Toward An Adventist Theology of Health (3) – On Disease

Notwithstanding the enormous and consistent development of today’s medicine, disease has not disappeared from our lives. It has just changed form, rhythm and mechanism of presentation. We realistically could just say, compared to other less industrialized cultures of the past and present, that we have invented novel ways of getting sick. This simple, empirical finding should push us to a double attitude. First, to keep resisting and fighting the rampant medical conformism and pessimism that tries to persuade us to embrace a deterministic view of disease. Second, to resist the temptation of enclosing ourselves in the monolithic view of disease and health that our religion, culture or society has built up. Disease is not a cruel reality only to poor, uneducated or non-religious people, but a human condition that binds us all in the same destiny.

In our industrialized societies disease is described as an abnormal condition, a disorder of structure or function that affects a part of, or the whole organism. It is usually configured as a medical condition associated with specific symptoms. It may be caused by factors coming from an external source, as in infectious diseases, or it may be caused by internal dysfunctions, as in autoimmune diseases. The causal study of disease is called pathology. Notwithstanding the accuracy and reliability of such an understanding, shared also by Adventists, we should humbly admit its limitations. A larger perspective in trying to understand disease comes from trans-cultural medical anthropology. Byron Good (1992), together with advocates of so called Narrative Medicine, has observed that disease has other dimensions we tend to forget and cancel – objective, subjective and social (disease, illness, sickness). Trans-cultural medical anthropology tells us that the definition of disease is highly context-dependent because human diseases only exist in relation to other people, and we live in varied cultural contexts. These studies have shown that whether people believe themselves to be ill varies with class, gender, ethnic group and less obvious factors, such as the proximity and support of family members. What counts as a disease also changes over historical time, partly as a result of increasing expectations of health, partly due to changes in diagnostic ability, but mostly for a mixture of social and economic reasons. This paradoxical and fluctuating process in defining disease has been present in Western medicine itself. One example of “pathologization” of a human condition is osteoporosis, which was officially recognized as a disease by the WHO (World Health Organization) in 1994 – switching from being an unavoidable part of normal aging into a pathology. But sometimes it also happened the other way around, when disorders were “de-pathologized”, as happened with homosexuality in 1973 (DSM-II) or in 1992 by the WHO (ICD-10).

These short introductory considerations show that disease can't be considered only a medical condition. It's a larger and more complex anthropological reality. For this reason, as in all cultures, disease shouldn't be considered a settled matter in today’s Western societies. Instead it's an open process in which not only the category of disease but medicine itself needs to be critically assessed. Let's briefly analyze two contradictory and parallel orientations of Western medicine concerning the understanding of disease.

1. The overrated Analytical trend of Western medicine

Western medicine is too rich and heterogeneous to be summarized and reduced to a cliché. But nobody and no event is above a critical assessment. And though it still is an open and ongoing process, there exists sufficient scientific and cultural data to evidence its nature and trend. Among its various characteristics, the one that perhaps links all of them, and also better explains the vocation and core of western medicine, is analysis. If we define analysis as the exercise of decomposing any material or abstract entity into its elementary and basic constituents, and if we apply this to the understanding of what disease is within current society, we'll have a reliable picture of the nature of Western medicine. The commitment to clarity and evidence, derived from the introduction of this analytical medical paradigm, has pushed today’s medicine to be obsessed with proximate and direct rather than with distal and indirect causality. This is especially visible in the history of modern pathology.

While the explanation of disease was still partially linked to extra-corporeal elements (social, religious, mystical) or to imprecise and inaccurate corporeal substrates (e.g. humoral theory), the Italian anatomist Giovanni Batista Morgagni (1682–1771), from the university of Padua, started linking diseases to specific anatomical organs. He published his opus magnum, “De Sedibus et Causis Morborum per Anatomen Indagatis” (about the seats and causes of diseases through anatomical investigation), in 1761 when he was 79 years old. In 70 letters to an unknown friend Morgagni described 640 autopsies, structurally correlating the symptoms of his patients with the pathological findings at autopsy, thus fostering the growing belief that diseases had an anatomical substrate. Morgagni was the first to understand and demonstrate the necessity of basing diagnosis, prognosis and treatment on a comprehensive knowledge of anatomical conditions. His treatise was the commencement of an era of steady progress in pathology and in practical medicine.

But the specificity of where diseases originate, even if appropriately located by Morgagni in particular anatomical organs, was still not enough. More precision was required. The next step was made by a French anatomist and physiologist Marie François Xavier Bichat (1771-1802). He is remembered as the father of modern histology because, despite working without a microscope, he was the first to introduce the notion of tissues as distinct entities. He also maintained that diseases attacked tissues rather than whole organs or the entire body, causing a revolution in anatomical pathology. By simple methods (e.g. cooking), he was able to identify 21 types of tissue, improving the foundation for tissue-based disease. In his autopsies he correlated the clinical findings with “histology”, a term that really gained currency 50 years later.

Precision nevertheless, even after the acceptance of an analytical perspective, had to be pushed even further. The next decisive step was done by the German Rudolf Virchow (1821-1902), regarded by many as the greatest figure in the history of pathology. Virchow’s greatest accomplishment was his observation that a whole organism does not get sick. Only certain cells or groups of cells do. In 1855, at the age of 34, he published his now famous aphorism “omnis cellula e cellula” (“every cell stems from another cell”). With this approach Virchow launched the field of cellular pathology. He stated that all diseases involve changes in normal cells, that is, all pathology ultimately is cellular pathology. This insight led to major progress in the practice of medicine. It meant that disease entities could be defined much more sharply. Diseases could be characterized not merely by a group of clinical symptoms but by typical cellular changes. His new insights resulted in a collection of twenty of his lectures into his most important work “Die Cellularpathologie” (1858). This remarkable book was a harbinger of what was to come. Medicine passed from an organ-based to a cell-based understanding of disease. The “new pathology” of modern times was born.

The analytical evolution of Western medicine was still not satisfied, however. It kept going forward, searching for more clarity than that offered by Virchow. Faithful to its commitment to precision and its implicit motto (“divide” to know more and “separate” to better control the disease), medicine entered the still unknown world of the sub-cellular microcosmos. And this search has informed the development and destiny of all 20th century medicine up until now. An evidence of this incontestable trend was the birth of “molecular medicine” that describes a smaller part of a cell as the very lieu of disease. In November 1949, Linus Pauling (1901-1994) with other colleagues published a revolutionary article, “Sickle Cell Anemia: a Molecular Disease”, in the journal Science. It was the first proof of a human disease caused by an abnormal protein. Sickle cell anemia became the first disease understood at the molecular level. Using electrophoresis, they demonstrated that individuals with sickle cell disease had a modified form of hemoglobin in their red blood cells, and that individuals with sickle cell trait had both normal and abnormal forms of hemoglobin. This was the first demonstration causally linking an abnormal protein to a disease, and also the first demonstration that Mendelian inheritance determined the specific physical properties of proteins, not simply their presence or absence.

But when you have explained the most, you don't necessarily understand better what disease is and, unfortunately, diseases don't consequently disappear. The clarity, specificity and precision of today’s medicine in explaining diseases paradoxically coexists with the mystery of new diseases that reveal the limits of analysis.

2. The emergent compensative holism of western societies

But the profile of Western medicine and culture has never been monolithic. Since the very beginning some persons and groups tried to resist this reductive trend. They initiated expression to an alternative, holistic view of disease. More recently, in the 1960s and 70s, this trend was visible with the emergence of so called Psychosomatic Medicine. This new perspective, within medicine itself, tried to compensate for the excessive isolationism in describing and understanding human phenomena. It proposed an interdisciplinary look, with an intention to explore the relationships among social, psychological, and behavioral factors on bodily processes and quality of life.

This holistic trend has not disappeared at all but rather has been enormously reinforced lately, not only in medicine but in Western societies in general. It is visible in the emergence of a more complex and heterogeneous phenomenon of alternative and complementary medicines. These health care practices, products and therapies, range from biologically plausible but not well tested, to being directly contradicted by evidence and science.

How does Adventism place itself in this historic medical scenario? The popular view affirms that our health message really represents a true alternative to this reductive analytical trend of Western medicine. But does it? What is undeniable is that Adventism chooses health as a major dimension of spirituality and anthropology as no other Christian or religious group probably does. But the originality stops here. Because our oft-proclaimed unique holism has evidently some big limitations. First, medical holism was not born with Adventism. Second, the more innovative, propulsive and diffuse holism today is not the Adventist one. Third, Adventism’s holism is and remains shortsightedly a mechanical, limited and individualistic holism. Fourth, within Adventism itself, theoretically and in the practice of its members, holism is not evidenced. It is just the same analytical, determinant trend of Western medicine. This is visible for instance in the studies, publications or initiatives of our major and almost unique worldwide medical center: Loma Linda University. There three institutions (Medical School, School of Public Health, School of Religion) co-exist but don't really interact to create a credible and corrective to the evident reductive view of today’s medicine. Some limited corrective initiatives are offered here and there as palliatives but which, in the end, keep maintaining and even reinforcing the analytical trend of our health institutions and message.

Hanz Gutierrez is a Peruvian theologian, philosopher and physician. Currently he is Chair of the Systematic Theology Department at the Italian Adventist Theological Faculty of “Villa Aurora” and director of the CECSUR (Cultural Center for Human and Religious Sciences) in Florence, Italy.

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This is a companion discussion topic for the original entry at http://spectrummagazine.org/node/7278

The dominate approach to medical practice is allopathic–including LLU Medical Center. And they are effective with it, on a par or better than most. With that as a given, the best the Division of Religion, and the School of Public Health can accomplish is to enhance the field of Medical ethics. Yet the Loma Linda community is boastfully proud of their senior citizens and their longevity. As tested by a recent assay on Spectrum. Diet, exercise of mind and body, and a loving relationship with man and God. Adds to the quality of life if not its length. tom Z

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Some quotations from James B. Johnson, M.D. and Donald R. Laub, sr, M.D.
Obesity and lack of physical activity may account for up to 30 % of several major cancers including colon, endometrial, kidney, postmenopausal breast cancer, cancer of the esophagus.
Inflammation disorders. Pancreas [ type II diabetes], Joints [arthritis], Arteries [plaque buildup causing occlusion, atherosclerosis], Lungs [bronchi, bronchioles, air sacs causing asthma, etc]
Side effects of some of these include Kidney damage, Heart attack, Stroke, Neuropathy, Decrease circulation in extremities, Carotid artery blockages.

In other word, many of our 1st world diseases could be radically reduced or perhaps eliminated by proper food intake, fluid intake, and physical activity during the day.

Chronic dehydration, which up to 75% of Americans have. Chronic dehydration can lead to k,idney stones, bladder cancer.
Dehydration can decrease kidney function. Stimulate the retention of Sodium in the body, retain fluid, diminish urine output. A reduction of blood volume can cause decreased Sodium and Potassium to the brain. This brain sensitivity can lead to Headaches. Also cause Anxiety, Stress, Tiredness, Mental Fatigue.
Stress on the Kidneys can also set in motion chemicals that raise blood pressure and cause Hypertension. Hypertension causes stress on Kidney blood vessels, causing damage to the Kidneys.
Irreversible Kidney damage requires one of two treatments — Kidney Dialysis 3 times a week for the remainder of one’s life. OR, Kidney Transplant.

When we add the effects of Smoking and over use of Alcohol there is a lot of disabled older americans who are unable to work, require early Disability payments, housing assistance, Food Stamps, SSI, frequent subsidized hospitalization, home health care, and other benefits paid for by Tax Dollars.

To decide on fluid intake needs – Divide your weight by 2. This is how many glasses of water [other fluids] one needs during the day for basic needs. If one does moderate exercise, ADD 2 more 8 ounce glasses. If sweating, ADD 4 more 8 ounce glasses. One needs around 10 to 12 8 ounce glasses of fluids per day.
Better to sip on water all day then gulp it down all at once. Warm liquid is absorbed easier than very cold liquids.

Fiber food requirements – Minimum of 20 grams of Fiber a day. Healthier intake is 30 to 40 grams of fiber.
Suggested one eat 9 [nine] 1/2 [one-half] servings of fruits and vegetables a day. Add grains, nuts-seeds, beans-peas.
Milk, dairy products, meat have no fiber, just calories. If using meat, use it as a side-dish, not the main dish. Fish and low-fat chicken the best. Beef and Pork have a lot of fat one does not need.

SDAs have been given instruction that we should be eating fruits, nuts, grains, vegetables for almost 150 years now. [This is the Fiber laden diet that is now everywhere on the web. Just Google Fiber on the Internet and see. And look at YouTube.] If Seventh day Adventists REALLY believed in their Health Message [as outlined in the book Ministry of Healing] of Body, Mind, Spirit, EVERY Seventh day Adventist church group would be able to advertise themselves as THE HEALING CHURCH. Would put their shingle by the road side. Open their doors, and invite people in to be HEALED.
But we are too busy with DOCTRINE to be concerned with the Human Condition and helping them to live life, and live it more abundantly.
The SDA church could be the 7 DAYS church of God instead of just being the 7th day church of God.

Ernie–
Perhaps the School of Public Health at Loma Linda might consider HOW to Create every SDA congregation into a Healing Church, a place where people can go for HEALING of Body, Mind, Spirit.

When people consciously pursue healthy living, there is, I would think, an inherent holististic element to the process. People who are concerned about quality of life and longevity already have something to live for. It is not by accident that people who are poor and miserable tend to lead very unhealthy lives.

In the pursuit of good health, I don’t see that Adventists have much of an advantage over anybody else. EGW’s concept of good health seems to have been based on the vitalistic assumption that anything that supposedly stimulated people’s sexual urges, such as meat and spices, had to be banned from the diet since sex depleted the innate and limited reservoir of vital energy. And the application of the Torah’s food taboos on church members was always overwhelmingly religious in nature, given that the alleged deleterious health impact of eating mountain badger and lobster always remained a mere claim. (The Bible has no health message; the Torah’s distinction between clean and unclean meats was a cultural marker unrelated to any health issue. The only health issue of concern to the Biblical authors was getting enough food to eat.).

Things obviously have changed, but when I was a part of the church in the 1970s, people imagined that a healthy lifestyle meant respecting the taboos of the Torah and the 19th century health reformers (i.e. stimulants).

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Interesting and very deep article…just a couple of thoughts. The closing statement about SM, SR, and SPH not working together is out-dated. Besides the many GRASP grants now be rewarded which require at least 2 schools to work together, I just saw the film, A Certain Kind of Light, featuring SR’s Dr Wil Alexander’s journey in melding a new approach to wholistic care-listening to a patient’s story and acknowledging it–into the treatment plan. (Check the trailer here: http://youtu.be/nvWHQUHy7kg)

As to the comment about “SDA’s don’t really have an advantage” needs to look at the landmark AdvHealthStudy2, which clearly shows what lifestyle practices give SDAs an advantage (even among SDAs who don’t practice all the lifestyles).

While LLUH and all of its schools and medical center are not perfect–and many of us alum complain that we have been too apologetic with many of our healthy lifestyle practices that now we are playing catch-up to the other non-religious healthcare and research systems promoting what we’ve known for over 100 years-I believe we are making progress and am glad to be a part of it. (Disclaimer: I’m a SPH grad, class of '93, and joined the SPH faculty full-time in 2014 after over 20 years working in a medical group practicing and promoting lifestyle wellness behaviors for patients.)

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“Listening to patients” is not included in current health insurance plans, which is why fewer have the time. Many prefer to see the NP or PA as they are usually the ones who ask questions and listen to patients. All the plans must consider the cost and payment to physicians.

While the Blue Zones laud the SdA health in Loma Linda, there are also four or more similar Blue Zones where a large group of centenarians live. Wine is a daily practice, something Adventists avoid, and many are liberal in their use of cheese, but fewer dairy products, overall, than the American diets. Participation in community to integrate a family atmosphere is most important, also.

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Having worked in a medical group that was 80% HMO plans, I totally understand the “lack of time”. And yet, in the School of Medicine curriculum here at LLUSM, they are teaching the medical students and residents the importance of listening and it’s impact on outcome. Taking a few extra minutes can have over all positive impact on the outcome, thus reducing overall treatment time. I think they are doing some studies on this to quantify it all. As we move more to a capitated system, the risk now falls more on the medical providers and not the insurance plans, thus making this more attractive for providers to take the time for.

Yes, while LL is the only Blue Zone in the US, you are right, there are other BZ around the world, each with their unique characteristics. I would say that the cheese in europe is far different than the cheese here in the US. And while they may not be vegan, they are much more physically active than Americans across the board, so I believe that plays a part. As for wine, there’s nothing special about the fermentation itself–you can get the same benefits eating the dark skin in the grapes, so we don’t usually recommend wine drinking as necessary because of the risk of addiction when you can just eat grapes and get the same benefit. But for those who do drink alcohol, it can have benefits IF you do so in moderation. Drinking more does NOT give you more benefit, only causes more problems.

And here, the Sabbath rest was a big factor as well, which incorporates family time, doing good and acts of service, etc. So yes, I agree there are other factors to longevity besides diet.

As a former lobsterman, I can assure you this is a meat that begins to rot with a very hideous odor within minutes of death (hence those fun lobster pools in seafood restaurants). Lobster meat has very limited food value, and is generally eaten with gobs of butter. Overall, not a top health choice. As to mountain badgers, I can provide no first hand observations.
Why be so aggressively dismissive of the levitical admonitions? They are simple, common sense health guidelines of which we Adventists may be overly proud. But they are not ours, and where is your evidence they are cultural? Even if they are cultural, they are remarkable in the way, 4,000 years ago or thereabouts, they mirror recent research.
Granted we tend as a church to mishandle our teachings about health to the point that they have the opposite effect in many, and result in unintended consequences. But they are very helpful to those who take them as God intended.

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George, you know more about lobster than I ever will, but my point was not to promote either lobster or mountain badger, but simply point out that health is not a concern of the Torah. The food taboos of Judaism were tribal and religious in nature and had nothing to do with health–that is, if you go by what the Bible says. That is why Jews were permitted to sell unclean meat to gentiles, since they were not bound by the strictures of the Torah. “Do not eat anything you find already dead. You may give it to an alien living in any of your towns, and he may eat it, or you may sell it to a foreigner.”-Deuteronomy 14:21a. If you believe that EGW overrides the Bible, you are of course obligated to go with her, but she got it wrong. On the other hand, she was right in promoting healthy eating, something the Bible does not.

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As long as the “listening” does not exceed 4 minutes. Why? med evaluation, code 99213, is allowed “up to 15 minutes” for billing purposes. It takes the patient 2 minutes to walk from the waiting room to the interview room (forget those with walkers or with screaming children, just grin and bear it), another 2 minutes for pleasantries then the work begins, making sure the physician has about 2 minutes for med education and another 3-4 minutes for charting progress notes (never mind the computer glitches/crashes - revolving wheel of death).

Who pays for lost time? The physician of course. The physician can listen as long as he likes except the reimbursements are based on CPT codes.

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Not much of an advantage : That is right. I learned nothing new from Numbers - did you read his “Prophetess of Health” ?

Now 78, I am a fifth generation Adventist and know quite a lot about the tendencies in early 19th century here. Already a century before the wider approach was cultivated by University of Halle , under Pietistic influence. The first ones seeking the contact to Erzberger / Andrews - out of political and economical reasons besides their theology - were adherent to “Lebensreform” ( the remedies of Nature - or nature - ,just also no vaccination, just no crops from artificially fertilized soil - dress reform, educational reforfm) and in all these matters Ertzbergre had to hear : “So what, nothing new for us !” Sorry to say I only found one study about the “lebensreform” the early SDA in Gemany culivated, although theology , music, “lifestyle” - - -medical theory and practice within SDA out of the local 19th cwéntury environment still are alive.

I for myself cherish elements of Romanticism, please note ! (Just in lifestyle and medicine, noz in music !)

My heritage led me to Psychosomatics. . And I had the chance to head the first departmen for Psychosomatica in ann Austrian hospital - the plan just failed bevcaue of a sudden unexpected stop for new positions in Vienna City Municipail Hospitals. - and I woud have needed an OA position at first.

But my erxperience as a consutant at Pulmologisches Znetrum Baumgartner Hoehe would richly give matreial - just neglected by SDA medicine.

One example : She, about 50, was kow as a patient with chronic astma. After another treatment of for weeks - I also was involved - ready to be dismissed. All the measurable funcztions were normal. In our talk some aggresssive conflict with her mother she had to care for appeared : “Well. you know, sometimes one really could give her a blow !” -" OK, here is my arm, do it !" She really hit me - and within seconds we had an asthmtic state completely with
all the functions and the serum parameters ( eosinophiles, histamine and some antihistamine protein) heavily outranging. - - asthmatics are often seemingly very quiet, calm, friendly people - with explosive aggressions and even own interests being deeply hidden - and you can help with complex loosening - up therapiy concepts.

Hanz contribution 2 had astonishingly few (very few !) commentaries. I fully support his view; Andreas Bochmann - Theologische Hochschule Friedensau - also not long ago posted his obsrevations on the “stiffness” to be observed within SDA (and other Protestants) (See “American Gothic”): Health - living healthy - is more than diet, exercises, drinking large amounts of water - - it also requires a “body awareness” - just feeling good in lustfully experiencing your body - YOU ARE BODY ! At first to recognize, then to feel and enjoy , to fee the warmth of sunshine, the rain, all the joyfully practiced movements and actions - please this ist far more than “exercise”, htis is lustful play !. And holisic healing !

They in Bogenhofen, our national academy, had planned to deal with the issue : Psychosomatics in the college and / or the theological seminary.

They asked for literature donations, calculating a literature budget that just made the fee for one years subscription of a scientifically acknowledges periodical. Well, they got my whole library on books and I paid for the subscription of "“Kunst-, Musik- und Tanztherapie” - the best overall covering periodical I found. for quite a decade. The music teacher eagerly expected every issue. The others : “What ??? Being creative with clay ?? Making your own music ??? - - and . - dance !!!”

See Jeremiah 31 : 13

Nonono, we rather regulatily publish cooking advices !

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Gerhard
On Church 1.0 [check out their web site and/or their Facebook site] and watch the program for January 16. About the middle way through they watched a short discussion on the Role OF Oxytocin on the Brain. What stimulates the levels, and how it improves one’s sense of self.
A great discussion [actually wasnt presented that way] on Psychosomatic feelings.

Church 1.0 is an SDA church in the SanFrancisco, CA area. Services are on line every week. 3 PM eastern US time.

Thank xou very much, I will see to get it on my screen.