Georg Ivanovas From Autism to Humanism - systems theory in medicine

6. Systemic Medicine

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6.3 Regulation and disease

Pathologies in a network are regulative. Such a regulation might lead to morphological alterations like the remodelling process in asthma (chap. 5.5.c). But a disturbed regulation might also be the consequence of a morphologic alteration. That is, no clear causal relation between function and structure can be found anymore. Therefore the search for a definite cause becomes doubtful. In such a view, disease is emergent. It was a kind of a shock for the biologists that even the genome, long time thought of as the grail of causality, is involved into such recursive processes (Chen et al 2008). For an orthodox thinking such a view creates some difficulties (Nature editorial 2005 b) as many of the trivial concepts of the machine model just vanish. The distinction between nature and nurture, for example, or between inner and outer, as demonstrated earlier with the gut flora (chap. 2.8.b) or in ‘mind’ models (chap. 2.3.h). All these distinctions including how the observed system should be defined is mainly a question of convenience, results from the problem to be solved.

The recent attempt to define chronic disease as an imbalance of the immune system is a major step towards this direction. Th1 cells and Th2 cells are reciprocally organized. Th1 inhibits Th2 and vice versa (Schwartz 2002). That is, T helper cells have a tendency to develop a schismogenetic pattern (chap. 4.2). When one side prevails disease arises. A prevalence of Th1 helper cells is connected with a predominance of humoural immunity leading to autoallergic pictures like multiple sclerosis, rheumatic arthritis, Hashimoto and others (type 1 disease). A prevalence of Th2 helper cells is connected with a predominance of cellular immunity leading to diseases like systemic lupus erythematosus, vasculitis, atopic disease characterized by a lack of reaction to acute infections, e.g., hepatitis B and C, tuberculosis (type 2 disease) (Kreutzfeld/Müller 2001) or haematological malignancies (Soderberg et al 2004).

As Th1 and Th2 tend to develop a schismogenetic pattern, this recursive cycle has to be embedded in a larger context of biochemical and physiological reactions (inner environment). Otherwise the least divergence from the balance would necessarily lead to an increasing imbalance, finally destroying the human. One could define the whole of this inner environment, of the milieu intérieur as a semantic structure. This implies that whatever happens in this context has a certain meaning. The meaning is to protect the whole organism. One part of the protective measure is the immune system. It has to distinguish between self and non-self. In practice it is a tightrope walk between an insufficient immune defence and autoaggression (Germain 2001)..

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