Time, uncertainty, relativity, normality and modern medicineML Kothari, Lopa A Mehta
Department of Anatomy, Seth G. S. Medical College, Parel, Bombay-400 012, India
Correspondence Address: Source of Support: None, Conflict of Interest: None PMID: 529164
Source of Support: None, Conflict of Interest: None
This year marks the birth anniversary of Albert Einstein, born on March 14, 1879. JBS Haldane  called him the greatest Jew since Jesus; scientists rate him as the greatest scientist so far. The reason is not far to seek: Einstein, "working only with mathematical scribblings"  revolutionized scientific thought, and reordered the universe. This essay, a tribute to him, proposes, a la Einstein, a reordering, of modern medicine on the basis of four simple concepts-Time, Uncertainty, Relativity, and Normality (TURN).
If a la Einstein, mass is configured, energy then a la Portmann,  life is configured time. A material object or an organism is identified by the space it defines, for a given time. Each object/ organism becomes, thus, a space-time unit. The time element is especially evident at the animate level, where the time-limit during which the organism-unicellular life-forms to the biggest whale -will define space, is predictably and observably set. Burnet , describes man as "the 4-dimensional clone in spacetime." Over an individual's lifespan, the space-aspect of this space-time unit does not exhibit as many changes or attract as much attention as the time-aspect. It's as well that, through history, life has been synonymized with time. This synonymy is medically most interesting since it is time that foists senescence and diseases on an organism: "Senescence takes a generally similar form in each species, whether judged by the physicochemical changes in collagen, the incidence of degenerative changes in blood vessels or the high incidence of malignant disease. The essence surely is that there is a genetic 'programme in time' laid down for each species. There must be a biological clock and a means by which a series of processes can be made to occur according to the expediencies of evolutionary survival" (Burnet  ).
Van Der Leeuw,  aphorises that we are time, we are timed, we are the timer. "We are temporal...The man of nine thirty is not the same as the man of nine twenty-five. We are time." The most important point in the foregoing, vis-a-vis man's disease and dying, is the apparently sweeping generalization that "The man of nine thirty is not the same as the man of nine twenty-five." This small statement carries with it the ability to resolve many a paradox witnessed in modern medical practice-the enigma, for example, of a person just dropping dead while full of life, or soon after being medically given a clean bill of health. Modern medicine has failed to understand, emphasize, or highlight the fact that death is being increasingly viewed as a physiological function ,,, [Figure 1] that owes allegiance only to time. No wonder, "Altogether death has nothing to do with health and sickness, it uses them for its ends" (Benn  ). Benn's  discomforting aphorism explains why people, pink and in the prime of their life, die a "natural death," and people who are manifestly afflicted with a major disease/s not only drag on, but even seem to thrive.
For studying the development of major diseases exclusively in relation to age in rats, Simms and co-workers  created animal quarters called for their sophistry the Rat Palace. "Visitors who had contact with other rats were strictly forbidden." And yet, in this rat-utopia, diseases and death occurred with predictable timing and frequency. Comparing the rat-findings with those in man, the authors  concluded that "except for the difference in time scale," the findings on rats were applicable to man and that "the factors that determine longevity (or mortality) of the two species appear to operate in a similar manner." Needless to state, the diseases in rats bore as much relation to death, as in man: The two occurred independent of each other. This rat-man comparison brings us to the next important part of TURN-namely, relativity.
Although the cells and the collagen fibres of all mammals are very similar, they age at a rate that is inversely proportional to their lifespan. Further, given the time-adjustment between different mammalian species (e.g., 3 years for a rat is 70 years for man), both the cells and the collagen fibres reach the same endpoint in all the mammalian species. In terms of cells and fibres (cytofibernetics), we are forced to conclude that man is no more than 70/2 or 70/12 times longer lived mouse or dog respectively. Man's aging is relatively slow, that of the dog less slow, and the mouse least slow. The rates differ, but not the basic style. The problem is one of relativity.
In a human herd, however, the genes of one man are exactly like that of another, and yet one lives for 19 years, and the other for 91 years; one woman gets cancer, the other escapes, and so on. To understand the basis of these differences, one needs to appreciate the bioforce of normality as governs a given herd. While relativity explains interspecies differences, normality explains intraspecies differences, between organisms.
Normal/normality, being fundamentally a field/distribution phenomenon, is always applicable , only 'to a group, herd, or a population. "Population thinking denies uniformity and looks to the range of diverse individuals within a group. The range, not the average, is the reality .... Just as popular thinking accepts range as reality, it dismisses as nonexistent the `average man,' a being whom no one has ever met anyway." (Ardrey  ). Pickering  has searched for the dividing lines between hypo-, normal-, and hypertension, and found none. Cholesterol levels  exhibit the same Pickeringian puzzle of where does normality end, and abnormality begin? Let us paraphrase Ardrey,  to say, that The range, and not the mean or the average, is the normality.
If physiologic features such as blood pressure ,, or HCl secretion  exhibit normality in their distribution, pathologic features-even of the most serious nature [Figure 2] are no less normally distributed. In any human population, it is the normality of distribution of (the so-called) pathologic traits that determines the occurrence, severity, age at diagnosis, post-diagnostic/post-treatment survival, or the age at death, of such diverse states as congenital malformations, peptic ulcer, hypertension, diabetes mellitus, cancer, heart attack, and what have you ,,,, To take but one example, of cancer, , it needs to be realized that every human being genetically possesses the cancerability of tissues. Such cancerability, as a biologic feature, is normally distributed. All humans can, thus, develop cancer, yet only a fixed percentage (20%) of them does. This is dependent on the fact that to express cancerability, a human being must cross [Figure 3] a certain threshold ,,, World over, 80% do not cross this. Hence the global impartiality, nay the democracy , of cancer. This discussion on the normalness of pathologic and lethal processes can be best concluded by considering the final end of all pathologies, viz., death. In animals inbred or outbred, and in humans the world over, the age-at-death is normally distributed, and as was emphasized earlier, this distribution is not dependent on the presence and/or the severity of some particular disease processes. Death, like diseases (to which even infections are no exceptions), is democratic. No wonder, death is held as the most impartial of all.
Often, diseases, such as cancer, heart attack, stroke are considered prerogatives of the senile population. Not so, once normality is understood. The tails of the Gaussian curve stretch to infnity, , an aspect of normality that explains the occurrence of carcinoma of tongue in a newborn ,  diabetes mellitus in a boy of 17 days,  carcinoma cervix in an infant,  carcinoma prostate in a child of 3,  heart attack in infants,  short survival despite mild disease, long survival despite severe disease, or a disease-free individual aged 105 years.
The discussion on normality can be concluded with the realization that each of the many features, physiologic or pathologic, that comprise a human being, is unpredictably, and unhelpably distributed on the normal curve, independent of all other features. To the utter chagrin of modern medicine and its specialists, such a normal state of affairs makes uncertain the what, when, why of every disease, forcing modern medicine to be plagued by uncertainty at the level of every individual patient.
It is, however, the uncertainty principle that lends medical practice its mysterious element of unpredictability that charms and challenges the man of action  the medical man. It is uncertainty, backed by temporality and normality that accounts for esophageal mucosa declared normal today, but found cancerous tomorrow, ECG assured as OK today, and worrisome tomorrow, the patient givenup-as-gone today, surviving to attend his physician's funeral, tomorrow. But for uncertainty, medical practice would not have been half as fascinating. Thank God, for uncertainty.
In summary, we may state here the implications of the TURN concepts vis-a-vis modern medicine. TURN erases the hyper-hypo-cratic borderlines, that modern medicine has created, by showing that the difference between the "normal" and the "abnormal" is not that between black and white but that between different shades of grey, with no dividing line anywhere. TURN rationalizes the overlap [Figure 3] of no-diabetes and diabetes,  or of mere pathology (dys-is, as distinguished from dis-ease),merely symptomatic pathology, and presumably "lethal" pathology by showing that while these are symptoms of senescence, they bear questionable relation to the occurrence of death. TURN thus accords to death [Figure 4] the status of an independent, physiologic function by highlighting that "we are purposely programmed to die.  TURN dismisses as naive, modern medicine's causalism-fat causes heart attack, coitus causes cancer. TURN promises to cure modern medicine of its errorism, the obsession that every ill-congenital, cardiac or cancerous-is preventable outcome of some molecular/genetic/cytologic errors. TURN exposes modern medicine's cure-all-ism which is but ceremonial/essential palliative care of "killer" diseases which, regardless, chart their own course in a patient, often for the better, despite modern medicine. TURN is the new, and necessary, basis of physiology, pathology, and thanatology, and all that passes as modern medicine.
[Figure 1], [Figure 2], [Figure 3], [Figure 4]