“Knowledge of perception and ignorance about decision theory both contributed to a large step forward in our research.”

– Daniel Kahneman

The body—miracle that it is—can do some things but not others. For this reason, whatever misfortunes may befall the body, one or another organ system will fail in a way that we call a final common pathway disease—such as liver, kidney, or heart failure.

You may already have inferred that there are many causal pathways that may lead to any of the final common pathway diseases. Interventionist medicine began with efforts to avert death at the last minute. In a time of pandemic, this is our first response. We also avail ourselves of the far less telegenic or filmic approach of prevention by interruption of disease transmission, which is far easier now than when lepers were sent to Kalaupapa on Molokai to die together, or were simply dumped in the ocean. If the present pandemic is too tame for you, watch the film Molokai, in which David Wenham played Father Damien.

Though new fields such as Preventive Medicine and Public Health have progressed by leaps and bounds, most efforts to save lives remain last-minute and last-ditch. One reason for this is a lack of appreciation for the causal web and its implications—one of which is that molecularism is ineffectual for prevention. We cannot reverse an infinitely complex process one molecule at a time all the way up the scale to the biome, nor can we understand habitat and biome diseases through reductionist molecular models.

Fortunately, patients and problem-solving doctors can discover new ailments and—in the course of care—identify those that are reversible and yet not amenable to pathological diagnostic classification systems. Identifying these intermediate steps between ultimate causes and consequences offer clinical investigators the chance to interrupt a process early enough to effect preventive cure. Such interruption has been the goal of early detection and intervention. Unfortunately, that approach runs the risk of seeming to improve outcomes by simply increasing overdiagnosis or length of illness.

The goal, then, is to detect and remove first, or primary, causes, as may be feasible for other patients who suffer chronic ambient poisoning with no special history of occupational or severe environmental exposures. For more, go to the FAQ page on EvolveMedicine.us.