Georg Ivanovas From Autism to Humanism - systems theory in medicine
2.1 The medical paradigm
The current way to process data and to create knowledge shall be demonstrated with the effects of wine onto health. It might serve as a blueprint for all kind of medical research. The advantage of this example is that it covers nearly all aspects of medical research. Simultaneously it inspires our fantasy more than other examples which will be discussed later. Moreover, the effect attributed to wine exceeds those of many other well-known therapies. Thus, this example is not only of theoretical value but ranks high in the practice of medicine.
Drinking moderately red wine prolongs life (Streppel et al 2009), has a protective effect for cardiovascular diseases, is helpful in chronic obstructive pulmonary disease (Culpitt et al 2003) and prevents stroke (Mukamal et al 2005). It even counters cardiovascular effects of smoking (Lekakis/Papamichael 2003) and of a fat diet, at least in mice (Baur et al 2006). May be this due to its content of Melatonin (Iriti et al 2006), or of Resveratrol which prolongs life in drosophila (Valenzano et al 2006) and shows certain protective effects against deafness (Coghlan 2006). Or it is due to the suppression of endothelin-1 (Coder et al. 2006). Or it is due to its property to inhibit bacterial growth, especially of Chlamydia pneumoniae bacterium that some blame for clogged arteries and heart disease (Mahady 2004), although some contradict (European Society of Cardiology 2004). Or due to its natural antioxidants effective in pancreatic cancer cells (University of Rochester Medical Centre 2008). Or is it even due to the activation of Aldehyde Dehydrogenase-2 which reduces ischemic damage to the heart (Chen et al 2008b)
Red wine is also protective against prostate cancer, attributed to its content of flavonoids (Schoonen 2004). The red wine Cabernet Sauvignon (there is a lot of room to investigate the effect of different grapes) might lower the risk of Alzheimer’s disease (Wang et al 2006).
But white wine (one to three glasses per day) improves the function of the lung (American Thoracic Society 2002) and is said to have an equal amount of bioactive substances to red wine (Falchi et al 2006). Wine in general has a protective effect on dementia (Truelsen et al 2002), boosts brainpower (Khamsi 2005) and non drinking is equally related to mild dementia as drinking large quantities (Antttila et al 2004). On the other side, beer might have anti-cancer (Arimoto-Kobayashi 2005) or anti-inflammatory effects (Winkler et al. 2006).
In the normal assumption of additivity it would be advisable to drink daily 1-2 glasses of red wine for heart and brain, 1-2 glasses of white wine for the lung, and a beer to provide cancer.
However, this is not advisable for everybody, as there seems to exist an increased risk for heart problems after the age of 55, when young people drink only small amounts of alcohol (Pearson 2004a). Furthermore, there are gender differences and women get more easily drunk by wine than men what is not true for beer (Zandonella 2001). Whether this is the reason why they become more quickly pregnant through wine and not through beer and other sprits (Dobson, 2003b) is not clear. Moreover, women have a higher risk for breast cancer in drinking wine (Newcomb et al. 2009).
To solve the alcohol problem, there have been attempts to give the ingredients of wine in the form of a pill (Fox 2004). But this would only be possible if we knew what actually works. Some maintain that it is only the alcohol (Mukamal et al 2003). Others even believe that the benefit of wine is a pure myth (Kröger 2003) and contribute its beneficial effects to the way of life that people with constant and moderate drinking live. By that the ‘French paradox’ (low coronary mortality connected with high consumption of animal fats) has been explained. An example might be the oldest man in Greece. With 110 he drinks moderately alcohol, never stopped smoking, still walks alone if he has the possibility and never took any medicine (NET, Evening news, Greece, 9.1.04).
But things are even more complex. Even if wine or alcohol should have a protective effect for cardiovascular diseases it might be harmful as even small amounts impair the ability of driving what leads to more car accidents (Horne et al. 2003). The old people who ’benefited from wine’ lived in a world with little traffic and might never have had a driving license.
So what about the following statement? “A drink a day keeps the doctor away from some of us, concludes a review by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) in the United States. But you need to ask your doctor if your level of drinking is healthy, it adds” (Pearson 2004b). What shall the physician answer? Is it reasonable to recommend the drinking of alcohol to non-drinkers (Goldberg 2003)? Despite of all discussions on the health protective potency, alcohol in practice is as harmful as smoking (Pearson 2004a) and many illegal drugs (Nutt et al 2007).
The attempt to reduce the side effects of drinking by identifying those who are genetically susceptible seems to be vanishing as until now 51 related genes have been found (Johnson et al 2006). But as these genes have been shown to be related to alcohol abuse in general and no differentiation between red wine, white wine, beer and liquors was made. May be there is a specific gene for red or white wine, or even Cabernet Sauvignon?
To mix up such insular findings creates the undisciplined pattern, so often to be found in the medical discourse. The autistic part is the ignorance of the level of abstraction. The example of alcohol and health involves at least 5 different logical levels. To correlate them needs a polycontextural model, a structure that enables us to decide on issues like truth and meaning (chap. 3.5).