The accepted mystery of the placebo effect proves there is more to health and in fact any type of subjectively judged intervention than present objective indicators can tell us.
The mind and psychology are key ingredients.referring to demonstrable evidence of neuroplasticity this is the best structural basis for a holistic explanation of our physiological adaptability to illness.
Respiratory illness and chest infections dominate medical causes for hospital admission.I would argue the pathophysiology is especially connected with the psychological state.insular infarcts may alter mood and autonomics and are connected with sudden cardiac death and there is plenty of lab evidence demonstrating immunological derangement and psychological stress.
The difficulty in targetting specific immunotherapy demonstrates that these mediators are not so much causal as much as indicators of status and that once again the brain in all its totality both as homeostatic regulator of autonomic function and mood is where the problem begins.
All multicellular organisms have been tuning their response to infection since life itself spawned.this is not a new battle.and respect should be given to inbuilt and evolutionarily dictated developments in our response to sepsis.
A 200 year period of growth in our armament to combatting infection should still recognise the limitations of this relatively recent Victorian mechanistically simplistic pathogen targetted approach.
The holistic psychological approach is not a panacea.and such talk only serves to polarise a counterproductive debate.it should be seen as equal to the other more conventional aspects of modern medicine
But modern medicine has certainly overestimated its ability to test and appropriately interpret trials for evidence of benefit.otherwise there ought to be complete subjective and objective concordance about the response to say treatment for chronic pain or depression.
We have to recognise our inability to currently sieve out isolated features of a complex multisystem process and the expectation of finding a solution through such an approach.
Does gene therapy negate my argument.
If gene therapy can demonstrate total cure then maybe.but 1)that has so far not been the case (see cystic fibrosis),and 2)how do you demonstrate the absence of a significant psychological adjunct as part of the reason for success? ( not the placebo effect but a psychological predisposition to better outcomes) and 3)doesn’t the existence of epigenetics override the simplistic incorporation of a gene as a cure and bring in a more important multifactorial element into the gene concept that could yet again come down to traditional psychological predisposition?
Ideally if there was the equivalent of a ” pleasure” centre for psychological motivation this might be our best predictor of success of a treatment.it would probably instigate a spate of trials using a new class of mood receptor targeted drugs which would subsequently fail to demonstrate convincing evidence of benefit in those who are not psych motivated in the first place and the drugs would then lose favour.
A predictable failure of our whole approach as a means of assessing the problem.
Chicken and egg is a recurring metaphor for our limitations in understanding and neuroscience while having the potential to straddle modern and alternative interpretations to healthcare is currently driven by a political dogma for a financially assessable modern approach and developments in technology eg MRI scans demonstrating cause or effect?
so for now we will have no reliable way outside our intrinsically flawed in vitro type means of assessing the impact of a psychologically integrated
uapproach to medical treatment.
But without having pure isolated auditable targets.focus on impact of good motivation,adequate refreshing sleep,mental stimulation,appropriate cultural empathy and inclusiveness will always come second in a financial and legally accountable and politically driven system driving the concept of a pathogenic causal microorganism as the basis for infectious disease.
and while I might have ranted about a circadian neuroscientists overly prejudicial bias against examples of night time creativity,I am completely au fait with idea of keeping homeostatic harmony with autonomic systems that have evolved over millions of years.
Although that argument doesn’t allow for the idea of trying to change anything at all which does not reflect our intuitive capacity to adapt to derangements of normal circadian rhythms.
I just think a greater emphasis on the symbiosis of normal routine incorporated so far as possible into a treatment strategy gives us the best chance of getting better.and in a world where an exhausted and comfortably sleeping baby is disturbed because a doctor did not consider the impact of 1-2 hourly nebulisers during the night defaulty administered on the basis of unreliable pulse oximetry means we still do not know how to apply common sense individualised tailoring to treatment and interpretation of evidence in ahealthcare system that pressurises the need for automated protocolising in order to strike the balance the needs of the one and the needs of the many.
The pendulum swings back and forth.the dawn breaks for all of us,the dusk is the twilight whose moonbeams reveal the few ,and in the dim light emerge those nightshift nuts and coked up sleep deprived clubbers who don’t mind the sound of jackhammers and nails scraping the blackboard with their Belgian hoovers blasting thru the night….
The Second Foundation,the world of the mind where one abandons discrete physicality for harmony with one surroundings,suffusing into its very fabric and blessing all matter with the hand of the Divine