Erudite British historian CP Snow observed that a person who is not familiar with the second law of thermodynamics is equivalent to a person who has not read Shakespeare. My profession is illiterate. It doesn't know Ophelia or Lear. The second law is not in medicine's vocabulary.
This lament is not an intellectual stunt but speaks to a formidable fundamental gap in the understanding of medicine's mission that I nominate to be the assertion and assurance of the human potential. Medicine's ruling operational strategy is disease. It should be health. Its mission is far better served by prevention than repair.
This understanding is what the second law provides. The ruling medical paradigm is reductionistic. It seeks component solutions, genes, transplants, to system problems, lifestyle. It seeks acute solutions, drugs, surgery to process problems, chronic illness. Square peg, round hole.
My profession needs to change focus to health and prevention, to system and process. Medicine has a lack of appreciation of the second law and its emphasis on the effect of energy flow on matter. its conceptual framework is shallow. It is dysfunctional. It is illiterate.
My good friend Dr. Gene Yates, professor of medicine at UCLA, offers homeodynamics as a central mechanism for life. Homeostasis, the standard term, is simply wrong. Stasis is death. Life is dynamic. Life is a verb, not a noun. The second law demands a different vocabulary, but more importantly a different approach.
Intellectually we find matter easier to visualize, to touch, and describe. But matter is only a bit player in life. Energy is where the second law commands the script. Energy cannot be seen, much as gravity, but is nonetheless real.
Life derives from the interplay of matter and energy, of nature and nurture. The interface of these is where health and disease conjoin. This geography is alien to medicine. Medicine is blind to this reality. It is conceptually stunted.
Aging, for example, is explicitly understood only by incorporating the precepts of the second law. Since aging is not a disease, understanding and confronting it demands a different paradigm. So too does frailty, a too-common accompaniment of aging, also find explication within thermodynamics. Further, personal interest inquires, "Why is physical exercise good and lethargy bad for everything?" Similarly, the answer to this profound query lies within the second law.
The Eastern philosophies have more comfort with the notion of energy flow, the chi of life. This interface is incredibly more complex than the components and episodes matrix of current medicine alone, but life is more complex than medicine will acknowledge.
Nobel laureate Sydney Brenner observed, "You can't know everything, but you don't have to know everything, only enough." "Enough for what?" is the imperative query. Answer: Enough to enable pursuit of the human potential. Such a possibility becomes apparent only by incorporation of the second law into the medical province.
Medicine needs to become literate, and read more Shakespeare.
Next week's "Dare to Be 100" blog post explains why physical exercise is good for everything, and lethargy bad.
For more by Walter M. Bortz II, M.D., click here.
For more on personal health, click here.