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Disease Continuum: Let's focus on health, not labels

Nutrition Health Review, Wntr, 1997 by Emanuel Cheraskin

Most of us have biases, which, as far as we know, are the result of long and tortuous training. As an allopath, graduated from an accredited midwestern medical school, I have many one-sided opinions. For example, I have the notion that if cancer is curable, it is the result of one of three techniques: surgery, chemotherapy or radiation. Of course, it may not respond to these, and I am willing to accept that. This is what I have been taught, and this is part of my convictions, even though the American Institute of Cancer Research has given us many lifestyle recommendations, such as eating better, quitting smoking and exercising.

THE GENESIS OF DISEASE

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From a practical standpoint, all disease is preceded by an incubation period. In the instance of acute mechanical trauma (e.g., an automobile wreck), the latency is obviously brief and inconsequential from a diagnostic and therapeutic point of view. In the case of chronic disorders such as cancer, the incubation time extends over months and frequently over years or decades. Clearly, the longer the prodromal time, the greater the opportunity to anticipate the end problem and abort the process.

Initially, for example, the patient notes only feeling of fatigue. When one checks this symptom in our most contemporary and definitive diagnostic encyclopedia, the International Classification of Diseases, one finds a list of 18 classifiable items. However, this particular symptom does not fit any single disease. Hence, the complaint may be ignored, assigned a meaningless label, or regarded as a minor emotional problem. In any case, because the clinical state cannot be given a name, it follows that the treatment is purely symptomatic.

More often than not, the situation continues or worsens, and other symptoms appear. Sooner or later, the findings begin to cluster in systems, organs, or on localized sites. Now the patient also experiences several gastrointestinal complaints- indigestion, anorexia constipation or hemorrhoids. At this stage, the constellation is still not classifiable with textbook terminology. Hence, symptomatic treatment continues. Further observation is the only recommended alternative. If many organ systems or anatomic sites are involved, the syndrome may, by exclusions, be assigned a psychological or psychiatric etiology.

Finally, when the syndrome is clearly identifiable in terms of a classical textbook description, a lump is discovered and a "diagnosis" is pronounced.

In other words, in the traditional practice of medicine, disease does not really exist until a diagnosis is established. A diagnosis is possible only when a set number and constellation of findings ripen. Therefore, for practical purposes, the long and tortuous incubation period -- clinically, biochemically, and enzymatically -- frequently goes unlabeled or given a meaningless tag. And so, on orthydoxy, the name of the game is the name!

THE NEW AND NOW MEDICAL GRAIL

Since the beginning of time, there have been efforts to pigeonhole disease. Towards the end of the 19th century, Dr. William Fall initiated the first international classification of diseases. Throughout these years there have been obvious disagreements, dissatisfactions, and debates. The present authority is expressed in a text originally published in 1979. This classification has the blessing of most officiating agencies. The impressive Steering Committee consisted of the American Association of Health Data Systems, American Hospital Associations, American Medical Record Association, Association for Health Records, Council on Clinical Classification, and the World Health Organization's Center for Disease in North America, sponsored by the National Center for Health Statistics Department of Health and Human Services.

The publications of ICD-9-CM constitutes both a national and global landmark. It means that one categorization of disease, injuries, impairments, symptoms, and causes of death will supplant the two, three or sometimes four present systems that have confounded clinical and statistical comparisons in the United States for decades. The providers and users of the information -- based on this encyclopedia -- will also have the assurance that this volume represents the best contemporary thinking or clinicians, nosologists, and statisticians. So, if you want to hang a label on, or actually give a number to, a medical problem so you understand the disorder, its etiology, and solution, this international volume should provide the needed information.

Does it really do this? The implications of this name-calling game are profound and yet ludicrous, medical concern with thiamine and niacin is due to beriberi and pellagra (in their classical form, both are rare and unlikely syndromes). The value of vitamin E is still suspect in many medical circles, since a deficiency of this vitamin has not been linked with a particular disease (even though the substance may be important in a host of vital metabolic processes). It is jokingly referred to as the vitamin in search of a disease.

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Disease Continuum: Let's focus on health, not labels

Nutrition Health Review, Wntr, 1997 by Emanuel Cheraskin

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