1. THEORETICAL CONCEPT OF DISEASES OF CIVILIZATION (ECOPASTEURIAN THEORY OF MODERN PATHOLOGY) Pasechnik A.V. Department of Pathophisiology. Russian University of People’s Friendship. Moscow.117198. M-Maklaya st.8.Medical faculty (pasechnik@med.rudn.ru) pasechnik@med.rudn.ru "VIS MEDICATRIX NATURAE"

2. THEORETICAL CONCEPT OF DISEASES OF CIVILIZATION Vis Medicatrix Naturae: The Healing Power of Nature, contraria sunt comlementaria

6. Adapted from Piccirillo et al. Seminars in Immunology April 2004

7. The Shape of Things to Come Cover Illustration, The Economist, Dec 13, 2002 That the bankruptcy of the contemporary science illustrated by research on the diseases of civilization is the occasion to create a policy of health which will serve the man rather than industry.

8. For about 50 years, the degenerative paradigm had a strong influence in the way we conceived “causality” and “patterns of diseases occurrence in populations.” During the last decade, it has lost its original strength. Several conditions earlier assumed to be degenerative, among them atherosclerosis, have now been increasingly described as inflammatory. The emergence of AIDS re-introduced infection and its correlates – immune response, resistance/vulnerability – to the scientific fore.

9. l 60% of doctor visits are for complaints with no known physiological basis l 25% of office visits are for problems patients could treat themselves l 20% of 1992 health care costs ($134 billion) spent on unnecessary procedures & services HEALTH CARE IN CRISIS

10. l Human Beings = machine l Disease = biological malfunction l Doctor = repairman l Physical determinants of disease l Curing vs. Healing THE BIOMEDICAL MODEL

11. "ORGANIC" WORLD VIEW " l Purpose = live in harmony with nature What makes thinking about health equity difficult from the outset is that the concept of health itself is not easy to grasp

12. ECOPASTEURIAN THEORY OF MODERN PATHOLOGY Life = I + E + O

13. Germ Theory The Theory that microorganisms may cause some or all disease. Louis Pasteur first fully proposed Germ Theory of Disease in 1850 Considered by many to be the most important contribution to modern medicine

14. What causes the disease? It is not likely there will be a cure until the cause of this disease is identified.

15. Hippocrates: " It is more important to know what sort of person has a disease than what sort of disease a person has " ??? This paper seeks to contribute by putting forward an approach to health equity

16. Examination of the state of medicine in the perspective of ecological imperatives and nonanthropocentric metaphysics prompts a new approach to current problems of health care (A.V. Pasechnik, 1985- 2005)  Whereas the early half of the 20th century was still an аge of infections diseases, mortality caused by them later declined by 99% and an "epidemic" of chronic noninfectious diseases (diseases of civilization) such as atherosclerosis, cancer, hypertension, diabetes, etc. set in. Vast accumulated data indicate no downtrend in incidence of these diseases despite the implementation of large - scale programmes of multifactor disease prevention.

17. Incurable suffering from the "hiatus theoreticus"? : Awareness about the critical situation generates the need to search for conceptual alternatives, new theoretical expla­nations for this range of global ргоblems that would account for the present - day "drift" of methodological approaches (the dialectio treatment of the problem, "complimentariness" in N. Bohr's sense, views of P.Feyerab'end, or Einstein's view­point emphasizing a free choice of theoretical postulates. The process of theoretical mastering of factual data has found its expression in a new conception (paradigm) of medicine. Concisely it can be summarized as follows:

18. Disease as the infections process also contains the opposi­ te truth, that of a natural form of self-саге A set of systemic reactions of the organism describing the development of infec­tions processes is treated аз realization of the natural "therapentic" mechanisms ("assimilation" of ordering from the environment) ensuring protection from the development of the diseases of civilization. By bringing the infections ргосеss to pase, the organism fulfils an expedient, system - forming activity essential for its vitality. The morpho - functional structure of the organism requires some periodic "sanitary" procedures conducive to liberating from the "substrate" of modern forms of diseases.

20. Life process is included into the system of natural laws and is directed, organized and structured. Today me know that it were bacteria that hundreds of millions years ago constituted the initial biological system of the Earth. They formed the base upon which the entire complex "network" of the living matter developed. The strategy of wiping infections diseases with time gives rise to its opposite, i.e. the development of auto­immune and allergic processes underlying the genesis of chronic noninfections diseases. Within this frame of reference the problem of diseases of civilization is a consequence of taking the activity of curbing (negating) the infections reactivity beyond the limits of the admissible.

21. The prime issue is to develop this new strategy of medicine; it is nеcеssагу to elaborate maximum permissible levels of using this sanogenetic natural law. It should be emphasized that we do not negate the strategy of combating diseases, representing threat for life, and risk factors. We imply the need to preserve in a "humanized" form sone measure of infections reactivity as a … physiological demand. It is impossible to continue ways to the future of medicine, not knowing the purpose. It is impossible to make it and not knowing a starting point, whence roads originate, not having investigated territory on which will pass ways. Researches on this theme eventually have led to to formulations of the uniform monocausal theory of a pathology (ecopastteurian to the theory of illnesses of a civilization).

22. The organism "does not know", that there is the modern doctor already quite often possessing means of struggle against illness even by more effective, than his(its) own protective (therapeutic) forces. Stoping occuring in depth of bodies of change with the help of system of compensation - adaptive reactions and it sharply modifying and "shading" natural mechanisms of recovery, the doctor, « that not knowing », modifies ways of full treatment of illnesses. And if the history of treatment of illnesses of the person until recently is a history basically unidirectional, sinergic actions of protective forces of an organism and the doctor who is always taking into account these forces and trying them to stimulate the modern history finally represents rigid and painful(unhealthy) "competition" of these of two therapeutic practic. The person in the intrinsic disclosing constantly balances between natural - natural and social limits of the maintenance(contents), in detail outlines all in the greater completeness the identity. According to this and on the basis of the analysis of structure of cumulative results of medical activity we are convinced, that truly scientific representation about " illnesses of a civilization " should start with presence of natural background of the person during which have arisen and there were the natural preconditions of a human life immanently containing in mechanisms of "therapeutic" activity. In other words, the question is a material substratum, the carrier sanogenetic the potentialities, providing constant and “vital” qualities of organic integrity.

23. Thus Horace, some 2000 years ago, as stated at the very beginning of this book, warned that 'you may drive out Nature with a pitchfork, but she will ever hurry back, to triumph in stealth over your foolish contempt' If we are adapted to anything in this world, we are certainly adapted to infectious (immune) agent. Pasechnik’ concept of disese (ECOPASTEURIAN THEORY OF MODERN PATHOLOGY) aims to impress the general public with an extreme evolutionary perspective on the historical and phylogenetic sources of human disease. The concept distinction lies in the detailing of evolutionary levels or grades of organic life, first defined by increasing cellular complexity and later by specifically hominid evolutionary gradations. The causes and correlates of diseases can then be narrowed down to the disruption of adaptations occurring at certain levels, and the approach is often (although not always) productive epidemiologically for inferring etiologies.

24. Representation developed by us about prima causa illnesses of a civilization or a modern chronic not infectious pathology (А.V. Pasechnik,1988-2005) it is defined (determined) in the following maintenance(contents). Sanogenic the immune potentialities of an organism determining protection against development nosological of forms of illnesses of a civilization and infectious immune reactance are additional mechanisms and concepts (in Bohr sense; Niels Bohr's theory of complementarity was an attempt to solve the enormous problems of interpretation) - vis medicatrix naturae. As the immune system cannot react to the by means of reaction to cross microbic structures an organism realizes the participation in regulation of immune function, restrictions of inflammatory processes, a antigen- structural homeostasis, preservation of the ecology, regeneration, the control of tumoral process, ageing.

25. The paradigm has changed. To advance epidemiology under the infectious/inflammatory paradigm, a transition from a empirical to a Darwinian and Ecopasteurian (Pasechnik, 1985-2005) habit of thought will be necessary. Standardized rates and stereotyped programs, which make no allowances for variability inside and between populations, are not informative or really effective in changing reality. Patterns of diseases occurrences are contingent. “Populations in continuing movement”must be the object of study of this new Darwinian (Ecopasteurian) epidemiology.

26. The healing power of nature. vis medicatrix naturae The body has the inherent ability to establish, maintain, and restore health. The physician's role is to facilitate and augment this process, to act to identify and remove obstacles to health and recovery, and to support the creation of a healthy internal and external environment. Identify and treat the cause. tolle causam The physician must evaluate fundamental underlying causes on all levels, directing treatment at root causes rather than at symptomatic expression. First do no harm. primum no nocere The physician's actions can support or antagonize the actions of the vis medicatrix naturae. Therefore, methods designed to suppress symptoms without removing underlying causes are considered harmful and are avoided or minimized. Prevention. Prevention is the best "cure" The emphasis is on building health rather than on fighting disease.

27. THIS work is based on human evolution, and stemming from it the perfect adaptation of all species to their natural environment To sum up, the author believes that solely by close attention to evolutionary principles can we hope to escape the coronary danger (diseases of civilization en toto) menacing each one of us today. Today this approach and it(him) aspect (vis medicatrix naturae, contraria sunt comlementaria) as it is represented, is adequately enough entered in modern lines of a science ("complimentariness" in N. Bohr's sense, dissipative structures, entered by Prigozhin or “ the order from chaos ”, dialectics) and are found with the reflection in concepts "programming" in utero the future life and the future illnesses, in "hygienic" idea of genesis an allergic pathology… (pasechnik@med.rudn.ru)