Health management system - AbsoluteAstronomy.com

The health management system (HMS) is an evolutionary medicine

Evolutionary medicine

Evolutionary medicine or Darwinian medicine is the application of modern evolutionary theory to understanding health and disease. It provides a complementary scientific approach to the present mechanistic explanations that dominate medical science, and particularly modern medical education...

regulative process proposed by Nicholas Humphrey

Nicholas Humphrey

Professor Nicholas Keynes Humphrey is an English psychologist, based in Cambridge, who is known for his work on the evolution of human intelligence and consciousness. His interests are wide ranging...

in which actuarial assessment of fitness and economic-type cost-benefit analysis

Cost-benefit analysis

Cost–benefit analysis , sometimes called benefit–cost analysis , is a systematic process for calculating and comparing benefits and costs of a project for two purposes: to determine if it is a sound investment , to see how it compares with alternate projects...

determines the body’s regulation of its physiology

Physiology

Physiology is the science of the function of living systems. This includes how organisms, organ systems, organs, cells, and bio-molecules carry out the chemical or physical functions that exist in a living system. The highest honor awarded in physiology is the Nobel Prize in Physiology or...

and health

Health

Health is the level of functional or metabolic efficiency of a living being. In humans, it is the general condition of a person's mind, body and spirit, usually meaning to be free from illness, injury or pain...

. This incorporation of cost-benefit calculations into body regulation provides a science grounded approach to mind-body

Mind-body

Mind-body may refer to:* Mind-body connection, a medical model* Mind-body dichotomy, a philosophy of mind* Mind-body exercise, a form of exercise that combines body movement with mental focus* Mind-body intervention, an alternative medicine...

phenomena such as placebos that are otherwise not explainable by low level, noneconomic, and purely feedback based homeostatic

Homeostasis

Homeostasis is the property of a system that regulates its internal environment and tends to maintain a stable, constant condition of properties like temperature or pH...

or allostatic

Allostasis

Allostasis is the process of achieving stability, or homeostasis, through physiological or behavioral change. This can be carried out by means of alteration in HPA axis hormones, the autonomic nervous system, cytokines, or a number of other systems, and is generally adaptive in the short term...

theories.

Many medical symptoms such as inflammation
Inflammation
Inflammation is part of the complex biological response of vascular tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. Inflammation is a protective attempt by the organism to remove the injurious stimuli and to initiate the healing process...

, fever
Fever
Fever is a common medical sign characterized by an elevation of temperature above the normal range of due to an increase in the body temperature regulatory set-point. This increase in set-point triggers increased muscle tone and shivering.As a person's temperature increases, there is, in...

, pain
Pain
Pain is an unpleasant sensation often caused by intense or damaging stimuli such as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone."...

, sickness behavior
Sickness behavior
thumb|350px|right|[[Michael Peter Ancher|Ancher, Michael]], "The Sick Girl", 1882, [[Statens Museum for Kunst]]Sickness behavior is a coordinated set of adaptive behavioral changes that develop in ill individuals during the course of an infection....

, or morning sickness
Morning sickness
Morning sickness, also called nausea gravidarum, nausea, vomiting of pregnancy , or pregnancy sickness is a condition that affects more than half of all pregnant women. Related to increased oestrogen levels, a similar form of nausea is also seen in some women who use hormonal contraception or...

have an evolutionary medicine
Evolutionary medicine
Evolutionary medicine or Darwinian medicine is the application of modern evolutionary theory to understanding health and disease. It provides a complementary scientific approach to the present mechanistic explanations that dominate medical science, and particularly modern medical education...

function of enabling the body to protect, heal or restore itself from injury
Injury
-By cause:*Traumatic injury, a body wound or shock produced by sudden physical injury, as from violence or accident*Other injuries from external physical causes, such as radiation injury, burn injury or frostbite*Injury from infection...

, infection
Infection
An infection is the colonization of a host organism by parasite species. Infecting parasites seek to use the host's resources to reproduce, often resulting in disease...

or other physiological disruption.
The deployment of self-treatments have costs
Deployment cost-benefit selection in physiology
Deployment cost–benefit selection in physiology concerns the costs and benefits of physiological process that can be deployed and selected in regard to whether they will increase or not an animal’s survival and biological fitness...

as well as benefits with the result that evolution has selected management processes in the brain such that self-treatments are used only when they provide an overall cost benefit advantage. The brain controls such physiological process through top down regulation
Neural top down control of physiology
Neural top down control of physiology concerns the direct regulation by the brain of physiological functions...

.
External treatment and the availability of support is factored into the health management system’s cost benefit assessment as to whether to deploy or not an evolved self-treatment.

Placebos are explained as the result of false information about the availability of external treatment and support that mislead the health management system into not deploying evolved self-treatments. This results in the placebo suppression of medical symptoms.

Evolutionary medicine

Since Hippocrates

Hippocrates

Hippocrates of Cos or Hippokrates of Kos was an ancient Greek physician of the Age of Pericles , and is considered one of the most outstanding figures in the history of medicine...

, it has been recognized that the body has self-healing powers (vis medicatrix naturae

Vis medicatrix naturae

Vis medicatrix naturae is the Latin translation of the Greek, νονσων φνσεις ιητροι, a phrase attributed to Hippocrates but which he did not actually use...

). Modern evolutionary medicine

Evolutionary medicine

identifies them with physiologically based self-treatments that provide the body with prophylactic, healing, or restorative capabilities against injuries, infections and physiological disruption. Examples include:

Immune responses
Immunity (medical)
Immunity is a biological term that describes a state of having sufficient biological defenses to avoid infection, disease, or other unwanted biological invasion. Immunity involves both specific and non-specific components. The non-specific components act either as barriers or as eliminators of wide...
Fever
Fever
Fever is a common medical sign characterized by an elevation of temperature above the normal range of due to an increase in the body temperature regulatory set-point. This increase in set-point triggers increased muscle tone and shivering.As a person's temperature increases, there is, in...
Sickness behavior
Sickness behavior
thumb|350px|right|[[Michael Peter Ancher|Ancher, Michael]], "The Sick Girl", 1882, [[Statens Museum for Kunst]]Sickness behavior is a coordinated set of adaptive behavioral changes that develop in ill individuals during the course of an infection....
Nausea
Nausea
Nausea , is a sensation of unease and discomfort in the upper stomach with an involuntary urge to vomit. It often, but not always, precedes vomiting...
Morning sickness
Morning sickness
Morning sickness, also called nausea gravidarum, nausea, vomiting of pregnancy , or pregnancy sickness is a condition that affects more than half of all pregnant women. Related to increased oestrogen levels, a similar form of nausea is also seen in some women who use hormonal contraception or...
Diarrhea
Diarrhea
Diarrhea , also spelled diarrhoea, is the condition of having three or more loose or liquid bowel movements per day. It is a common cause of death in developing countries and the second most common cause of infant deaths worldwide. The loss of fluids through diarrhea can cause dehydration and...
Hypoferremia
Iron deficiency (medicine)
Iron deficiency is one of the most common of the nutritional deficiencies. Iron is present in all cells in the human body, and has several vital functions...
Depression
Pain

These evolved self-treatments deployed by the body are experienced by humans as unpleasant and unwanted illness symptoms.

Deployment

Such self-treatments according to evolutionary medicine are deployed to increase an individual’s biological fitness.

Two factors effect their deployment.

First, it is usually advantageous to deploy them on a precautionary basis

Precautionary principle

The precautionary principle or precautionary approach states that if an action or policy has a suspected risk of causing harm to the public or to the environment, in the absence of scientific consensus that the action or policy is harmful, the burden of proof that it is not harmful falls on those...

. As a result, it will often turn out that they have been deployed apparently unnecessarily, though this has in fact been advantageous since in probabilistic terms they have provided an insurance against a potentially costly outcome. As Nesse notes: "Vomiting, for example, may cost only a few hundred calories and a few minutes, whereas not vomiting may result in a 5% chance of death" page 77.

Second, self-treatments are costly both in using energy, and also in their risk of damaging the body.

Immunity – energy for activating lymphocyte and antibody production, and in the risk of an immune response resulting in an immune related disorder.
Fever – energy (each 1 °C raise in blood temperature increases energy expenditure by 10–15%. 90% of the total cost of fighting pneumonia
Pneumonia
Pneumonia is an inflammatory condition of the lung—especially affecting the microscopic air sacs —associated with fever, chest symptoms, and a lack of air space on a chest X-ray. Pneumonia is typically caused by an infection but there are a number of other causes...

goes on increased body temperature. There is also the risk of hyperpyrexia.
Sickness behavior – restricted ability by an animal to forage and defend itself
Nausea – loss of food nutrients, and potential risk of aspiration
Morning sickness – loss of food nutrients when a mother needs additional, not less, nourishment
Hypoferremia – impairment in biological processes needing iron resulting in iron deficiency anemia
Iron deficiency anemia
Iron-deficiency anemia is a common anemia that occurs when iron loss occurs, and/or the dietary intake or absorption of iron is insufficient...
Depression – impaired activity and problem solving
Evolutionary approaches to depression
Evolutionary psychology has proposed several different evolutionary explanations for depression.- Background :Major depression is a leading cause of disability worldwide, and in 2000 was the fourth leading contributor to the global burden of disease ; it is also an important risk factor for suicide...

.
Pain – restricted movement and the inability to concentrate

One factor in deployment is low level physiological control by proinflammatory cytokine

Proinflammatory cytokine

A proinflammatory cytokine is a cytokine which promotes systemic inflammation.Examples include IL-1 and TNF alpha....

s such as IL-1

IL-1

IL-1 may refer to:* Interleukin 1, a protein* Illinois' 1st congressional district* Illinois Route 1* Building 1 of Infinite Loop , the Headquarters of Apple Inc....

triggered by bacterial lipopolysaccharides (LPS).

Another is higher level control

Neural top down control of physiology

Neural top down control of physiology concerns the direct regulation by the brain of physiological functions...

in which the brain takes into account what it learns about circumstances and how that makes it well and ill. Conditioning

Classical conditioning

Classical conditioning is a form of conditioning that was first demonstrated by Ivan Pavlov...

shows the existence of such learnt control: give saccharin paired in a drink with a drug that creates immunosuppression

Immunosuppression

Immunosuppression involves an act that reduces the activation or efficacy of the immune system. Some portions of the immune system itself have immuno-suppressive effects on other parts of the immune system, and immunosuppression may occur as an adverse reaction to treatment of other...

, and later on, giving saccharin alone will produce immunosuppression. Such conditioning happens both in experimental rodents and humans.

Economic resource management

Evolution, according to Nicholas Humphrey

Nicholas Humphrey

, has selected an internal health management system that uses cost benefit analysis upon whether the deployment of a self-treatment aids biological fitness, and so should be activated.

a specially designed procedure for “economic resource management” that is, I believe, one of the key features of the “natural health-care service” which has evolved in ourselves and other animals to help us deal throughout our lives with repeated bouts of sickness, injury, and other threats to our well-being.

An analogy is explicitly made with the health economics

Health economics

Health economics is a branch of economics concerned with issues related to efficiency, effectiveness, value and behavior in the production and consumption of health and health care...

consideration used in management decisions involving external medical treatment.

Now, if you wonder about this choice of managerial terminology for talking about biological healing systems, I should say that it is quite deliberate (and so is the pun on NHS.) With the phrase “natural health-care service” I do intend to evoke, at a biological level, all the economic connotations that are so much a part of modern health-care in society.

External medications

External medications will effect the cost benefits advantages of deploying an evolved self-treatment. Some animals use external ones

Zoopharmacognosy

Zoopharmacognosy refers to the process by which non-Human animals self-medicate, by selecting and using plants, soils, and insects to treat and prevent disease. Coined by Dr...

. Wild animals

Wildlife

Wildlife includes all non-domesticated plants, animals and other organisms. Domesticating wild plant and animal species for human benefit has occurred many times all over the planet, and has a major impact on the environment, both positive and negative....

, including apes, do so in the form of ingested detoxifying clays

Geophagy

Geophagy is the practice of eating earthy or soil-like substances such as clay, and chalk. It exists in animals in the wild and also in humans, most often in rural or preindustrial societies among children and pregnant women...

, rough leafs that clear gut parasites, and pharmacologically active plants Complimentary to this, research finds that animals have the ability to select and prefer substances that aid their recuperation from illness.

Social support

The welfare of social animals (including humans) depends upon other individuals (social buffering

Tend and befriend

Tend and befriend is a behavior exhibited by some animals, including humans, when under threat. It refers to protection of offspring and seeking out the social group for mutual defense . The tend-and-befriend idea was originally developed by Dr. Shelley E...

). The actuarial assessments of the costs and benefits of deploying a self-treatment therefore will depend upon the presence, or not, of other individuals. The presence of helpful others will effect, for example, the risk of predators when incapacitated, and—in those case in which animals do this (such as humans)—the provision of food, and care during sickness.

The health management system factors in the presence of such external treatment and social support as one aspect of the circumstances needed to determine whether it is advantageous to deploy or not an evolved self-treatment.

False information

All humans societies use external medications, and some individuals exist that are considered to have special healing knowledge about illnesses and their treatments. Humans are also usually supportive to those in their group. The availability of these things will effect the cost benefits of the body deploying its own biological ones. This could, in turn, lead to the health management system (given its beliefs (information) about treatments and support) to deploy or not, or doing so differently, the body’s own treatments.

Nicholas Humphrey describes how the health management system explains placebos – an external treatment without direct physiological effects – as follows:

Suppose, for example, a doctor gives someone who is suffering an infection a pill that she rightly believes to contain an antibiotic: because her hopes will be raised she will no doubt make appropriate adjustments to her health-management strategy – lowering her precautionary defences in anticipation of the sickness not lasting long.

The health management system, in other words, when faced with an infection is tricked into making a mistaken cost benefit analysis using false information. The effect of that false information is that the benefits of the self-treatment cease to outweigh its costs. As a result, it is not deployed, and an individual does not experience unwanted medical symptoms.

Lack of harm

Failure to deploy an evolved self-treatment need not put an individual at risk since evolution has advantaged their deployment on a precautionary basis. As Nicholas Humphrey notes:

many of the health-care measures we’ve been discussing are precautionary measures designed to protect from dangers that lie ahead in an uncertain future. Pain is a way of making sure you give your body rest just in case you need it. Rationing the use of the immune system is a way of making sure you have the resources to cope with renewed attacks just in case they happen. Your healing systems are basically tending to be cautious, and sometimes over-cautious, as if working on the principle of better safe than sorry.

Therefore, not deploying an evolved self-treatment, and so not having a medical symptom due to placebo false information might be without consequence.

Central governor

The health management system’s idea of a top down neural control of the body is also found in the idea that a central governor

Central governor

thumb|250px|right|The Norwegian mountain runner [[Jon Tvedt]] engaging in a strenuous run: it is suggested that the central governor ensures that such [[exercise physiology|endurance exertion]] does not threaten the body's [[homeostasis]]...

regulates muscle fatigue

Muscle weakness

Muscle weakness or myasthenia is a lack of muscle strength. The causes are many and can be divided into conditions that have true or perceived muscle weakness...

to protect the body from the harmful effects (such as anoxia

Hypoxia (medical)

Hypoxia, or hypoxiation, is a pathological condition in which the body as a whole or a region of the body is deprived of adequate oxygen supply. Variations in arterial oxygen concentrations can be part of the normal physiology, for example, during strenuous physical exercise...

and hyperglycemia

Hyperglycemia

Hyperglycemia or Hyperglycæmia, or high blood sugar, is a condition in which an excessive amount of glucose circulates in the blood plasma. This is generally a glucose level higher than 13.5mmol/l , but symptoms may not start to become noticeable until even higher values such as 15-20 mmol/l...

) of over prolonged exercise.

The idea of a fatigue governor was first proposed in 1924 by the 1922 Nobel Prize

Nobel Prize in Physiology or Medicine

The Nobel Prize in Physiology or Medicine administered by the Nobel Foundation, is awarded once a year for outstanding discoveries in the field of life science and medicine. It is one of five Nobel Prizes established in 1895 by Swedish chemist Alfred Nobel, the inventor of dynamite, in his will...

winner Archibald Hill

Archibald Hill

Archibald Vivian Hill CH OBE FRS was an English physiologist, one of the founders of the diverse disciplines of biophysics and operations research...

, and more recently, on the basis of modern research, by Tim Noakes.

Like with the health management system, the central governor shares the idea that much of what is attributed to low level feedback homeostatic regulation is, in fact, due to top down

Top-down and bottom-up design

Top–down and bottom–up are strategies of information processing and knowledge ordering, mostly involving software, but also other humanistic and scientific theories . In practice, they can be seen as a style of thinking and teaching...

control by the brain. The advantage of this top down management is that the brain can enhance such regulation by allowing it to be modified by information. For example in endurance running, a cost benefit

Cost-benefit analysis

trade exists off between the advantages of continuing to run, and the risk if this is too prolonged that it might harm the body. Being able to regulate fatigue in terms of information about the benefits and costs of continued exercise would enhance biological fitness.

Low level theories exist that suggest that fatigue is due mechanical failure of the exercising muscles ("peripheral fatigue"). However, such low level theories do not explain why running muscle fatigue is effected by information relevant to cost benefit trade offs. For example, marathon

Marathon

The marathon is a long-distance running event with an official distance of 42.195 kilometres , that is usually run as a road race...

runners can carry on running longer if told they are near the finishing line, than far away. The existence of a central governor can explain this effect.

External links

Richard Dawkins interviews Nicholas Humphrey upon Placebos

The source of this article is wikipedia, the free encyclopedia. The text of this article is licensed under the GFDL.

Evolutionary medicine

Deployment

Economic resource management

External medications

Social support

False information

Lack of harm

Central governor

See also

External links