Meanwhile, he is sick, i.e. is in a state of ill-health, namely the whole organism. It is important that such a conclusion at the same time deepens our understanding of the disease as one of the conditions of the body. We draw the reader's attention to the fact that the philosophy and methodology of cognition of pathology should be based simultaneously on two components: factual (symptoms, clinical data, laboratory, functional and instrumental examinations) and semantic (generalizing). Moreover, generalization should be carried out at different levels of the organization of the living - from the cell to the whole organism. At the same time, the psychology and practice of understanding the disease often leads us towards the primary importance of the specifics of symptoms and individual morpho-functional and biochemical parameters characteristic of pathology. The latter, indeed, are important and necessary elements that characterize a diseased organism (markers, criteria), but they are not a disease as a state of the whole organism in the process of supporting life. Therefore, the thinking and psychology of a doctor should be based on basic general theoretical ideas about the essence of the disease, which form an idea of the pathology of the body, and then concretized to the level of a symptom, syndrome, nosology and disease of each patient. In turn, this is the theoretical basis for improving diagnosis and treatment. The material presented in this book is aimed at the formation of a doctor, researcher and teacher of understanding the disease based on the patterns of development of pathology. We hope that the proposed philosophy of disease will be a useful foundation for medical thinking in practical medicine and at the same time the formation of the methodology of medical science. “Most of all I want to emphasize the importance of theory. This is especially important to do, because in our time they are simply terrified of abstract thinking in medicine.” G. Selye CHAPTER I Theory of Medicine: Science, Education and Medical Practice According to one of the most accepted definitions, “Medicine is a system of scientific knowledge and practical measures united by the goal of recognizing, treating and preventing diseases, maintaining and strengthening the health and working capacity of people, and prolonging life” [ ] . In our opinion, this is also an area of industrial, public and social human activity, aimed at the development of scientific and practical medicine. Of course, the most important part of medicine is medical education, which acts as a link between science and practice, providing training for a medical worker who carries out medical practice. It should be noted that at present medicine is one of the most intensively developing areas of human practice. And this is not surprising, because a person becomes an object and a subject of civilization. Indeed, the entire development of science, technology, production, has as its main goal the maximum satisfaction of the needs of the individual and society as a whole. It goes without saying that the basic human need is health and longevity. Therefore, medicine is increasingly strengthening its position as the most important priority area of human activity. In the modern world, the development of any human activity is based on the achievements of science. Accordingly, the science intensity of medicine is also increasing. [37] . The avalanche of new information about the structure, function, biochemistry and biophysics of living organisms is growing every day. In understanding the essence of the living, medical science has moved to the molecular genetic level of knowledge. These achievements are associated with new technologies for diagnostics and treatment, the emergence of a huge variety of pharmacological preparations that make it possible to influence and control individual elements and mechanisms of a living organism [69] . At the same time, it becomes clear that the number of new facts does not always immediately lead to the formation of new ideas, their theoretical understanding and understanding of the essence of medical problems. How not to remember that back in 1845, A. I. Herzen wrote: “Natural scientists and physicians always refer to the fact that they are not yet up to the theory, that they have not collected all the facts, not all the experiments have been made, in total ... endless facts many and ... no matter how much you collect, you will not reach the end ... ” Indeed, with the dismemberment of a single human organism into parts with a deepening of knowledge about its elemental components, the need to develop a theory of medicine increases proportionally [57] . We draw the reader's attention to the statement of G. Selye, taken as an epigraph to this chapter. Unfortunately, it can be stated that for more than half a century after this statement, little has changed in medicine, and scientists still pay insufficient attention to theory, preferring to engage in prestigious analytical research. However, the history of medicine shows that the emergence of new theoretical concepts has always served as a powerful stimulus for the development of medical science and practice, and the creation of fundamental laws and generalizations, i.e. new theory. If we make a brief excursion into the history of medical theory, then in the development of the theoretical foundations of medicine, in our opinion, three main periods can be distinguished. The first historical period, in our opinion, can be conditionally characterized as descriptive and speculative. Its length in time is quite large - from the moment when a person began to provide medical care, i.e. engage in medical practice, until the XVII-XIX centuries - the period of the beginning of active analytical scientific research on human nature. The main information about this historical period has come down to us mainly from ancient Greece. The solidary theory of Democritus' disease, in fact, was the prototype of all subsequent theories of medicine, where the fundamental are structural (morphological) changes that determine the state of the body. In the same period of time, a humoral direction was also formed in the theory of the disease, the most prominent representative of which was Hippocrates, who explained the onset of the disease by improper mixing of the four basic fluids in the body. This interpretation later laid the foundations of the biochemical (humoral) direction in pathology. It is important to note that in their reasoning, interpretations, ancient physicians proceeded from the described observations of a healthy and sick person as an integral object. In general, these views were defined as natural philosophy. However, the lack of specific knowledge about the structure and functions of the body did not allow scientists of that period to develop objective medical theories, and their reasoning was often predominantly speculative, which manifested itself both in brilliant conjectures and in idealistic delusions. New facts in medicine accumulated slowly, and theoretical thought, not having them, often formulated conclusions and theories that had nothing in common with reality. However, the great healers of the past, based on their clinical practice, sought to get closer to understanding the disease, developed medical theory, understanding its practical significance. Avicenna said especially clearly and specifically about the meaning of the theory: “Under the theory of medicine, we understand that part that teaches only the basic rules ...” [1]. In general, we can agree with Professor A.D. Pavlovsky, who wrote more than a hundred years ago, analyzing the history of thinking in medicine: “In its historical development, medicine has gone through the same phases as philosophy and natural science.” With the introduction of new methods for studying the structure and function of the body, the number of facts that became the property of medical science increased dramatically, especially in the 19th century, and, as a result, the theory of medicine during this period can be characterized as analytical-materialistic. Almost all theories of medicine of this period were based on specific materialistic positions, based on constantly growing analytical data on the structure and functions of the body. And, it was during this period that the foundations of all currently existing theories in medicine were formed. However, from the second half of the 20th century, and especially with the onset of the 21st century, it became clear that the theories existing in medicine began to lag behind the rapid progress in analytical research. We can return to the thought of A.I. Herzen and agree that there is no limit to the accumulation of new data. In this regard, we believe that at present the time has come for the third stage in the development of the theory of medicine, the main content of which should be the creation of an anthropocentric synthetic theory of medicine . Meanwhile, although the need fo