My principle of the disease optimality for doctors indeed

Myckola Yabluchansky
My principle of the disease optimality
For doctors indeed

Yabluchansky M. My principle of the disease optimality. For doctors indeed. 2002.
The principle of disease optimality defines its norm, the optimal variant when a patient pays a little payment by his/her health for a qualitative recovery. “Whales” of the principle disease optimality are philosophy of health and disease, theory of optimal processes, and a principle of optimality in biology. The principle of disease optimality proves a strategy and a tactic of a treatment of a patient through its normalization by bringing to the conditions of an optimal variant. New clinic could be established on the principle of disease optimality.
This book writes for physicians and their patients and for everybody who care of the private health.
©Yabluchansky M.


Instead of introduction
It is the beginning of the century. Expectations for the changes are being justified.
For me, as for a doctor, the most important part is a professional part. There are a lot of new things here. They are not in the trifles, but in the philosophy of the subject.
I became the participant of a doctor’s perception his/her role in medicine and the role of medicine in the society. It gave us a lot of useful things. The example, which I use not for the first time, is intervention of the ideas of the optimality to the clinics. I was lucky to summarize them as the “principle of the disease optimality”. The principle is the local application of one of the most fundamental natural phenomena, which is known in different spheres of natural sciences.
In the references one can find an incomplete summary of publications on this theme. The main works of the author in this important for me sphere are included there.
In spite of the locality of the principle, its sequences for the medicine I see as revolutionary in the real understanding of this word.
The principle intuitionally justifies corrected by the time and recognized by the medical society philosophy which is build on the trust to the nature, effective use of its constructive motive forces.
For me, the century we entered is the century of optimality.
In the furious pace of life there is a time deficiency. There is lack of it for the “other’s” ideas. Especially there are a lot of them in the thick books which are like anachronism on the stage of effused to the endlessness medical science. That is why it appeared an idea of my small book – distillation of my own thoughts on the topic of disease optimality.
The way how the philosophy of disease optimality is accepted is a question for me, its author, but not for the philosophy by itself. It already exists according to its own independent laws. I know many doctors, professionals, who not only like this philosophy, but this philosophy also helps them in their routine work.
Probably there are doctors who didn’t accept this philosophy because they didn’t understand it. However, there are more doctors who didn’t come across it.
I wrote this little book to promote faster dissemination of the philosophy.
You, not me, can judge this publication, but I did my best.
I will be grateful for your criticism and suggestions.
The theme of the disease optimality is important for me, and I will not leave your reaction without the answer.
You can write on one of the emails: mydoctorlife@gmail.com, myabl@mail.ru.
Sincerely,
Myckola Yabluchansky.

Prehistory of the principle
A clinic is in crisis.
The crisis is conditioned by many reasons. In the list there are economic, social, ecological, and, naturally, medical problems.
For me, the medical problems are concentrated in incorrect understanding of diseases. This incorrect understanding being out of the reality of modern life, leads to the false diagnosis and treatment decisions.
According to the faulty philosophy dominating in a modern clinic diseases are opposed to the norms of health, and the condition of a patient is evaluated by deflection from the norms of a healthy person.
By this philosophy the actions of a doctor are directed to the “normalization” of functions and structures of a patient in the sense of bringing to the norms of a healthy person. It doesn’t mean what a price is and if it is possible.
Endless line of tests and mistakes in the patient management proves that this philosophy is dead-end and defines the crisis of the clinic.
The example is the acute myocardial infarction. Its history is in “insistent” refusals from every time appearing new “promising” treatment methods.
We needed years to become sure that:
• Steroids limit the infarction zone but complicate its recovering
• Indirect anticoagulants (out of thrombolitic therapy as a compound link) increase the risk of thrombo-embolic complications.
• Non-steroid anti-inflammation means lead to the development of post infarction heart aneurism in a case of a wrong prescription.
• Coronaroactive remedies in systematic use “rob” the infarction zone.
As a result a prognosis and outcome of the disease becomes worse.
In majority we continue thinking that a disease is not a natural condition of a human life; and that only the norms of a healthy person have a right for existence in the world which we created.
I see a crisis of a modern clinic in this approach.
A Disease should be Normal
The reason of a clinics crisis is in wrong understanding of health. The sequence of these misunderstandings is a wrong approach to a patient, disappointment in the basis of a clinic.
Let’s analyze a formula “sanos-patos”. Everything is correct in it. Two measures are opposed – the measures of disease and health.
There is a trouble with the formula “norm-pathology”. Health is reduced to the norm. A disease is opposed to the norm.
I will explain my idea; it is clear.
In philosophy a measure – a category and a norm- is an idea connected with the measure. If we have a measure, we should have a norm as it goes without saying.
The norm is one of the parts of the measure which is rather limited defined by the aim function. Under the aim function we understand a norm. One aim is one norm. Unlimited number of aims leads to unlimited number of norms in the same measure. Moreover, every norm is concrete.
Let’s take an example from an engendering. A bulb. It can be used beginning from a part of a second until some years. There is a norm – a bulb is ok if it can be used during a certain period of time. There are a lot of bulbs. They are different. Even I know few dozens: from the torch bulbs to usual lamp ones. Each of them has its own norm.
Let’s take an example from sport. Sportsmen’s achievements are different in sprint, football and baseball,… if we make a champion in sprint to lift a weight, and a champion in swimming or chess… the result is not too difficult to predict.
Another example is from education. There are different educational standards in economics, mathematics, and medicine. Every standard is a norm. Two young people, who are twins, differ because they graduated from different departments. They had different educational standards. Everyone confirms his/her own standard, his/her norm of education. In all the examples the norms are connected with the aim functions. A bulb should work not less then…; sportsmen should run not more then…; a certain student should have an exact amount of courses, have a definite number of exams according to his/her specialty.
A measure of a disease cannot exist without norms even inductively; the same as a measure of health; the same as any measure. I formulate a norm of a disease as a variant when a patient pays a minimum payment by his/her health resources.
The idea of a norm of a disease is much wider then the idea of a norm of health.
There can be a variant of a particular disease with its particular characteristics in a certain patient, with concrete geno- and phenotypic determinants, with social, ecological and other conditions. These exacting diagnostic and other characteristics are typical for this moment of a disease development.
The aim here is a variant when a patient pays a minimum payment by his/her health recourses for a disease under certain conditions.
I want to stress that a local root of a mistaken approach of a clinic is partly in a fact that correct construction “sanos-patos” is opposed to the incorrect one “norm-disease”.
A strategy when parameters of a patient are brought to the norms of a healthy person is mistaken.
“Normalization” of a heart output and frequency of heart contractions in understanding of the norms of a healthy person in the case of a heart failure damages a heart and shortens a life.
Reasonable decrease heart output and increase of contraction frequency is one of the mechanisms of compensation of heart pump dysfunction.
Hyperthermic syndrome in a case of an acute pneumonia corresponding it severeness is necessary condition of a qualitative recovery of a patient.
Gastroenterology again got into trouble: now it is anti-helicobacter pillory therapy of a ulcer disease. I don’t know if it is good or not but the risk of oesophagus tumors and other complications increases. The world is excited. Not so long time ago it was inspired to forget everything that was worked out in its treatment before.
There is numerous numbers of examples.
I admire how the ancients understood health and disease: “health is natural in human under certain conditions; under other conditions a disease is also natural…” (Golbah).
“Remedy” for a modern clinic
Philosophical analysis of health and analysis predetermines spread of optimality ideas on clinic.
The problem of patient treatment according to this idea is formulated as a strategy of optimal management which provides the most favorable (optimal) from all other variants flowing of a disease.
The strategy of optimal management is a subject of a research of mathematical theory of optimal processes which is the most common instrument of an optimal solving of management tasks.
In the frames of this theory a patient management can be considered as a particular task.
The theory was created because of engineering demands and it became one of the most perspective directions of modern mathematics.
It gives methodology and methods of finding of optimal management:
A) Optimality in a meaning of getting an aim of a process for the shortest period of time;
B) Optimality in a meaning of getting an aim of a process with the minimum inputs of resources.
The tasks which a doctor solves in his/her work with a patient are management.
Diagnostic and prognoses are intermediate stages.
There is only one aim – to help a patient; to do the best to make a treatment or, in the other words, to make management.
That is why a mathematical theory of optimal processes is a “remedy” for a modern clinic.
Through principle to a new clinic
Natural spread of the theory of optimal processes on a disease in its philosophical understanding leads to formulation of a principle of disease optimality.
The principle states – the only variant is optimal which needs the minimum payment by the resources of health.
The principle soared hovered for a long time; but it isn’t and wasn’t understood in a right way.
G. Selye wrote: “is it possible to improve a natural defending mechanism? A theory “nature knows better” is seems to be rather applicable to adjustments. It is considered that… a natural selection … gradually developed the best possible defending reactions. But it is not so. We often can improve nature by suppressing the reactions which were developed for a defense but not necessarily useful under all the circumstances”.
There is a mistake here. Violation of optimality of a mechanism selected by nature is considered as its non-optimality.
I like the ideas of I. Davydovsky: “biological expediency of inflammation as natural spontaneous act doesn’t mean that this act in individual conditions is always necessary or that it conducts an absolute defense and “targeted” on it… a doctor faces a necessity not only to see spontaneous automatically developing processes of inflammation, but also to interfere before it starts”.
Please note; according to I. Davydovsky a doctor should interfere to an inflammation process only in a case of violation its natural (spontaneous) progression.
I think that the basis of the principle is fastened genetically as a mechanism of recovering. This is the way how nature selected them.
The aim of a doctor is to help a patient to go through a disease with the minimum losses. This is a real philosophy of family doctors.
The principle makes basic changes into the methodology of patient management. Its main point is optimal management. The sphere of the use of optimal management in the sense of fast actions is mainly in urgent conditions and in the sense of losses minimization is in a whole clinic.
An optimal progression of a disease provides:
1) Qualitative recovering in a case of acute forms;
2) Stable remission, less often and not severe complications in chronic forms;
3) The best possible quality of a patient’s life.
“Arrow of time” and reversibility of a disease
Aspiration to improve is always present in the world.
G. Selye, whom I quote in the previous paragraph, is not the only one.
Our post soviet space in contrast to the others accumulated a lot of experiences of planetarium size. It is easy for us “to make a fairy tale a reality”. It doesn’t matter that it is a fairy tale. The problem is we have to pay for it. And sometimes it is too expensive.
Normalization of a patient’s condition in a sense of bringing his/her functions to the norms of a healthy person is equal to the nature improvement, because a priory is allowed, it is axiomatized that nature is not perfect.
I want to insure you that this theme is more serious then just thinking about imperfectness of nature. Our (western) philosophy was built under a pressure of deterministic ideas. Of course they have a lot of clever things, but the most important ones go from classical (Newton) mechanics.
Deterministic ideas which are realized according to abstract mathematical tools, which were fixed for this mechanics, allow the existence of reversibility of time.
A representative of an exact science who is based on a deterministic platform would say: “give me a law and a reference point and I will predict the future and the past”.
It is right. He will do it. But this prediction in our real world doesn’t worth a pin. Real world is not deterministic, but it could be. Deterministic world is a rude idealization of a real one. Deterministic world is not alive; it is dead, and it doesn’t allow development.
Human nature more then a real world despises deterministic per se. The same related to the reversibility as well as in a narrow medical understanding.
The ancients said that it was not possible to come into the same river. I understand it in a meaning of impossibility of reversibility.
It is not understandable how we could loose this divine philosophy. East is wiser. From the ancient times they accept nature as a spontaneous harmony and put it into the deterministic frames is the same with subordinating it to the external power. Get know the Chinese pulse diagnostics. The problem is if the characteristics of pulse are disharmonious with the health condition of a patient. It is a catastrophe when a sick person has a pulse of a health one.
Making a research about order and chaos, definiteness and indefiniteness I. Prigozhin comes indisputable conclusion about deterministic – probabilistic world organization and the existence of the “arrow of time”. In the other words he confirms one of the most ancient philosophies of the irreversibility of a developing world.
There is no place for reversibility of a disease in the “arrow of time”. It is a mystics. It is necessary to go through a disease.
As for the words of “family doctors” a doctor should “lead a patient through a disease”.
I want to add, it should be done by the best way, according to the principle.
Principle and diagnosis
A disease diagnosis of a patient is not full or even wrong if it doesn’t contain information about an optimality degree (a degree deviation from the optimal variant) of a disease.
Out of this a doctor doesn’t have enough information for planning and fulfilling a correct treatment.
A clinical diagnosis is an inwardly non-contradictory formalized conclusion about patient’s health.
A possible formula of a diagnosis:
1. Naming of a disease (in the terms of international classification);
2. Remoteness of a disease (for acute diseases it is necessary to have an exact data; for chronic disease a remoteness should be in years and it should be a date of a last exacerbation);
3. Etiology ( if it is defined and has and if it important);
4. A stage (phase) of a disease development;
5. A degree of a disease severity;
6. Progression of a disease (optimal, non-optimal and how it is expressed);
7. Main clinic syndromes;
8. Complications;
9. Health resources;
10. Prognosis (for a present disease, recovery, life quality of a patient).
The formula in points 1-8, 10 is taken to any disease a patient has.
Point 6 is a key-point in a light of a principle, in the meaning of a achieving the tasks of a clinic.
Diagnosis as a conclusion about a patient’s health corresponds to it and changes with it. It is not a frozen construction.
“Qui bene diagnoscirt, bene curat”, Ancients said.
Good diagnostics should follow a principle.
You would never use it in full measure if you didn’t learn to formulate a full diagnosis and didn’t make it a rule of your professional activity.
Incomplete (out of definition of trajectory of a disease progression) diagnosis is like an incorrect understanding of a disease: it is harmful and dangerous in the same measure.
I hope the examples are not needed.
There are no miracles
Diagnosis is based on the information got about a patient. There are at least four sources of it.
The first one is a result of cooperation with a patient (interviewing, examination, objective research) and with his/her environment.
The second one is information got from medical documentation.
The third one is a variety of results got by special (important and unimportant) examinations.
The fourth one is the use of the previous three methods in a patient’s management (in the prism of time).
There are no problems with the first method. If we are not right we blame ourselves for our mistakes. As for the others, it is necessary to be attentive. It is not known who, when and under what circumstances got them and how they were interpreted.
Unfortunately, it is natural for human being to make mistakes. It is bad when somebody’s mistake is taken as a truth. It can cost a lot. That is why we should be careful with those data.
It is a false practice to trust somebody’s information unconditionally.
We should remember there is only one convincing argument Its Majesty The Fact if it was got by a right way.
And also – there are no miracles.
A patient by himself and all variety of data about him/her should be in a so-called bijective (mutual – simple) accordance: a patient shouldn’t be added to a data, but a data should be added to a patient. If there is no accordance we should think about a data problem first.
There is an example from my practice:
-Professor, you have cor triloculare pateint.
-How old is he?
-48.
-Let’s see. We will be the first.
The heart had four chambers.
That was necessary to prove.
About a data quality
Objective data can be received only by objective methods. Different methods can be proposed for defining the same data.
Different methods have different accuracy. That is why data received on the basis of different methods cannot be absolutely identical. But in general they should be the same if they were taken in a right way. There should be naturally the same interpretation.
If you are not sure in data you should redefine them in a different place and what is better by the other methods. It should be done for conscience’ sake and you will have greater confidence in a diagnosis.
About a “cost” and data interpretation
Data is a fact, and facts are stubborn things.
A fact is a fact, not more. It should be interpreted. There is a variety of recommendations, but it doesn’t mean that the facts should be evaluated in such a way.
I remember a detailed lecture in the school of European Society of Cardiology on heart failure on the border of Millenniums. There was a criterion of the lecture: patients with the ejection fraction of the left ventricle more then 25% have higher survival and patients with ejection fraction less then 25% have lower survival. There is no doubt that the criterion is comfortable if it is used correctly.
There is an example. The ejection fraction is 50%, but 30% goes back to the left atrium and only 20 % goes forward to the aorta. Is it really an ejection fraction? What is the chance to survive?
Every index, as an iceberg, has two parts: “under-water” and “above-water”.
“Above-water” part is a part which we oriented on and which we interpret.
“Under-water” part is not “under lock and key” but it is difficult to see it.
If you don’t remember about an “under-water” part, as in the example with the ejection fraction, you should be ready to have troubles.
You will have them in the diagnosis first, then in a patient’s management. There is no optimal patient’s management here.
It is just not more then good advice.
Nature is miserly
There is a tradition that we think that it is bad if data changes. It is right that it is bad, but we should remember that it changes because of bad circumstances.
One should remember that nature is miserly. Every structure has many functions, participates in many of them, as well as every function is associated with many structures and their changes. It is not necessary that the functions are associated with circumstances which are good for our hypothesis.
Also we should remember that there are the same mechanisms for pathological and physiological processes.
Nature doesn’t have special tools for pathological processes. It is miserly!
Do you want an example?
There are a lot of them.
According to my natural stinginess I’m giving you only one example: a patient with atherothrombosis has a hyperfibrinogenemia.
Is it bad or good?
According to everything it can be bad, because of risk of thrombosis and thrombo-embolytic…
On the other hand, in the case of atherosclerosis or erosion plagues is there another way for recovery as not through the primary “patching up” by thrombus on the basis of which the conjunctive tissue will form?
Nature has not created any other mechanisms!
So, should we interfere into these selected by nature mechanisms of “patching up” of plaques?
Is it good to interfere?
Are you afraid of risk of thromboemboli? Of course, there is such a risk.
But who knows statistics? Is it greater when interfere or do not interfere into the system of coagulation?
Wait, how many factors of coagulation are there? Is it just for a word to speak about dynamic balance in the coagulation system?
So, hyperfibrinogenemia in atherothrombosis is not for thrombosis and thromboembolisms, but as an effect of complicated atherosclerosis, which can be a result of…
Yes, you understand correctly. I didn’t finish, which can be the result of thoughtless medical actions.
Let’s remember, nature is not just “miserly”, but it is wise and we should take it into the consideration.
We should learn from it.
Stinginess is not a very bad quality. It is much better then wastefulness.
Not to go to far
Necessity and adequacy is a double condition which allows building a complete clinic diagnosis as a basis of a qualitative medical management.
Satisfaction of necessity is the minimum for the required amount of an examination.
Satisfaction of adequacy is the maximum.
Under-defining and under-fulfilling lead to the incomplete diagnosis. Over-defining and over-fulfilling lead to incredible expenses of a diagnosis, from financial losses to physical and moral detriments.
Moreover, every new examination increases a risk of non - qualitative data with the following results (because of different reasons).
The principle of disease optimality is a result, special case of optimality tasks, where optimality of a diagnostic process with thoughtfully planed procedures of a patient’s examinations takes place.
Careful optimal planning is in the basis of all doctor’s work/
There are no miracles
Medical management, especially on the basis of the philosophy of disease optimality, is good advice if there are problems with getting and interpreting facts and diagnosis construction.
Let’s remember, there are no miracles in reality!
Principle of patient’s management
The principle doesn’t contradict to the existing methodology of patient’s management. It restricts the most qualitative and full patient’s recovery.
Beginning treatment a real, in my understanding, doctor evaluates how duration, severity and organization of system and local patho- sanogenetic mechanisms of a disease correspond to or differ from an optimal variant with the aim to make a right decision about an amount, quality and consistency of interfering.
Medical actions should correspond to patient’s health and its changes.
Mental sphere
A person is a single whole in his mental and physical features. Mental features dominate. It should be given the biggest attention. We should help to form an adequate personal aims of patient in understanding his disease and getting control over it.
It is difficult to overestimate the role of psychology and good psychotherapy in the solving the tasks of recovery, the best movement through the disease and quality of life in general.
A word can heal.
A word must heal.
Give more attention to a patient.
Physical health
The formula – healthy spirit is in a healthy body – is a gold one. Physical activity prevents distress, chronic tiredness, early ageing, and increases resistance to diseases. It is important for health, but for recovery and favorable disease progression it is even more then important. We speak only about its characteristics. It should be balanced with health and should be determined by it.
In recommendation on physical activity doctors should take into the consideration a patient’s life style and his stereotypes.
Nutritional culture
There cannot be health without nutrition culture, especially when we speak about a sick person. The first rule here is moderation. Overweight predisposes to diseases.
There should be a special attention to quality and quantity of food.
We should stress the accordance of nutrition ration to a phase of a disease.
There is no appetite during the pick of acute and exacerbation of chronic diseases. It is normal. The appetite will return later.
Correctly organized nutrition as well as physical activities is the first medicine. In its absence any other actions don’t get a wished result.
Detoxification
Intoxication slows and changes of metabolism, complicates management, and worsens a disease progression. In making detoxification the priority should given to the natural ways: water regime and other cleaning procedures. Medical starvation is useful. It is used in a wide diapason, beginning from a part starvation to the full one. Parenteral interventions may be used as components of intensive therapy. But it solves its own tasks.
Influence on etiological and risk factors
In a case of a chronic disease the first reason of it has a historical meaning and that is why there is no necessity in etiotropic therapy. It is more important in acute and lingering forms of diseases. But even in this case an etiological factor is important if it is present with the interaction with patient’s organism. By itself this therapy is not effective enough. We should take into consideration how useful or harmful is it. Very often it is enough make impacts which increase reactivity of patient’s organism and optimizes his recovery.
We always should pay attention to risk factors.
Optimization of a disease
Optimization of a disease is realized via intervention into its (patho- and sanogenetic) mechanisms. These mechanisms are rehabilitative on their nature if there is no damage. They are directed on the recovery in the case of acute and sub-acute disease or at the end of a phase of exacerbation of a chronic disease. Moreover, the price is always minimal.
The aim of an intervention is to bring a disease to uncomplicated conditions and in no way to the norms of a healthy person!
Optimization assumes thoughtful control of a disease progression.
We always should be in a hurry with optimization because the basis of uncomplicated or complicated disease progression is formed during the first hours and days.
If we begin optimization late its effectiveness would be smaller.
Syndrome therapy
Syndrome therapy is directional on syndromes and is not connected with the mechanisms of a main disease. In the other words syndrome is a manifestation of a disease and its mechanisms. Intervention should be done in dangerous conditions and during periods of its overcoming. In the other cases the priority should be given to patho- and sanogenetic therapy, which also solves syndrome tasks.
General approach to use of medicines
Medicines are not prescribed forever on the same scheme. Therapies should evolution according to a disease. It is enough only to help a patient in difficult time. Sometimes we don’t realize that out treatment is not effective. Sometimes disease self organize and we are just witnesses of their (right or wrong) progression.
Polypragmasy is a difficult problem. We always want to predict everything. We should limit the amount of medicines to the minimum.
Drugs work not only in peace but also during stereotype activities. It is important not only to give doses but also intervals of taking medicines.
Peculiarities of a disease and a patient are put on pharmacokinetics of medicines. Base on optimality of a human organism and his wish to live when you prescribe drugs.
It will never let you down!
Principle of surgery patients’ management
Surgery clinic is not an exception. If there is time, pre-surgery preparation includes mobilization of mental, functional, and structural reserves of a patient’s organism for the surgery. During the intervention the priority is given to the methods which minimize functional and structural consequences of the organ under operation and the access to it.
Post-surgery period is a strategy of a patient’s management when his norms are not the norms of a healthy person.
Consequences of wrong directed therapy
A therapy which goes against the principle out of the optimization of patho – sanogenetic mechanisms of a disease, especially when it breaks them, has unfavorable consequences for its outcome. It is wrong.
Festine lente
This ancient wisdom is one of the strongest. Human health is a very important value to deal with it non-thoughtfully. The actions should be considered! Look before you leap. May be there is no need to leap.
The most important aim
A norm, an optimal variant of a disease is the first question we have when we choose a strategy for a patient’s management.
Is it a reasonable question that a suitable criterion here is the fastest recovery?
The answer is that a recovery date cannot be the criterion. A disease is figuratively like pregnancy. Is it good if it is premature? What about a prolonged one? Everyone knows that pregnancy is good when a baby is born on time.
The principle allows only one criteria of optimality: minimum losses of health for a disease.
The mistakes which were concentrated in a clinic are associated mostly with our distrust to a patient’s organism, perfection of his rehabilitation mechanisms, forgetting about a strategic aim of treatment with its substitution by absolute separate tasks.
It is still painful for me that the main thing for us is in shortening of the hospitalization periods, limitation of the myocardial infarction zone, suppression of an inflammation process in lungs, fastening cicatrisation of an ulcer. Only now the highest double criterion of treatment quality comes with many difficulties. This criterion is increasing of health quality and life span of a patient. It is interesting is there any other alternative philosophy to the principle which provides achieving this high criterion?
Secretly, for me disease optimality is a mean to increase health quality and life span of a patient.
The principle allows the existence of one global aim of treatment. This aim is achievement of the most qualitative patient’s recovery with the minimum price for his health. Depending on a disease the recovery can be complete or incomplete.
The other aims are local and they must obey to the global one. If the local aims are absolute the patient’s management would be ineffective. Be careful, all of them are ersatz!
Formalization of the principle application
It should be formalized. It can give a bigger chance that there would be less mistakes.
I see the application in such a way:
• Identification of an optimal variant for a patient;
• Patient’s diagnosis before a deviation of a disease from an optimal variant (including);
• Defining a degree and a character of deviation of a disease from an optimal variant;
• Establishing a (global) aim of a disease optimality in a patient;
• Patient’s management by the optimization of a disease progression;
• Solving local aims in cases of changes in a health condition of patients by the methods which don’t contradict to the aim of disease optimality.
The principle and new directions of science
The principle opens new directions in science which base on reexamination, addition to a clinic by formalized knowledge by optimal and non-optimal disease’s variants.
We need data that would allow us to differentiate an optimal and nonoptimal varients of a deasease on the all stages of its clinical course.
In the other case a doctor has only one criterion – deviation degree of index data (gender, age and other) from norms of a healthy person. Then a doctor has one approach to a patient’s management – to bring a patient to the norms of a healthy person by any means.
An old disease.
A dangerous disease!
Become supporters
Practical use of the principle requires professionalism and responsibility before a patient in the same measure.
It is necessary not only regulate a disease progression but also to optimize it.
It is much easier to evaluate syndromes as something pathological, suppress them and in the case of worsening of a patient’s health, if it happens, explain everything by imperfectness of a modern medicine.
There are a lot of examples when patients overcome not only their diseases but also bad treatment.
I’m sure that a doctor is a person who accepted human optimality and base on it helps his patients, a person who sees and treats a patient but not disease.
M. Mudrov said:”I’m going to announce you a new truth which can be unbelievable and which would be difficult to accept for many of you: “treatment is not overcoming a disease. It is in healing of a patient”.
I would like to add: “on the basis of the principle”.
Instead of conclusion
Dear colleague, I hope you accepted a philosophy of a patient’s management which is built on the principle of disease optimality.
I hope that those who red previous publications and got familiar with this third one of my principle also liked it, as well as its changes and additions.
Disease optimality is one of the fundamental laws of human nature. It created this law, put and continues to put it through the millstones of evolution, making it more filigree and perfect. I have a deep feeling of confidence that nature makes it according to a will of the wisest intellect – the creator.
Shouldn’t we trust nature? Shouldn’t we coordinate our actions with its wisdom?
Not bringing a patient to the norms of a healthy person, but his treatment according to the norms of optimal variant of a disease provides the best possible recovery. Even if he can’t overcome his disease.
The principle of disease optimality is the philosophy, a general approach to a disease but also it is an individual patient’s management.
It is also a new clinic.
We are establishing this clinic.
Join us!
References
1. Avtandilov G.G, Yabluchansky M.I., Salbiev K.D. at al. Quontitative morphology and mathematical modeling of the myocardial infarction. -Novosibirsk: Science, 1984.
2. Bobrov V.A., Yabluchansky M.I. Heart arrhythmia: The problem state and new approaches to the treatment. – Ukrainian Journal of cardiology. - № 1, 1996.
3. Vojno-Yasenetsky M.I. Biology and pathology of infectious processes. Leningrad, 1981.
4. Davydodsky I.V. The common pathology of the man. Мoskau.:Medicina, 1969.
5. Davydodsky I.V. The causality problem in the medicine. Мoskau.:Medicina ,1987.
6. Malaya L.T., Yabluchansky M.I., Vlasenko M.V. Non-complicated and complicated myocardial infarction healing forms, Кiev.:Health, 1992.
7. Marchuk G.I. Mathematical models in the immunology. Мoskau: Science, 1980.
8. Pontryagin L.S., Boltyansky V.G., Gamkrelidze R.V. at al. Mathematical theiry of the optimal processes. Мoskau: Science, 1983.
9. Prigogine I., Stengers I. Order from chaos. – Мoskau: Progress, 1986.
10. Prigogine I. The end of the distinctness. - Мoskau: Science, 1999.
11. Rashevsky N. Some medical aspects of the mathematical biology. Мoskau: World, 1966.
12. Rosen R. The optimality principle in biology. Мoskau: World, 1969.
13. Selye G. On the level of the entire organism. Мoskau: World, 1972.
14. Selye G. The stress without the distress. Мoskau: Progress, 1982.
15. Khvorostinka V.N., Yabluchansky M.I., Panchuk S.N. at al. Therapeutic gastroenterology. Guidance for the practical doctors. – Kharkov, Basis, 1999.
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18. Yabluchansky M.I., Каntor B.Ya., Маrtynenko A.V. The functional investigations data interpretation of the cardiovascular system. - Kharkov: Basis, 1993.
19. Yabluchansky M.I. The somatic patients’ optimal menedgment (the general approach). — Kharkov: Basis, 1995.
20. Yabluchansky M.I., Маrtynenko A.V, Isaeva A.S. The basis of the practical using of the circulation system variability technolpgy. – Kharkov: Basis, 2000.
21. Yabluchansky M.I. The acute myocardial infarction strategy (for doctors indeed). – Kharkov: Basis, 2000.
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23. Yabluchansky M.I. Carefully, the ejection fraction.– Kharkov: University edition, 2002.

The principle of disease optimality defines its norm, the optimal variant when a patient pays a little payment by his/her health for a qualitative recovery.
“Whales” of the principle disease optimality are philosophy of health and disease, (mathematical) theory of optimal processes, and a principle of optimality in biology.
The opposition of “norm – pathology” is incorrect; the correct opposition is “sanology-pathology” and “health-disease”.
In health and disease, as in any other measure, norms are defined; for the norms of a disease, naturally, we should consider its optimal progression.
The principle of a disease optimality requires an additional information about a degree of optimality (non-optimality) of its progression to a diagnosis.
The principle of disease optimality proves a strategy and a tactic of a treatment of a patient through its normalization by bringing to the conditions of an optimal variant. Solving of separate tasks shouldn’t, at least, deviate from an optimal variant.
New clinic could be established on the principle of disease optimality.

Диагноз, под которым готов подписаться

Качка, що кульгає на обидві ноги

Все, до чого він доторкається, перетворюється в … попіл.

Жив у VII столітті до н.е. такий собі грецький цар Мідас, який, згідно міфології, мав унікальний дар: все, до чого він торкався, перетворювалось на золото. Спершу, коли в нього з'явився такий дар, жадібний цар дуже зрадів: він ходив своєю рідною країною, торкався до всього, що траплялося на очі, і підраховував прибутки.

Але пізніше виявився і інший бік медалі: цар Мідас мало не вмер з голоду, тому що їжа, до якої він торкався, теж перетворювалася в золото. Зрештою розум переміг жадобу: цар звернувся до бога Діоніса, щоб той позбавив його надприродного дару.

Час "царювання" Ющенка дуже нагадує події цього древньогрецького міфу: те, що спершу здавалося політичним золотом, виявилось м'яко кажучи попелом.

В хронічних поразках держави Україна та нинішнього українського істеблішменту можна звинувачувати кого завгодно і що завгодно.

Але головна відповідальність за всі політичні та економічні негаразди в країні повинна лежати на першій особі держави – президентові цієї держави. Інакше навіщо було брати на себе відповідальність за долю держави на цілих п'ять років?

Новини ТаблоID

Черновецький заспівав, як через нього не доспали. АУДІО

Мексиканську королеву краси затримали з партією наркотиків

Еротична фотосесія Астаф‘євої на сторінках ювілейного "Плейбою"

Кличко з підгузками сина увійшов до десятки

Федір Бондарчук з поламаною рукою рвався до Шуфрича і Ступки
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Те, що президент ніяким чином не хоче нести відповідальність за стан справ в країні, а скоріше, веде себе як сторонній спостерігач, критик та експерт з усіх внутрішньо- та зовнішньополітичних питань, зрештою стало причиною того, що Україна поступово де-факто перетворюється з президентської на парламентську державу.

Абсолютно закономірним також є ситуація, що склалася останнім часом, в якій президент фактично усунений від реального впливу на перебіг політичних та економічних подій. І знову ж таки не через дії явних чи уявних ворогів Ющенка, якими називаються Тимошенко, Янукович, Кремль тощо, а саме через бездіяльність або деструктивну діяльність президента та його секретаріату.

Ще недавно пропрезидентська фракція блоку "Наша Україна – Народна Самооборона", одним із варіантів назви якого перед останніми парламентськими виборами був "Блок Ющенка", наразі стала по суті антипрезидентською.

На наших очах здався останній плацдарм Ющенка – рідна партія "Народний союз Наша Україна", яка створювалась після феєричних революційних подій 2004 року під Ющенка і для Ющенка.

Явно послідовно закономірним є той факт, що розпад партії прискорився саме тоді, коли сам президент публічно її очолив.

Новини Життя

82,6% українців сидітимуть на Новий рік біля телевізора

Пластичний хірург заправляв своє авто жиром пацієнтів

Що європейці купують у порадунки на Різдво?


Останнє в блогах

Юрій Свірко:
Вчорашня "Сегодня" – ганьба України

Анатолій Луценко:
Час девальвації

Віктор Уколов:
''Нижче плінтуса''


Тимошенко поки набирає оберти, залучаючи на свою сторону все нові сили та нових союзників із різних таборів. Звичайно, то – ситуативні союзники, які хутко втечуть з корабля, якщо той почне тонути.

Янукович, після того, який в третій раз за своє політичне життя, практично тримаючи владу в руках, в черговий раз лоханувся і умудрився в останній момент втратити все (!!!), намагається просто зобразити "гарну міну за поганої гри" та втримати фракцію та партію від "серйозної внутрішньопартійної дискусії". Ще одна така ганебна поразка, і він – політичний труп. Показовою є нейтральність позиції Ахметова щодо ідеї створення коаліції ПР із БЮТ.

Ні Ющенко, ні Янукович вже не можуть стати центрами політичної консолідації в країні. Якщо економічна та фінансова криза змете теперішній уряд Тимошенко, нас чекає скоріше повна пертурбація теперішньої влади, ніж проста зміна "шила на мило", як ще надіються обидва Віктора.

І хай вони облишать свої "дівочі мрії".

Але такий хід подій – шанс для політиків нового покоління, які здатні нарешті зламати всевладдя злодійкуватих чиновників в країні.

Наразі бачиться найбільш ймовірними два варіанта розвитку подій в Україні найближчим часом: або уряд Тимошенко зуміє опанувати та зупинити економічну та фінансову кризу в Україні (що є дуже нелегким завданням!), або навесні нас чекає черговий неформальний Майдан.

І тоді дістанеться всім: і президенту, і уряду, і опозиції, і парламенту, і місцевій владі і т.д., і т.п.

Те, що про нинішнього президента згодом будуть складатися міфи, подібні до міфів про царя Мідаса – очевидно. Надто контраверсійним став час президентства Ющенка.

До речі: справжній, не міфологічний цар Мідас, в кінці свого царювання перебив своїх співвітчизників та став тираном. Закінчив життя самогубством, випивши бичачу кров.

Сергій Сорока

http://www.pravda.com.ua/news/2008/12/24/86711.htm

Если это "майбутнє" - всю президентскую рать на свалку, то тогда оно действительно совершается сегодня

Ющенко проведе підсумкову річну прес-конференцію

У вівторок, 23 грудня, о 18.00 в «Українському домі» розпочнеться підсумкова річна прес-конференція Президента України Віктора ЮЩЕНКА під назвою «Майбутнє твориться сьогодні».

Як повідомляв УНІАН, формат прес-конференції передбачає відповіді глави держави на запитання акредитованих медіа безпосередньо в «Українському домі», відповіді на запитання представників регіональних ЗМІ з усіх областей держави під час прямих телемостів з Одесою, Рівним та Дніпропетровськом, а також відповіді на запитання користувачів мережі Інтернет - переможців конкурсу «Спитай Президента України».


постiйна адреса статтi:
http://www.unian.net/ukr/news/news-291597.html

Бедная "эта страна", у которой такой Президент

В http://news.liga.net/news/N0868539.html Президент сказал: "В этой стране, кроме Президента, эту тему никто не поднимает, - отметил глава украинского государства. - И если вы хотите думать о рейтинге, лучше об этом не говорить. Но если вы хотите думать о поколении ваших детей, и если вы порядочный политик, у вас нет другого способа. Только вставать каждый день и говорить нации - мы должны быть самодостаточными, мы должны находиться под покровом тех моделей безопасности, которые говорят о вечной Украине".

Хроническая болезнь почек или пример, достойный подражания

Зашел к студентам 6-го курса, а они рассматривают хроническую болезнь почек.
Я им о том, что есть большая река Днепр, которая с многих ручейков, потому что "с небольшого ручейка начинается река".
Но в большой воде Днепра какая вода с этого ручейка, это вопрос, потому что ответа на него просто нет. Все смешалось в водах Днепра.
Так же точно и у Давыдовского - в цепи причинно-следственных отношений первопричина с некоторого момента утрачивается и имеет исключительно историческое значение.
Поэтому и получается правильно, потому что работает "хроническая болезнь почек".
Если тему развить, распространить на другие системы, то МКБ следующего пересмотра "усушится" так, порядка на три.
Результат - и врачам будет легче, и пациентам лучше.
Действительно, пример, достойный подражания.

От себя не убежишь

Понятно, спрятался от назначенной на эту дату интернет-конференции. И козе понятно, что давно нужны были действия, а не нарада точно на дату авансированной конференции. Но от себя не убежишь.

Ющенко проведе екстрену нараду
13.12.2008 21:32___ www.ПРАВДА.com.ua
У вівторок, 16 грудня, президент Віктор Ющенко проведе екстрену нараду з головами місцевих адміністрацій та мерами міст в зв'язку з проблемами теплопостачання в регіонах.
Українська правда

Это не касается украинского политикума, в особенности, мнящего себя лидером нации

Гольбах писал: "в природе могут быть лишь естественные причины и следствия".
В нашем политикуме с ньюансами, что в названии,причины и следствия только искуственные. Возможно,потому, что он сам далеко не природная конструкция.

Ничто не рождается и не умирает в природе

Так писал Гольбах.
Но эта его мысль есть отражение хорошо известного латинского выражения - «разрушение одного — рождение другого»,или,в оригинале,«desiructio unius,generatio alterius».
Точно также и у человека - пока он жив,вернее,пока он выживает при болезнях,разрушение одного обязательно сменяется рождением другого.Не может быть поэтому у живого человека чисто разрушительных патологических процессов. Даже когда он умирает,то только потому, что созидательные процессы по моменту времени или интенсивности не отвечали разрушительным.

Поль Анри Гольбах

"человек должен искать в самой природе и в своих собственных силах средства удовлетворения своих потребностей, лекарства от своих страданий и пути к счастью" - сказано сильно.
Еще сильнее будет,когда прислушаемся к сказанному, и будем использовать его в своей повседневной деятельности.
Что касается здоровья человека,я бы первую часть выражения ограничил природой человека, а именно, "своей природой", а слово "природа", как и слово "человек", писал бы с заглавной.
Мысь тогда с ограничениями на здоровье приобрела бы такое очертание:
Человек должен искать в самой своей Природе и в своих собственных силах средства удовлетворения своих потребностей, лекарства от своих страданий и пути к счастью.

Цена чашки сладкого чая или есть еще порох в пороховницах

Я не в буквальном, но переносном смысле.
Смысле, сколько стоит совет о чашке сладкого чая.
А суть такова.
Звонит старый давний друг, знаменитый профессор, знаменитее меня, думаю, которому так, около восьмидесяти, что с женой проблема, которая где-то того же возраста.
И проблема, что как позавтракает утром, так упадок сил. Ничего не может делать, и днями в постели. И консультантов крутится вокруг, хоть пруд пруди, и вроде ничего нет, ан проблема не решается.
Я как раз на поезд в командировку собирался, и с советом: "А Вы ей каждый раз перед завтраком минут за (30-40) хорошо подслащенного чая, а вернусь, посмотрим".
Прошло больше недели, вернулся, звоню.
Меня мой друг перебивает благодарностями: "Жена как на свет народилась, активная, дома все путем, супермаркеты чистит, ...". В общем я как бы спаситель.
Вот Вам и цена совета с чашкой сладкого чая.
Красивая клиническая задача принесла моральное удовлетворение: "Есть еще порох в пороховницах".

Грош цена ферритину

Гемоглобин в норме - в дециграммах на литр или еще как, а вот ферритина недостает. Недостает - сказано мягко,потому что ровно половина от нижнего уровня возрастной и половой нормы.
Так вот нужно железо такому пациенту или нет, вот в чем вопрос.
Потому что если критерии исключения для лечения препаратами железа в нормальном гемоглобине, так грош цена ферритину.
Ферритину, но не низкому уровню ферритина!

Непостижимое в этом мире

Альберт Энштейн: "Самое непостижимое в этом мире - то, что он постижим".
Понимаю, правильно, не постижим, но постигаем, потому что постигать его и постигать.
Как и природу Человека, постижением которой занимается непостижимая по размерам плеяда медиков.
Непостижимая по размерам плеяда медиков постигает постигаемую, но не постижимую природу Человека.
Получается, непостижимое в этом мире - и постигаемая природа Человека тоже.

Полагаться на закостенелые выражения не стоит

Природа "скупа" и не может под процесс - фермент. Под процесс фермент - это когда инвентаризация процессов не проводилась, и все посылаются на старые догмы, которые давно бы в архив ...
Увеличение активности фермента в крови - это не столько отражение процессов разрушительных, сколько процессов созидательных. И не имеет значения, какой фермент вы имеете ввиду.
Так что полагаться на закостенелые выражения не стоит.