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Sturmberg JP, Picard M, Aron DC, Bennett JM, Bircher J, deHaven MJ, Gijzel SMW, Heng HH, Marcum JA, Martin CM, Miles A, Peterson CL, Rohleder N, Walker C, Olde Rikkert MGM, Melis RJF. Health and Disease-Emergent States Resulting From Adaptive Social and Biological Network Interactions. Front Med (Lausanne) 2019; 6:59. [PMID: 30984762 PMCID: PMC6447670 DOI: 10.3389/fmed.2019.00059] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 03/06/2019] [Indexed: 12/25/2022] Open
Abstract
Health is an adaptive state unique to each person. This subjective state must be distinguished from the objective state of disease. The experience of health and illness (or poor health) can occur both in the absence and presence of objective disease. Given that the subjective experience of health, as well as the finding of objective disease in the community, follow a Pareto distribution, the following questions arise: What are the processes that allow the emergence of four observable states-(1) subjective health in the absence of objective disease, (2) subjective health in the presence of objective disease, (3) illness in the absence of objective disease, and (4) illness in the presence of objective disease? If we consider each individual as a unique biological system, these four health states must emerge from physiological network structures and personal behaviors. The underlying physiological mechanisms primarily arise from the dynamics of external environmental and internal patho/physiological stimuli, which activate regulatory systems including the hypothalamic-pituitary-adrenal axis and autonomic nervous system. Together with other systems, they enable feedback interactions between all of the person's system domains and impact on his system's entropy. These interactions affect individual behaviors, emotional, and cognitive responses, as well as molecular, cellular, and organ system level functions. This paper explores the hypothesis that health is an emergent state that arises from hierarchical network interactions between a person's external environment and internal physiology. As a result, the concept of health synthesizes available qualitative and quantitative evidence of interdependencies and constraints that indicate its top-down and bottom-up causative mechanisms. Thus, to provide effective care, we must use strategies that combine person-centeredness with the scientific approaches that address the molecular network physiology, which together underpin health and disease. Moreover, we propose that good health can also be promoted by strengthening resilience and self-efficacy at the personal and social level, and via cohesion at the population level. Understanding health as a state that is both individualized and that emerges from multi-scale interdependencies between microlevel physiological mechanisms of health and disease and macrolevel societal domains may provide the basis for a new public discourse for health service and health system redesign.
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Affiliation(s)
- Joachim P. Sturmberg
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Martin Picard
- Division of Behavioral Medicine, Department of Psychiatry and Neurology, The H. Houston Merritt Center, Columbia Translational Neuroscience Initiative, Columbia Aging Center, Columbia University Medical Center, Columbia University, New York, NY, United States
| | - David C. Aron
- School of Medicine, Weatherhead School of Management, Louis Stokes Cleveland VA Medical Center, Case Western Reserve University, Cleveland, OH, United States
| | - Jeanette M. Bennett
- Department of Psychological Science, University of North Carolina at Charlotte, Charlotte, NC, United States
| | - Johannes Bircher
- Hepatology, Department for Biomedical Research, University of Bern, Bern, Switzerland
| | - Mark J. deHaven
- Health and Human Services, College of Health and Human Services, University of North Carolina at Charlotte, Charlotte, NC, United States
| | - Sanne M. W. Gijzel
- Department Geriatric Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Henry H. Heng
- Department of Pathology, Center for Molecular Medicine and Genetics, School of Medicine, Wayne State University, Detroit, MI, United States
| | - James A. Marcum
- Philosophy and Medical Humanities, Baylor University, Waco, TX, United States
| | - Carmel M. Martin
- Department of Medicine, Nursing and Allied Health, Monash Health, Melbourne, VIC, Australia
| | - Andrew Miles
- European Society for Person Centered Healthcare, London, United Kingdom
| | - Chris L. Peterson
- School of Humanities and Social Sciences, La Trobe University, Bundoora, VIC, Australia
| | - Nicolas Rohleder
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | | | | | - René J. F. Melis
- Department Geriatric Medicine, Radboud University Medical Center, Nijmegen, Netherlands
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Bennett JM, Reeves G, Billman GE, Sturmberg JP. Inflammation-Nature's Way to Efficiently Respond to All Types of Challenges: Implications for Understanding and Managing "the Epidemic" of Chronic Diseases. Front Med (Lausanne) 2018; 5:316. [PMID: 30538987 PMCID: PMC6277637 DOI: 10.3389/fmed.2018.00316] [Citation(s) in RCA: 211] [Impact Index Per Article: 35.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 10/23/2018] [Indexed: 01/06/2023] Open
Abstract
Siloed or singular system approach to disease management is common practice, developing out of traditional medical school education. Textbooks of medicine describe a huge number of discrete diseases, usually in a systematic fashion following headings like etiology, pathology, investigations, differential diagnoses, and management. This approach suggests that the body has a multitude of ways to respond to harmful incidences. However, physiology and systems biology provide evidence that there is a simple mechanism behind this phenotypical variability. Regardless if an injury or change was caused by trauma, infection, non-communicable disease, autoimmune disorders, or stress, the typical physiological response is: an increase in blood supply to the area, an increase in white cells into the affected tissue, an increase in phagocytic activity to remove the offending agent, followed by a down-regulation of these mechanisms resulting in healing. The cascade of inflammation is the body's unique mechanism to maintain its integrity in response to macroscopic as well as microscopic injuries. We hypothesize that chronic disease development and progression are linked to uncontrolled or dysfunctional inflammation to injuries regardless of their nature, physical, environmental, or psychological. Thus, we aim to reframe the prevailing approach of management of individual diseases into a more integrated systemic approach of treating the "person as a whole," enhancing the patient experience, ability to a make necessary changes, and maximize overall health and well-being. The first part of the paper reviews the local immune cascades of pro- and anti-inflammatory regulation and the interconnected feedback loops with neural and psychological pathways. The second part emphasizes one of nature's principles at work-system design and efficiency. Continually overwhelming this finely tuned system will result in systemic inflammation allowing chronic diseases to emerge; the pathways of several common conditions are described in detail. The final part of the paper considers the implications of these understandings for clinical care and explore how this lens could shape the physician-patient encounter and health system redesign. We conclude that healthcare professionals must advocate for an anti-inflammatory lifestyle at the patient level as well as at the local and national levels to enhance population health and well-being.
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Affiliation(s)
- Jeanette M. Bennett
- Department of Psychological Science, StressWAVES Biobehavioral Research Lab, The University of North Carolina at Charlotte, Charlotte, NC, United States
| | - Glenn Reeves
- School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
| | - George E. Billman
- Department of Physiology and Cell Biology, Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH, United States
| | - Joachim P. Sturmberg
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
- Foundation President, International Society for Systems and Complexity Sciences for Health, Delaware, United States
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