Conservation of Disease Theorem

[Marat]

I want to propose, provocatively, a conservation of disease theorem analogous to the conservation of energy principle, which states that energy can neither be created nor destroyed, but can only be changed in form. The conservation of disease theorem states that disease can never be cured, but it can only be changed in form, and the altered forms of disease are now labelled 'the burden of therapy.' Thus in diabetes, the disease untreated would itself produce death from metabolic acidosis, or if the blood sugar were inadequately controlled, it would cause neurological and vascular complications. Medicine cannot cure, but can only treat the disease, and the treatment simply transforms the burden of disease into the burden of treatment, with the treatment being a cruel and punishing, ceaseless effort by the patient to count carbohydrates consumed, measure blood glucose many times a day, endure repeated insulin injections every day, and finally suffer damaging and potentially lethal hypoglycemic episodes.

 

In renal failure, the disease untreated would result in death from uremia, but the treatment for the disease requires the patient to spend four hours hooked up to a dialysis machine by pencil-thick needles in the arm three times a week for the rest of his life. The dialysis process is exhausting, damaging to the body through its associated cytokine release, and can cause cramps from fluid loss, cancer from chemicals leached out of the tubing, and potentially lethal hypotension. The burden of treatment is so horrible that 25% of all patients eventually die by voluntarily withdrawing from dialysis.

 

In cancer, the disease untreated could lead to death, but the treatment of the disease by chemotherapy, radiotherapy, and surgery leaves the patient profoundly anemic, disfigured, exhausted, cachexic, and often results in death from the severity of the treatment rather than from the disease.

 

The examples could be multiplied, but the point is clear: What modern medicine has been able to do is merely transform the misery of the natural disease into a nearly equivalent or worse misery of the iatrogenic disease known as the 'treatment.' I say worse because aggressive cancer chemotherapy can kill people more uncomfortably than cancer itself can, and renal dialysis can be such a burdensome treatment that it forces patients to go through the stress of choosing suicide by withdrawing from treatment rather than accepting an inevitable and natural death from uremia as they would have had to do prior to the development of the 'miracle' of dialysis. Similarly, cancer patients who might have quietly wasted away a century ago are today brutally assaulted by toxic chemotherapy and radiotherapy or radical surgery, and the apparent gains in life expectancy from these interventions may in fact just be statistical artifacts resulting from our ability to diagnose cancers earlier so the natural time line to death appears longer.

 

Now of course this theorem is deliberately overstated to be provocative, since medicine can achieve some cures or genuine ameliorations, such as in mending broken legs or overcoming infections. But still, in the growing field of chronic illness, medicine seems unable to accomplish much beyond transforming disease symptoms into equally bad treatment symptoms. Even worse, the recommended treatments in diabetes, renal failure, and cancer are becoming ever more harsh as the results of existing treatment regimens are found to be ever more disappointing.

[ewmon]

The danger of some cures is known, and patients can choose to be treated or not. The Renaissance physician Paracelsus said 500 years ago that:

“Poison is in everything, and no thing is without poison. The dosage makes it either a poison or a remedy.”

 

Here are a few of the many successfully controlled diseases:

 

 

[CharonY]

The analogy fails in many aspects, especially considering the improvement of health outcomes e.g. quantified by life expectancy. Other examples besides vaccines are antibiotics that actively destroy the causative agents of the disease and whose negative effects vanish after the treatment (together with the disease) etc.

Also, this belongs into speculations.

[Marat]

As I commented in my original post, the theorem is deliberately overstated to be provocative. But consider it from an historical perspective: The great advances in life expectancy were mainly achieved not by medicine but by public health through improved sanitation and diet. Life expectancies were increasing through the decline of infectious disease long before there were effective treatments for many infectious diseases. Just look at the decline in death rates for tuberculosis long before BCG, or the decline in death rates for diphtheria long before it could be cured.

 

In the 19th century improvements in anesthesia and infection control thanks to Morgan, Lister, Simmelweis, and others made sophisticated surgery possible. In the 20th century, with sulfa drugs and penicillin, infection control took another major step forward. The other great advance in medicine in the late 19th and early 20th centuries was in hormone replacement therapy, from adrenal gland extracts to insulin. Organ transplantation has never been significant from a public health perspective since there are so few organs available for transplant, but this could be added to the progress made through the immunological work of Medawar, Florey and others in the 1940s.

 

But since the middle of the 20th century the problem has been chronic degenerative diseases, and in this area, which is the essential focus of medicine today and for the foreseeable future, the conservation of disease theorem seems to hold true. We get seriously inadequate results in the current efforts to manage these diseases through the palliative treatments now available, so the response has been to intensify the treatments. But this intensification ruins the patients' quality of life just as much as the disease does, so all we have succeeded in doing is transforming the natural burden of disease into the artificial burden of treatment. Perhaps we falsely think of this as 'success' because it allows us to feel in control of what is happening, even though this control contributes only to the arrogant self-satisfaction of the Medical Establishment rather than to the happiness of patients.

 

Increasingly, an intensive propaganda effort is being conducted to induce the patients to believe that the transformation of the misery of disease into an equal misery of treatment is in some bizarre sense 'progress' for them. Unfortunately, the Medical Establishment believes its own propaganda, and this may itself retard future medical progress towards actually curing disease.