Vera amoris socialis iustitia inspirati ad creaturam suam
(“true social justice inspired by love for humankind”)
This particular blog presents a short extract from another book being written for future publication for the benefit of the public and the students of Medicine and Law.
The preceding statement is not heard commonly in the conventional learned-mind of the English-speaking lineage as the linguistics of the Classics are now a fading memory for the newer generation. However, its theme epitomises what is intrinsic to the core principles of Medicine that is not truly understood until the seasoned clinician (and the patient) reaches the point of equilibrium in what it means to truly see the 'root' cause of illness and disease.
I. Era of Stethoscope to Era of Global Disease Epidemics
There are much written on the observed trend of improving rates of cardiovascular and respiratory diseases since the dawn of modern Medicine. The so-called “miracles” of Medicine have originated from the first part of 20th century and continued to expand to this day with advances in microbiology, biochemistry, molecular biology and genomics. The early days of discovery in crystallised forms of antibiotics used to treat cellulitis and pneumonia are as significant as the systematic development of hospitals and private clinics that spread throughout developed world.
The rapid expansion of Medicine and Science coincided with the new way of thinking during the era of Renaissance which fuelled the inquiry of “why and how” of illness and disease. The modern discipline of Cardiology is born through the two pivotal moments in time: Andreas Versalius in 1543, and William Harvey’s eventual publication in 1628 of the circulatory system including the pulmonary circulation. In contrast, the emergence of Respiratory Medicine occurred some years later in 1819 with the publication of the stethoscope invented by Rene Laennec. Until these pivotal and historically remarkable events, it is a traditionally held notion that humanity lived under the influences of religion, spirituality and feudal system of political powers that swept across the globe where fate and natural calamities ultimately determined health.
After all, being able to access a local family doctor was not the norm in a pre-Industrial Revolution era where the healers of the local commune intimately addressed the common ailments of the people. Compare to our current times, at least in this modern country of ours we are able to access practitioners of every disciplines with the support of the local General Practitioner.
II. Era of Complexity and Subspecialisation
The era of specialised care of the heart and lung is only recent given the ancient history of human existence, although it is very likely the antiquities would have dedicated their own form of Medicine to offer what is befitting for the health challenges of their time. As much is lost in linguistic translation and destruction of enriching manuscripts that document the immense wisdom and knowledge base of the past civilisation, notable figures such as Avicenna (980–1037 AD) have expanded their practice of Medicine to care for what we now see on daily basis with the diverse muscle diseases and conduction disorders of the heart. What we perceive as “new” is actually historically “old” disease entities that we are able to describe better with our fine-tuned scientific methods.
In our current era, we are confronted by the increasing complexity and cost of care for the “miracles” of Medicine we expected even at the extremes of age. There is no doubt that we are definitely seeing a different pattern of illnesses and diseases in the past millennia alone. While we are continually improving our diagnoses through technological advances, the traditional diseases of pneumonia and tuberculosis are progressively overtaken by chronic obstructive pulmonary disease (COPD), asthma, lung cancer and rarer forms of immune-mediated diseases of the lung. A similar concerning trend is equally seen in cardiac diseases with complex rhythm disorders and different forms of cardiomyopathy.
The public health upheavals between the 1840 and 1870 have transformed Respiratory Medicine due to the public health movement in the industrialised economies of the UK, Europe and the US that alerted the importance of public hygiene and lifestyle factors in human diseases. The modern emergence of cardiology is also around the similar time in 1883 when William Gaskell objectively documented the conduction of electrical impulses within the muscle fibres of the heart.
In response to the emerging challenges of chronic diseases of the 21st century, the two distinct disciplines of Cardiology and Respiratory Medicine is no longer the Generalist field of Medicine but bolted together by subspecialists and expanding workforce of allied professionals and scientists. It is no wonder we are increasingly encountered by the “Experts” and “Directors” in interventional cardiology, echocardiography, advanced heart failure, asthma, interstitial lung disease, pulmonary hypertension, COPD and so on as compared to the rarity of these professional labels alone even two decades ago.
If the survival statistics and life expectancy rates are to be ultimate surrogate marker for improvement in human health, a modest 4 out of 6 years increase in the average lifespan since 1970s is estimated from the rapid advances in the care of cardiovascular disease alone. However, this is also another matter of perspective as the public health proponent would state that the majority of improvements in human health following the Industrial Revolution occurred since the public health reforms of the 1840s. Despite the controversy, it seems that more the humanity is to know about illness and disease, Medicine is sought to care for greater in numbers and complexity. Hence, how can this be if the scientific advancement of human health is the expected contrary?
III. Role of “Poor” Lifestyle in Disorders of the Heart and the Lungs
Thus far, we have briefly examined the evolution of relatively young disciplines of Medicine dedicated to the care of the heart and the lungs. Obviously, this notion of “young” is entirely reliant on the perception of the modern Man who will not readily recall that there were countless lineage of healers and ancient healing systems in civilisation prior to what we have today. Therefore, the scope of this chapter is not presenting the details of how humanity has responded in restoring health when confronted by illness and disease but to understand the unaltered consistency in the overall pattern of disease causation through the ages.
Demonstrated in the previous chapters on the impact of “poor” diet and other lifestyle factors in teeth decay, musculoskeletal and ocular diseases (to mention a few), there is now an overwhelming evidence of how the chronic cardiovascular and respiratory diseases are established from the very young.
Outspoken proponents even share with the public that chronic disease is not a new concept but categorised according to the ability (and capacity) of modern Medicine to maintain the ill towards the desired goal of symptom-free state. Hence, the obesity epidemic since the 1980’s is now popularised into “diabesity” epidemic due to the inevitable co-existence of diabetes and obesity.
While the academics, public health leaders and legislators dialogue about the definition of what constitutes obesity according to body mass index (BMI), abdominal girth and body fat-skin fold thickness ratios, the end-game of blame for declining health is shared between the diversifying industry that provides the endless range of foods and the consumers who are no longer at the mercy of subsistence culture but what their money can buy.
When a third of the adult population is diagnosed of obesity and one tenth is projected to be “severely obese” (BMI of greater than 35) by 2025 in Australia alone, then it implies at least one third more have a variable degree of body habitus that have the potential to decline over time given the current doubling in rate of global obesity.
The classical observational study of aorta, the main artery in the human body, used to make the medical students cringe with disgust during the Pathology lectures in the 1980’s. If the prepubescent young could already develop lipid-rich and pro-inflammatory atheromatous plaque formation within their arteries, what would the cumulative effects of even a “reasonable” diet to the circulatory system of the adult in their 50’s or even 80’s? Hence, we now see patients treated with coronary artery bypass grafting and intravascular stenting who later present some months or several years later with the same obstructive issue in their blood vessel grafts. The reported proportion may be less substantial than it actually is, but then who is to know the health of the rest of the body’s circulation when the underlying ill does not change for the majority of so-called cardiac patients.
A similar trend is exposed in the practice of Respiratory Medicine. People treated for lung cancer, people with pre-existing advanced COPD and/or asthma, and those affected by recurrent inflammatory bronchitis either continues to live with their “old” ways of continuing to smoke, consume adverse diet that is totally unsuited for their changing state of health, and struggling with unresolved psycho-emotional issues that chronic lung diseases often bring to the fore.
If the global health statistics represent the impact of a single morbidity for the convenience’s sake for human understanding then we must realise that a typical patient does not only present with one health issue but there are often others in evolution. Hence, illness and disease is only a matter of time if the “root” cause of the effect is unidentified and unresolved given the importance of what happens during the early childhood, adulthood diseases are at the mercy of the early lifestyle factors.
Therefore, we face the undeniable evidence that supports of the importance of excessive weight gain in early childhood that is predictive of adulthood obesity. Once a well-recognised phenomenon in the advanced economies, there is an equally alarming pattern is seen in children of the middle-level economies such as South Africa, China and India.
IV. Projected trend in Global Cardiac and Respiratory Health
There is no doubt that human health is undergoing a tumultuous time of great change that is sweeping across the globe especially in the past two hundred years. While the standards of living have far outweighed the limitations of the human body in otherwise harsh environment, our human survival is limited by illness and disease which are contributed by our choices in how we live life. When the advanced countries suffer from the cancer epidemics, the immediate response is a renewed call for genetic splicing and gene replacement therapy from the top academia. In the field of Cardiology and Respiratory Medicine, the same genomic revolution is occurring while endeavours continue in developing artificial airways and lung for implantation, extracorporeal cardiac pumps for advanced heart failure, and the next generation of advanced pacemakers for the epidemic of conduction diseases in our ageing population.
As with the major cancers, the incident rates of heart and lung diseases will not decrease for some time as they are the two most ancient of diseases affecting the human body. While this approach continues to improve the physicality of how we diagnose and treat human disease, humanity will eventually reach a point of equilibrium where the have’s and have not’s will be confronted by an uncomfortable mosaic of humanity who continues to have the imprint of disease but physically functioning as “normal”. Given that no political systems have been able to yet fulfil the long-desired goal of universal wealth or even universal health where every individual are respected of their fundamental human rights and able to access the best of health care without compromises in equity and personal cost, the public needs to truly see the end-point of repairing the ills of our human body is not necessarily the wisest solution to the global epidemics of illness and disease.
Even in my own practice of Medicine, it is now an everyday occurrence that no amount of pharmacology is the solution to our human ills. In the introduction to this particular blog, the concept of “true social justice” is pivotal in re-defining the direction of human health for the next phase of global evolution in Medicine. From a practical perspective, we still rely on the technological advances of the Renaissance and the past 100 years of Industrial Revolution.
Even the global wars and civil conflict have catapulted Medicine in incremental leaps and bounds as it responded to the carnage of physical and emotional suffering. Cardiorespiratory Medicine is no different. While the technologies and technical skills are advancing, it is the author’s observation that our bedside clinical diagnostics have not changed much as with the fundamental framework of disease prevention. What my late Professors of Medicine and Surgery have taught me in their life’s dedication to Medicine over a period of three decades still serve our patients in their darkest hours. Hence, the adoption of supportive physical movements through regular exercise, nurturing diet, supportive social network, improvement in public and personal hygiene, and mass population control of contagion dramatically improves all aspects of cardiorespiratory health.
So, where do we go from here over the next 50 to 100 years of global human health? If a pessimistic posture is taken then it is estimated that we will likely lose up to a two-thirds of the human population from multi-system diseases and their complications. Obviously, the technologies will decelerate the inevitable progression as more trained super-specialists and generalists with super-specialty interests offer their labours to make the health care system buoyant in an increasingly difficult market environment of Medicine.
After visiting the scattered subsistence community of a remote Polynesian island few years ago, even my own eyes confirmed the worst-case scenario of our human advancement. While the mainstream observers write of the benefits of longer life expectancy, greater capacity to diagnose earlier and more specific drug therapy, there are still many parts of the world that cannot even access the basic level of health care befitting for the modern age. Hence, if up to two thirds of the world population is to be affected by some form of heart, lung and/or diabetic diseases then a greater proportion will suffer more than the rest due to geography, politics and economy of scale.
However, if we are to take the realistic and honest posture in Medicine then at least a third of the global population will suffer the inevitable while the rest will engender a renewed framework of health. Given our standards of hygiene, relationship, diagnosis and treatment continues to advance, there will be a renewed call for redefining the standards in cardiorespiratory health. Is it then possible that the very hidden reason for the uncontrolled spread of pulmonary tuberculosis is that there are still scattered pockets of our world which is deprived of social justice, over-crowding and lack of human resources which can facilitate the continuity in anti-tuberculous treatments? Is it also possible that coronary artery disease can finally be countered by the deepened level of quality in our relationships and meticulous attention to so-called “risk factor modification”? There are so countless clinical cases seen in one Physician’s clinic alone of those frankly honest people who felt the pain of continuing their ill ways and who have subsequently changed their “old” ways to restore health. These people represent “medical miracles” but also confirm that the human body can heal, too, if the scourge of disease have not caught up in the latter stage of palliation.
If we are to offer a brief synopsis of this confirming blog, I would offer a single point of relevance for the reader to take to their hearts. Even with all the astronomical cost in the billions and trillions of Dollars, Yuan, Euros and Yen needed for health care of all forms of human heart and lung diseases, it is impossible to truly know the extent of the "true cost".
The true cost cannot be known until we factor in the intersecting and overlapping contributions from the market economics of health and illness industry. Herein, we need to consider the impact on production, delivery and costs imposed by the global socio-political climate, the impact of self-interest, the unseen wastage of consumption of resources, the cost of mal-distribution of wealth, and yet the unseen dimension of non-physical ills that drive human illness and disease.
As unbelievable as the latter especially may sound, author-philosophers such as Serge Benhayon and many others before him in the human civilisation have voiced how the human being is the only species that continue to systematically self-harm its own existence. We can clearly see the evidence of the continued self-harm to the point of destruction of countless societies through indulgence, jealousy, hatred and bigotry of many invasions and wars. If wars are so destructive and cause insurmountable human suffering, why is that we still return to the evil of war? Likewise, if the terrible illness and disease of the heart and lungs cause countless misery and agony for the billions, why is it that we still return to the very things that can self-harm the body?
Endowed with the finest brain as the seat of our human intelligence, Medicine confirms that we are not improving in our health but expanding further in the complexity of our illness and our symptomatic solution to the illnesses. As impressive as the modern operating theatres and critical care equipment to keep people alive may be, the most impressive is the voluminous text of illness and disease we are now able to diagnose, index, classify, treat and even document the patterns amongst the different human population groups.
Yet, the human species are not getting any younger after its 1.5 million years since its origin (and likely, as long as 2.1 million years as per the recent archeological findings in China).
Supposedly, the best chance of future evolution is to integrate with artificial intelligence, introduce genetic splicing or harness the power of the Sun so the species can survive, perfect the physical ills, and proliferate beyond the planet Earth. If Darwinian philosophy applied, we just do not have enough time in the universe to evolve in so-called perfect human form given our intrinsic desire to self-harm and destroy even those of our own. If a more realistic school of thought is adopted, well, the future of our humanity will have the advanced technologies but feel more insecure than ever before.
Having seen the glimpses of what is ahead of us even in the disciplines of Cardiology and Respiratory Medicine, there is a lot of work to do to rebuild even the basic infrastructure of our human civilisation. All of our skilled hands are needed, and our willingness to listen to the divine wisdom and intelligence that we cannot simply ignore because it is unseen, unheard or unproven. Irrespective of religion, culture, politics and gender, there is a divine which is far greater than us that formed us, and continues to protect our existence because we also represent a part of the divinity. Human illness and disease represents the humility of the truths that we should know, and opportunity for us to realise that there is a far greater intelligence than what is within our human form.
So, even for those who are trolling the internet and the public forum as a health advocate or whatever title they meant to represent in the current life, why not live the integrity of true social justice in your bodies and let that the integrity speak for your work? No manicured words will ever replace the quality of your being which can serve as a model for humanity which is increasingly affected by illness and disease. Live your love, live your truth and be the compassionate human that you are.
Spring Hill, Brisbane