Posted by: drwbortz | April 14, 2010

Gateway to Next Medicine

In May of last year I gave a talk in Philadelphia at the annual meeting of the American College of Physicians to a couple hundred doctors.  My title was “Geriatrics: the Gateway to Next Medicine.”  A moment’s reflection reveals the essence of the title.  Since geriatrics describes the medical care of older people, the nature of aging is a critical domain in medicine.

Many unthinking, uninformed persons consider aging to be a disease, and it appears as such a category in numerous medical texts. But aging isn’t a disease at all. Stars age, canyons age, redwoods age. Are they diseased? If it is a disease then what kind of disease is it?  Since it is universal, including biology, it is certainly not confined to living things.

Where can we look for a unifying definition of aging?  Good question. What are the components of the definitions of this universal canon?  They are matter, energy and time.  All are involved in a requisite definition of aging.  I submit that the definition of aging is the effect of an energy flow on matter over time. There is an explicit statement given to us by the physicists of just such a unifying statement, which is known as the Second law of Thermodynamics.  This seemingly obscure and seemingly arcane formulation is said by British historian C. P. Snow to be a pillar of knowledge.   Snow wrote, “Not knowing the Second Law of Thermodynamics is like never having read a work of Shakespeare.”  Is his poetic indictment, he states that the First Law asserts that energy changes in its distribution but that its sum is constant. The Second Law of Thermodynamics has to do with the flow of energy. There are many nominated definitions. But they all encompass this notion that energy flow is unidirectional, just as is time.

Energy, such as that life generating gift from the sun, going from a hot source to an energy sink, dictates the imperative of the uni-directionality of flow. This is known in the trade as entropy.  20 years ago I wrote a paper in the Journal of Experimental Gerontology entitled “Aging as Entropy.”  Every human life, every life, starts at conception as a highly vigorous, highly ordered active entity, which over the course of a lifetime decays to disorder, to increasing degradation. The rate of this decay, this aging, depends on which species undergoes this, but all do regardless of what the immortalists may claim.  Too low order and organization leads eventually to defective function culminating in the ultimate entropic event which in living creatures goes by the name of death, or in inanimate objects, by the name of junk.

So the study of aging for a geriatrician yields first principles from which all else derives.  If aging is entropy, a unidirectional biophysical process to which there is no exception, then pills, potions, fountains, sheep glands, and prayers are irrelevant. Aging is not a disease and as such is not susceptible to cure.  It is life, and life, by definition, is a fatal condition.

My father, a geriatrican away ahead of his time in the 1930s, when asked, “Doctor Bortz, how do you stop aging?” replied with great insight, “I’m not interested in arrested development.”  So, the topic of my lecture to the American College of Physicians,” Geriatrics as a Gateway to Next Medicine,” is richly informed by these thermodynamic imperatives.  Its compass demands a different approach.  Instead of the component emphasis of current medicine, geriatrics demands a system approach.  Instead of an episodic snapshot understanding of the human lifespan, as presently conceived, a process emphasis is demanded.  Instead of a fixation on repair as the primary task of medicine it needs to redirect its energies to prevention.

Geriatrics is the gateway to Next Medicine.

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Responses

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