There are no controversies in clinical medicine – Philosophy of Healing
Majid Ali, M.D.
There Are Only Levels of Understanding and Enlightenment
In Nature’s Preoccupation With Complementarity and Contrariety (1998. 2nd edition 2005), I presented and discussed at length five aspects of human biology. First, oxygen is the organizing influence of human biology and governs the aging process. It is also a molecular Dr. Jekyll/Mr. Hyde par excellence—ushering life with one sleight of hand and terminating it with another. Second, human biology is an enormous web of webs—a vast and intricate network of energetic-molecular pathways. Everything in that web is connected to everything else. Third, the webs of human biology form a panoramic kaleidoscope. A singular change within that kaleidoscope causes everything to change. Fourth, spontaneity of oxidation in nature—sustained by oxygen above all else—provides the primary metabolic drive for all human life processes. It also assures that no oxygen-utilizing life form lives forever. Fifth, persistent and progressive oxidosis sets the stage for dysoxygenosis—a state of dysfunctional cellular oxygen metabolism resulting from an impaired function of enzymatic pathways involved with oxygen utilization. All clinical work of a practitioner of integrative medicine—in my view—should be based on a clear understanding of those five energetic-molecular aspects of human biology.
Two other issues in clinical medicine are of transcendent importance: (1) the spiritual serenity that is essential for long-term good health; and (2) chronic anger and sadness that fan the fires of oxidosis and dysoxygenosis. The so-called mind-body-trio is an artifact of thinking. Preoccupation with that trio, in reality, is an expression of our inability to sense, feel, and know the wholeness of the human condition. I have never seen anyone dissect a human and delineate where the body ends and the mind begins or where the mind ends and the spiritual begins. I address the issues of spiritual serenity and chronic anger as well as present the philosophic principles of integrative medicine in the second volume of this textbook.
Nature’s preoccupation with complementarity and contrariety has created an enormous range of structural plasticity and multifunctionality of molecules.
That is as true for simple molecules—reactive oxygen species, nitric oxide, and others—as it is for very complex molecules, such as hemoglobin, thrombin, macrophage migration inhibition factors, and others. Equally relevant to the integrative model are the Dr. Jekyll/Mr. Hyde dynamics of cellular ecosystems in the body. In pharmacologic medicine, it is generally assumed that molecules and cells have fixed, unchanging roles. That assumption forms the putative rationale and/or basis of the prevailing drug therapies that essentially block cell receptors, channels, pumps, enzymes, or mediators of healing responses. It is my clear purpose in this volume to challenge that assumption. To do that effectively and defend my major themes in this volume, I have dwelled on the history and chemistry of oxygen and described the oxidative phenomena that set the stage for cellular dysoxygenosis. Some readers may find segments of my materials cumbersome. However, I believe the full validity of my challenge may escape some readers without a full treatment of those essential aspects of human biology.
My primary purpose in writing Nature’s Preoccupation With Complementarity and Contrariety, of course, was to serve as a textbook for the practitioners of integrative medicine. In subsequent volumes, I described integrative therapies for various clinical states which my colleagues at the Institute and I have employed for nearly two decades. The primal issues for an integrative practitioner are long-term safety and efficacy of his therapies. Those issues are addressed by including full texts of some large true-to-life, long-term clinical outcome studies. In the pharmacologic model, my focushas been on short-term results obtained in acute states with agents that block certain cell receptors, channels, enzymes, pumps, or mediators of inflammatory or immune response. That is distinctly different from the goals and objectives of an integrative physician for health preservation and disease reversal. The nurturing and restorative nutrient, herbal, detox, and self-regulatory measures generally take longer than synthetic drugs to yield desirable results. This essential point is often not fully appreciated. This volume, then, is written also to address the scientific basis and rationale for integrative therapies that must be administered for months and years before their full clinical benefits are realized.
Integrative Molecular Evolution
Molecular evolution was, is, and will continue to be an unending sequence of integrative phenomena. Every molecule acquires new functions only through its dialogues with its substrates. Every molecular messenger changes the behavior of the molecule that receives themessage—and is altered by the response of the recipient. Insulin not only regulates the behavior of its receptor but also alters its molecular population. It is a proinflammatory molecule under some conditions and assumes anti-inflammatory functions under others. Hyperinsulinemia is epidemic now. It is largely associated with obesity and Type 2 diabetes in the West but in India it is a feature of low-weight Type 2 diabetes. So Nature creates molecular webs that move like kaleidoscopes. And every cell forms a microecologic system that is minuscule only in a physical sense—a perception that speaks only to our limited visual faculty.
No cell is an island. Every cell in a tissue communicates with others in its tribe. It accepts its charge and assumes its specific command only to serve the whole. Advances in genetics and epigenetics are revealing mesmerizing details of cross-talk among cells. Every community of cells that makes up an organ influences and, in turn, is influenced by others in structural and functional relationships. So the body organs are a macroecologic tissue-organ ecosystem that commerce freely in ingenious ways with neighboring organ ecosystems.
There is a burgeoning ‘new’ field of ecophysiology—the study of whole organisms, species, and communities—in the context of the ecologic conditions that impose physiological constraints upon them. Similarly, energetics in biology—the study of how living organisms balance their energy income and expenditure—is drawing more attention from biologists. Of course, the basic notion of integrative molecular evolution presented here is foundational for both fields. It is not only simple and fundamental but it has —and must be accorded full recognition—primacy in clinical medicine. For decades, it has puzzled me why we physicians do not think ecologically. It is surprising why the physician community continues to be indifferent to essential issues of molecular ecology and microecologic cellular systems that provide the pathophysiologic underpinnings of the derangements that are described as specific diseases