The Exercise of Judgment

Physicians who criticized the proposal to ground therapeutics in bacteriology especially feared that domination by theory would oversimplify practice…the complexity of clinical phenomena and the exercise of judgment could not be bypassed by bacteriological reductionism.” – John Warner, The Therapeutic Perspective – Medical Practice, Knowledge and Identity in America 1820-1885

We are living in a time of portentous epidemiological transition. Infections and pandemics like the Black Death are no longer Public Enemy #1 (as long as we don’t render antibiotics impotent through overuse). As a nation, 75% of our health care dollars goes to treatment of chronic disease. One out of every two American adults have at least one chronic disease and seven out of every ten deaths in the United States are due to chronic disease.[ref]CDC,, accessed 12/7/2013.[/ref]

Chronic disease is the new pink. It has been suggested that all chronic diseases have an inflammatory basis. This is not the old-school, short-term classical inflammation constrains to healing, it is a prolonged, dysregulatory and maladaptive inflammatory response which appears from the conventional perspective to perpetrate, rather than resolve disease.

I hope that the physicians and medical researchers of our time resist the temptation to succumb to inflammatory reductionism as they probe the darkness for solutions to chronic disease. The symptoms in this case are not the disease, so finding clever ways to remove the inflammation will only drive the problem deeper. We desperately need to pull back and look for the patterns in the trove of medical data we’re gathering. These conditions, unlike many infections caused by a single agent, are multi-causal.

Moreover, the causes and implications of chronic disease are not strictly biochemical. There are physics behind all physical matter. You and I are as much a product of physics as we are biology or chemistry. Chronic disease as far as I can tell is as much a problem of physics as it is of biochemistry. We must broaden our view if we are to meet this challenge successfully.


3 thoughts on “The Exercise of Judgment

  1. Steve V

    Thanks Gregg for presenting such a consideration of the multifactorial relationships of chronic disease. Yes physics and energetics orient us to foundational causes as well as opening doors to meeting the challenges of chronic disease successfully. There is much to consider in this respect,


  2. Lady Leo

    Treating the whole person, not just a disease, seems a more balanced approach for chronic illness. So often health care is treated like Whack A Mole, as symptoms are suppressed. Life style is a natural place for a patient to begin to make changes for themselves. I find many physicians seem relieved to offer drugs that will compensate for our lack of willingness to address issues in our daily routine. When they only have a few minutes to consult with the patient it seems the responsibility for our health care is largely our own.


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