The Infectious Disease Approach

A.        Introduction.


Infectious diseases are disorders caused by organisms such as bacteria, viruses, fungi or parasites.  Many organisms live in and on our bodies.  Most such organisms are normally harmless or even helpful, but under certain conditions, some organisms may cause disease.  Some infectious diseases can be passed from person to person. Some are transmitted by bites from insects or animals.  And others are acquired by ingesting contaminated food or water or being exposed to organisms in the environment.  Until relatively recently in human history, the vast majority of humans that survived childbirth and were not killed in wars or accidents died from infectious diseases.  Thus, diagnosing, preventing and curing infectious diseases have always been the primary focus of medical care.


Since each infectious disease is caused by a specific organism invading the body, each infectious disease has its own specific signs and symptoms.  Sometimes a doctor can diagnose an infectious disease based solely on the symptoms.  Sometimes it is necessary to take and test samples of body fluids to reveal evidence of the particular microbe that's causing an illness.


Once a medical professional concludes that a patient has a particular infectious disease, a great deal of useful information accompanies that diagnosis.  The doctor can confidently predict other symptoms, how the disease is likely to progress, how long it is likely to last, and what interventions will assist the body in defeating the organism that is causing the disease.  Once the organism has been neutralized, the body will continue to heal on its own, and the disease will be cured.


The infectious disease approach has been remarkably successful in eradicating many infectious diseases, such as smallpox, and in prescribing effective treatments for other infectious diseases.  In modern countries such as the United States, death from an infectious disease that receives medical attention is rare, and usually accompanied by some other risk factor (such as the subject having a severely compromised immune system).   Great success in preventing and curing infectious diseases has greatly lengthened life expectancy, especially in developed countries.  With that success and greater life expectancy the chronic degenerative diseases have emerged as the major health problem. 


B.        Infectious Disease Approach to Chronic Degenerative Disorders.


For a variety of reasons, the infectious disease approach is ineffective when addressing chronic degenerative diseases.  That's why these diseases are labeled "chronic."  Since chronic degenerative diseases are not caused by any specific organism, none of the conclusions that can be derived from identifying that organism are available.  There is no organism to be neutralized, so a traditional infectious disease “cure” is not possible. 


Typically with an infectious disease, an intervention that has the effect of interfering with some process that is essential for the survival of the causative organism is sufficient to initiate a cure.  The intervention doesn’t necessarily kill off the organism. The purpose of most interventions is to help the body’s immune system carry out its function of neutralizing invading organisms so that the body can then recover on its own.  The primary symptom of all chronic degenerative disorders is that an organ or system is not functioning as well as it should, with that dysfunction being the result of years of physiological deterioration.  No organism is causing that deterioration, so there is nothing attacking the body and nothing to neutralize.  Moreover, since the deterioration is the result of the body not activating the Growth Process and repairing itself, the concept of interfering with some process to allow the body to recover has no meaning.


Another reason the infectious disease approach is inappropriate for chronic degenerative disorders is that a person generally either has or doesn’t have an infectious disease.  FDS is defined as any deviation from our genetically programmed optimal phenotype.  Thus, almost everyone on the planet suffers from FDS to some degree, and most people evidence a noticeable decrease in function over multiple modalities by their fourth or fifth decade.  But the medical profession does not tend to recognize FDS as a medical problem until there is some potentially life-threatening event (such as a stroke or heart attack) many years or decades later.

Late recognition of the disorder is one reason why many medical professionals continue to approach chronic degenerative diseases as if they were infectious diseases.  Once an organ or system has deteriorated to a significant extent (as the result of the failure to activate the Growth Process), the body will take extreme measures to prevent complete failure of that organ or system. Decades of slow deterioration of the brain will ultimately result in dementia.  But that deterioration may not be recognized as a disease worthy of medical attention until certain symptoms of Alzheimer's Disease appear.  At that point, the doctors are observing the amyloid plaques and other symptoms that may well be the result of the body's efforts to ameliorate the problem as opposed to being the cause of the problem.  Nevertheless, one frequently hears statements such as “Alzheimer’s disease is attacking the brain”.  Those statements reinforce an infectious disease approach.  


Another problem with the infectious disease approach is the practice of labeling a disorder based solely on a set of symptoms.  That works perfectly well with a true infectious disease such as mumps or measles or Ebola.  The symptoms help identify the underlying causative organism, and much useful information can be derived from that identification.  But for noninfectious diseases, a similar set of symptoms can have a number of different causative factors. 


For example, there are cases of heart disease that are caused by outside organisms.  An infectious disease approach would be appropriate for these cases.  Other heart malfunctions may be caused by genetic defects.  Attempting to identify and correct those defects might be appropriate for these cases.  But the great majority of chronic degenerative diseases are characterized by the slow physiological deterioration of an organ or system over time, or FDS.  One can cite examples of disorders that have similar symptoms that have identifiable causes other than FDS.  One can also point to examples of otherwise “perfectly healthy” people who suddenly die from a stroke or heart attack.  These examples are not a condemnation of the Hypothesis, but rather show the limitations and potential problems inherent in labeling diseases based solely on a set of symptoms.

What is cancer?  It is not an infectious disease.  It is chronic, but it is not degenerative, so it is not a chronic degenerative disease.  As such, there is no reason to believe that activating the Growth Process would prevent or cure it.  At this point, all the Institute can say is that cancer is outside the scope of the Hypothesis.


C.        Risk Factors.


In the absence of an identifiable cause for chronic degenerative diseases, the concept of “risk factor” has been substituted.  The indiscriminate use of that concept, and the practice of equating risk factor to cause, has had unfortunate consequences.   When dealing with infectious diseases, inherent in the concept of "cause" is the understanding that if the cause of the disease (the causative organism) is eliminated, the disease will either be prevented or cured.  One can remove any or all of the acknowledged risk factors for any particular chronic degenerative disorder with no assurance that that disorder will not occur. 


Generally speaking, a risk factor for a particular ailment merely means that there is a positive correlation between the factor and the ailment.  The risk factor could be strongly connected to a cause of the ailment.  For example, impure drinking water is a risk factor for a host of infectious diseases.  That’s because the organisms that cause those diseases breed in and are transmitted to humans through the impure water.  Thus eliminating that risk factor by purifying drinking water has a significant positive effect on preventing infectious diseases.  Similarly, in the United States, reducing smoking and air pollution has had a positive effect on the incidence of a number of aging-associated diseases.  Certain of the chronic degenerative diseases may or may not be caused by those risk factors, but the risk factors certainly play a role in which particular disease strikes first and the rate at which the diseases progress.


On the other hand, numerous risk factors that have been identified as being associated with chronic degenerative diseases have little or nothing to do with cause.  A risk factor may be nothing more than an early symptom of a disease.  For example, high blood pressure is often cited as a risk factor for cardiovascular disease, when in fact it is a symptom of a cardiovascular disorder.  A risk factor could show a predilection for a disease.  For example one could have a genetic predisposition for a particular disease.  Similarly, certain diseases may occur more frequently in people of a certain sex, sexual preference, race, etc.  These risk factors generally don’t cause any particular disease.


Perhaps even worse, a particular factor can be labeled a risk factor for one or more of the chronic degenerative disease based merely on an unscientific belief that the factor must “be bad for you.”  The primary example of this type of indiscriminate use of the term is the pervasive belief that consumption of a particular food item “causes” a particular disease.  This paper will not belabor the many problems and waste of resources resulting from applying pseudoscience rather than science to significant public policy questions.

D.      Interventions.


A final issue relating to applying the infectious disease model to chronic degenerative disorders relates to the development and regulation of pharmaceutical interventions.  Drugs are governed by the Food and Drug Administration (FDA), which is tasked with making an affirmative substantive finding that a drug is “safe and effective” before approving the drug for sale to the public.  A drug that is intended to treat an infectious disease typically attacks the underlying causative organism in some fashion.  Thus the determination of whether it is safe and effective is relatively straightforward. If a study shows that subjects who took the drug recovered from the disease substantially more quickly than subjects who didn’t take the drug, it is probable the drug really did do something to trip up the bug.  Since the drug is targeted at the bug, rather than the body or its metabolic processes, the side effects should appear relatively quickly and be relatively obvious.  Also, since these drugs are designed to cure a disease, they are typically prescribed in a treatment regimen that lasts days or weeks rather than years.  


Drugs that are intended to treat chronic degenerative disorders cannot do so by attacking any invading organism.  Instead, many are designed to manage risk factors by, for example, interfering with the body’s ability to produce cholesterol.  But because they rely on forcing metabolism to veer from its preferred course, they necessarily cause side effects.  Examples include the bleeding risk caused by the anti-clotting properties of aspirin, or the muscle damage caused when statins restrict the production of life-giving metabolites that are generated in the same biochemical pathway as cholesterol.  Moreover, many of these drugs are prescribed for periods of years or the remainder of a subject’s life.  Effectiveness cannot be measured by effect on the ultimate disease.  And no such drug can be truly safe.  Thus, the determination that a drug is safe and effective is never straightforward and, like all bureaucratic determinations, is often driven by political and financial considerations rather than science.