Principle Based Medicine

Currently, the main theory of medicine is evidence based medicine. We propose a theory of principle based medicine. A principle based medicine is not to exclude evidence. On the contrary, principles are the summaries of broad range of evidence. A principle based medicine is to utilize a broad range of existing knowledge to help the health of the general public.  We will use some examples to illustrate the differences between principle based medicine and evidence based medicine.

1.      The impact of cholesterol on circulatory system

From evidence based medicine, there is a strong existence of cholesterol at plaques  in blood vessels. This is evidence that cholesterol deposits on blood vessels and hence intake of cholesterol is bad for human health.

We know that our body produces a lot of additional cholesterol, other than the intake of cholesterol from food. This means our body need extra cholesterol. From principle based deduction, it is unlikely that cholesterol is bad for human health. As for the existence of cholesterol at the plaques in the blood vessels, it can be understood as the repair of blood vessels using cholesterol. Blaming cholesterol for causing the plaques is like blaming band aid  for causing bruises, as band aid is often associated with bruises.

For many decades, the medical establishment has insisted cholesterol is bad for health. But for anyone who have taken a course in physiology, we know that human body produces extra cholesterol. From this fact, many people can easily deduce cholesterol is unlikely to be a health hazard. This is the power of principle based deduction and principle based medicine. This also indicates that evidence based medicine is often driven by pharmaceutical industry to market certain drugs. They often use narrowly focused evidence to ignore broader evidence suggested by basic principles.

2.      Vitamin D and sunshine

We know that exposure to sunlight help us produce vitamin D. From principle based science and medicine, we will naturally ask why exposure to sunlight help us produce vitamin D. Sunlight with wavelength 300nm, which is in the ultraviolet zone, participates in the chemical reactions that produce vitamin D. The most universal energy source inside human body is ATP. Why our body doesn't rely on ATP to produce vitamin D? Each photon with wavelength 300nm has more than ten times of energy than an ATP molecule can release. Suppose human body utilizes ATP to build vitamin D. It could take many steps, if it can construct these intermediate chemical reactions. So utilizing UV light is a great way to tap into solar energy when our bodies need high energy input in chemical reactions.

Are vitamin D and few other substances confirmed from the research the only products that require high energy input in their production in our body? From the principles of physics and economics, we may conclude it is highly unlikely. Probably many chemical processes utilize high energy UV light as well. If this is the case, there can be some significant lifestyle and health care implications.

In cold winter weather, it is difficult for bacteria to survive. Yet people get sick easily in winter time. This indicates our immune system becomes weak during winter. Since immune cells are energetic warriors against invaders, it is possible that some immune cells are produced with the help of high energy UV light. Hence the reduced exposure to sunlight may reduce the production of immune cells and other cells. This suggests several research questions.

During winter time, we are often advised by the health authority to have flu vaccine. Would promotion of regular sunlight exposure a more effective means to reduce the probability of flu and other illness?

Health authority often recommends the intake of vitamin D supplements. Would a recommendation of regular sunlight exposure provides a more systematic way to obtain vitamin D and other necessary nutrients? Sunlight exposure probably provides more systematic health benefits than ingesting individual supplements.

For people who are sick, should regular sunlight exposure become part of the treatment as a means of boosting immune system? This may be especially helpful in winter time in northern areas. It is also possible to make the treatment more targeted. The production of vitamin D requires UV light with wavelength of 300 nm. The production of other needed molecules may require light of specific wavelengths as well. One way to identify the required wavelengths is to record the wavelengths of the emitted light during the decomposition of these molecules. These wavelengths may provide clues for determining the required wavelengths in producing the needed molecules.

When we stay in sunshine in winter, our mood improves. This psychological response suggests sunshine provides great health benefits. From principle based medicine, we will do more research to further explore the mechanisms of these benefits and utilize such benefits.

With simple reasoning from principles of physics and economics, we find many possible ways to improve human health with more exposure to sunshine, especially during winter season in northern area. However, since sunshine is free and does not need prescription, there is little incentive for the medical profession to conduct evidence based research on the benefit of sunshine more systematically. As a result, the research and promotion efforts on sunshine is scanty relative to other treatments based on drugs, such as flu vaccine.

3.      Eating ice and obesity

Obesity generates a great amount of research interest. Eating ice and having cold drinks is a very common practice. It has been suggested that eating ice can aid in weight loss. The argument is very simple: it takes energy to melt ice. Thus, eating ice will burn more calories and reduce weight.

Eating ice and drinking cold drinks does burn calories. However, coldness generates many physiological responses in our bodies that may increase body weight.  When we eat ice, our sensory system detects coldness. As a protective mechanism, our bodies may increase fat production to provide better insulation. Eating ice may induce us to eat more food to compensate for the energy loss from melting ice.

In cold environments, animals often develop a very high fat content in their bodies. Similarly, those who drink cold beers often develop a beer belly.

The causes of obesity have been discussed extensively in the research community and in the public. But there is minimal research on the relationship between cold drinks, eating ice and obesity. As cold drinks are very prevalent, further research on the relationship between obesity and cold drinks will have important social and economic implications.

From the perspective of principle based medicine, this topic would be of great interest. However, ice does not require prescription and ice is very cheap to produce. There is little incentive to generate evidence based research on ice eating and obesity.

4.      On Cortisol and pain reduction

Cortisol is a common medicine. it is often used as a cream to treat eczema. How it works?

In general, human activities can be classified into two types. Activities to obtain external resources and activities to improve internal health conditions. Roughly speaking, activities while awake are to obtain resources and activities while asleep are to heal health problems. Our body regulate the focus of activities with some hormones, one of which is called cortisol. Cortisol level is high during day time. Cortisol suppress immune activities so most energy is channeled to muscle activities. Cortisol level is low during night time. Immune systems and other healing systems function at a high capacity to repair damages in our bodies and improve our health conditions.

From the above discussion, cortisol reduces the level of immune functions and other healing functions. Why cortisol becomes a medicine?

When cortisol is applied, the level of immune activities declines. Our body is less a battle field. That is why we feel better for sometime. However, the reduced fighting results from the retreat of our immune system, not the retreat of the microbes. The microbes may well take the reprieve as an opportunity to strength themselves. This is why conditions often turn worse after the application of cortisol.

But some people do feel better after the application of the cortisol. These are usually the people with minor problems. The application of cortisol reduce the level of itching while only slightly prolong the healing process. But for more serious conditions, the application of cortisol may turn a curable health problem into a chronicle health problem.

So what we can do? First, sleep more. More sleep is the best way to boost our immune system and other healing systems. Second, exercise more. exercise improves blood circulation. It also promote good sleep. Third, massage ourselves more. Massage improves blood circulation. It also reduces the cortisol level. Both will speed up healing, such as wound healing. By the way, viruses increase cortisol level, thus suppress immune response. Viruses are so smart.

The above discussion is about cortisol, a specific drug. But the mechanism applies to many drugs. The use of drug often weaken the function of our own systems. Of course physicians warn against the long term use of cortisol. But this is similar to the warning against long term use of cocaine. Cocaine make people happy over short term. But if happiness depends on cocaine, many people naturally will develop long term dependence on cocaine.

Concluding Remarks

Principle based medicine attempts to understand human body as an integrated system that is enabled and constrained by the physical and chemical environment. A principle based medicine will help us seek much broader evidence and give them explanations that are more consistent with physical and economical principles.