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276 lines
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<p><strong>Physiology texts and the real world</strong></p>
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<hr />
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Hospital accidents kill more people than highway accidents. But when people die while they are receiving
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standard, but irrational and antiscientific treatments and “support,” the deaths aren’t counted as accidents.
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The numbers are large. Medical training and medical textbooks bear great responsibility for those unnecessary
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deaths. Most medical research is done under the influence of mistaken assumptions, and so fails to correct the
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myths of medical training. If the “consumers” or victims of medicine are willing to demand concrete
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justifications before accepting “standard procedures,” they will create an atmosphere in which medical mythology
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will be a little harder to sustain.
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<hr />
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A sentence taken out of context is likely to be misleading. A chemical equation that is concerned only with the
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reactants, catalyst, and product, can be misleading, and its industrial application is likely to produce
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devastation and pollution along with the intended product. In nature and industry, the reactants, products, and
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energy changes are linked to the ecology and to the economy. In physiological chemistry, events in the organism
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are linked to the environment so closely that food, water, air, soil, and pollution form a firmly linked
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functional system. But “medical physiology” has evolved as a separate thing, in which formulas that describe
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specific situations are linked to each other by fragmentary schemes, terminology, and computer models. This
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jerrybuilt scheme is even more roughly set into a hypothetical environment of “the origin of life,” “evolution,”
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“inheritance,” “society,” and a few other perfunctory contextualizations that have no more relevance to the
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subject than do the literary epigraphs that are often used at the beginning of chapters in medical books, to
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signify that the author isn’t just a technical hack. This physiological mythology has made possible a practice
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of medicine in which “genes” and “a virus” are regularly invoked to explain things that can’t be remedied, and
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in which any fleshy body is described as “well nourished,” and in which malnutrition and poisoning by pollutants
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are systematically dismissed as explanations for sicknesses, while thousands of different drugs are administered
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according to instructions given by their salesmen. It is also deeply linked to attitudes that have turned the
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practice of medicine into the surest way for an individual to get rich and retire early. It creates a sense of
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confidence that the physician is doing the right thing, because there is a little physiological rationale for
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everything. <strong><em>When a practice is replaced by its opposite, there is also a rationale for
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that. </em></strong>In fact, medical textbooks are written to rationalize the highly arbitrary
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practices of the industry. If, for some reason, perpetual motion machines had been as successful economically as
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steam engines were, laws of thermodynamics would have been written to describe them, just as thermodynamic laws
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were invented to describe the theory of steam engines. It was odd and interesting when a vice presidential
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candidate stepped to the podium several years ago and asked “who am I? What am I doing here?” But those
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questions are really of the greatest importance and interest, and physiology should be an attempt to understand
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more fully what we are, what we are doing, and how we are doing it. When we have comprehensive answers to those
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questions, then we will be in a position to create systematically valid solutions for our problems. For
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physiology, the equivalent of medicine’s “first do no harm” would be “first, don’t believe unfounded doctrines.”
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Accepting that principle puts a person into a critical attitude, and experiments can become actually
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“empirical,” an extension of experience that allows you to perceive new things, rather than “testing
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hypotheses.” Unless a hypothesis is a generalization from real experience, rather than a deduction from a
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doctrine, progress is likely to be very slow. A first step in developing a critical attitude is to identify the
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idols that stand in the way of real understanding.
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<strong>Immunity, intelligence, appetites, tumor growth, aging, the proper development of organs—everything that
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we think of as the biological foundations of health and sickness—will be misinterpreted if there are
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fundamental misconceptions about physiology.</strong>
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Physiology is the study of the vital functions of organisms, but especially when talking about “pathologic
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physiology,” great emphasis in physiology textbooks is given to the processes that maintain homeostasis of
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the <em>milieu interieur,</em> or the constancy of composition of the “fluid in which tissue cells are
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bathed.” Since cells are embedded in a gel-like matrix, “connective tissue,” the connective tissue should have
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some serious attention in physiology courses, but in practice its composition is described, and then the rest of
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physiology treats it as the “extracellular space.” Only specialists in the extracellular matrix are likely to
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take it seriously as a factor in physiology. If medical physiologists are likely to think of cells as being
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“bathed in fluid” which fills the empty spaces around the cells, they are also likely to think of the cell’s
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interior as a watery solution which “fills the space enclosed by the cell membrane.” It is this image of the
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organism that has made traditional biochemistry possible, since enzymes extracted from cells and dissolved in
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water had been thought to function the way they function in the living state. But the living cell isn’t like a
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tiny water-filled test-tube.
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<strong>Some of the points that should be considered in a realistic (and therefore coherent) physiology
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text:</strong>
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<strong>Connective tissues, ground substance</strong>— making a multicell organism--secreting the right amount,
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modifying/maintaining it, responding to the scaffolding--where the crucial <em>milieu interieur</em
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> is.
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<strong>Cellular energy, a structural idea</strong>—a finely organized catalyst, a readiness for work, and
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conditions that determine the equilibrium of reactions.
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<strong>The dimensions of the organism</strong> range from cellular fields to organismic intentions, via
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functional systems.
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<strong>Physiology should be understood in terms of its geochemical setting,</strong> because otherwise
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basic definitions will be built up in the belief that life is discontinuous from its physical environment,
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separated by membranes, and maintained by the expense of energy mainly to preserve gradients across those
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membranes<strong>; </strong>while in actuality the chemical energy released by living substance is spent in
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renewing structures, and the gradients are mainly passive physical-chemical consequences of structure. The
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spontaneous polymerization that occurs under volcanic conditions creates substances with intrinsic functions.
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The living state is a substance that is always being renewed as it interacts with its environment, and from the
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larger persepective, it is an evolving catalyst that modifies the environment so that the whole system
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approaches equilibrium with the energy that flows through it. Since the evolving system stores energy in its
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structure, the cosmic energy sources and sinks are at the boundaries of the system, and are the only questions
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that (so far) transcend the issue of life in its environment. The chemistry of the planet is tied up with cosmic
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energy, but the nature of the system as a whole is still relatively unexplored. If plants are bracketed by the
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sun, carbon dioxide and water, animals are bracketed by sugar and oxygen.
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<strong>Acid-base</strong> <strong>regulation</strong>--selectivity; physical chemistry of coral, bone;
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kidney, lung; roles of oxygen, carbon dioxide and protein.
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<strong>An Arrhenius base</strong> is something which produces hydroxide ions when it’s dissolved in water.
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<strong>Metal, an element that forms a base</strong> by combining with a hydroxyl group (or groups).
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<strong>Base,</strong> an electropositive element (cation) that combines with an anion to form a salt; a
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compound ionizing to yield hydroxyl ion.
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<strong>Electropositive</strong> <strong>atoms</strong> tend to lose electrons.
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<strong>Electronegative atoms</strong>, such as oxygen, chlorine, and fluorine, tend to take up an electron and
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to become negatively ionized.
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<strong>Definitions of Arrhenius and Lewis</strong> for acids and bases. It’s important to keep both sides
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of an ionizable compound in mind, and to pay more attention to electrons than to protons.
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<strong>A</strong> <strong>Lewis acid</strong> is an electron acceptor.
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<strong>Alkali reserve, (Stedman’s phrase:) “the basic ions, mainly the bicarbonates” (bicarbonates of this or
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that; there is no abstract “bicarbonate.”)</strong>
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<strong>Carbon dioxide is a neutral Lewis acid, that associates with the hydroxide ion. </strong>(This
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observation may be shocking to people who have thought too long in terms of abstract “bicarbonate.”)
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<strong>Carbon dioxide regulates water, minerals, energy and cellular stability, excitation, and
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efficiency.</strong>
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<strong>Cellular respiration regulates both energy and substance disposition.</strong>
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<strong>Respiration regulates osmotic/oncotic pressure, including the hydration (and dehydration) of the
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extracellular matrix.</strong>
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<strong>Electrons, positive charges, electronegativity, and induction: </strong>The unity of metabolism and
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signalling interactions; hormones are physical-chemical agents, not information carriers. Electrets,
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piezoelectricity, and crystal/bond stresses are relevant to physiology; the behavior of ionic materials in bulk
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water provides misleading images for physiology. Space charges are more relevant to physiology than fluxes in
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ion channels.
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<strong>Inductive</strong> effect: an electronic effect transmitted through bonds in an organic compound
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due to the electronegativity of substituents.
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<strong>Cooperative adsorption</strong> interacts with inductive effects producing coherent, systemic
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changes and stabilities.
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<strong>Steroids, peptides, biogenic amines, and other things considered as hormones</strong> and
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transmitters, are active as modifiers of <strong><em>adsorption, induction, and metabolic pathways.</em
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></strong> Their structural effects create, or inhibit, phase transitions in cells. Synergies of
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radiation, estrogen, and hypoxia are intelligible in terms of phase instability.
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<strong>Alkaloids: </strong>organic substances occurring naturally, which are basic, forming salts with
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acids. The basic group is usually an amino function.
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<strong>The disposition of electrons</strong> in cells and tissues is a global phenomenon, integrating
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metabolism, pH, osmolarity, and sensitivity. <strong><em>Excitation creates a field of alkalinity.</em
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></strong>
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<strong>Cellular differentiation; developmental fields, polarities.</strong>
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<strong>Regulation of water; </strong>electroosmosis; edema in relation to cellular energy.
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<strong>Vicinal water, all water near surfaces, most of the water in cells, has special properties.</strong>
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<strong>Needs on the cellular level guide the organism’s adaptations.</strong>
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<strong>Functional systems, </strong>multilevel adaptive integrations, in which many “systems” and cell
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types are organized according to activity and needs, leading to anatomical and functional changes.
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<strong>Energy and relaxation, cellular inhibition, </strong>a structural state involving the entire cell
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substance. High energy phosphate bonds explain nothing about the cell’s energy.
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<strong>Multilevel self-regulation;</strong> cell intelligence, organic compensations (function producing
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structure, organ regeneration, vascular neogenesis, stem cell functions, immunity/morphogenesis,
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tubercles/tumors, fat/fiber/muscle/phagocytosis) permits highly organized and novel adaptive responses, which
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are goal-directed rather than mechanistically “programmed” from the genes.
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<strong>Sensitivity and motility</strong>—plants and animals, subtle cues, rhythms, motivations.
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<strong>Adaptation—learning, intention, and stress.</strong>
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<strong>Light, energy, motion; </strong>pigments and electron donor-acceptor bonds.
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<strong>Acceptor of action, innate and learned models of reality</strong>. Intentionality is involved in
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“reflexes.”
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<strong>Digestion</strong>—bowel and liver; immune system and nervous system; <strong>need </strong
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>and intepretation, analysis; approximation and assimilation. Intestinal flora and detoxifying.<strong
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> </strong>Detoxifying fatty acids, estrogen, insulin, nerve chemicals, etc. <strong> </strong>
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<strong>Nutrition—</strong>appetite and satisfaction.
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<strong>Reproduction, puberty, menopause;</strong> how they are affected by the environment.
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<strong>Humor, curiosity, exploratory and inventive potentials and need. </strong>
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<strong>Growth and aging;</strong> energy, individualization and generalization; mitosis and meiosis, germ
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cells.
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<strong>Nurse cells, </strong>their interactions in various organs<strong>.</strong>
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<strong>Chalones,</strong> wound hormones, phagocytes, regeneration, nerve products; inhibition of growth
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by nerves. Frog extracts in development. Anatomy is a dynamic system, whose integration is part of physiology.
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<strong>Inflammations and tumors are systemic events, </strong>in causes and effects.
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<strong>Inflammation, edema, fibrosis, calcification, and atrophy--the basic pathology</strong>.
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<strong><em>Organisms relate to the biosphere as factors in the creation of new equilibria.</em></strong>
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Between 1947 and 1956, Arthur C. Guyton, of Ole Miss, wrote a textbook of medical physiology, and one of his
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students, J. E. Hall, has added chapters to it. It is the most widely used physiology textbook in the world. It
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may be more influential than the bible, since it has shaped the behavior of millions of doctors, affecting
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billions of people. Its success probably has something to do with Guyton’s unusual personal experience. After
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graduating from Harvard Medical School and, along with others from Harvard, working in germ warfare,* he
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contracted polio, and returned to Mississippi. As someone moving from the centers of excellence and power to the
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most backward state in the nation, instead of using textbooks he wrote handouts for the classes he taught there,
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devising what he thought were plausible explanations for everything in physiology. A personalized perspective
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and desire to keep things simple made the book, based on those handouts, readable and popular. The
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circulatory system, and the movement of fluids in the body, are at the center of physiology, so it is of
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interest that Guyton believed that, in the “spaces around cells,” there is a negative pressure, a partial
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vacuum, that sucks fluid out of the capillaries. He believed that this suction would balance a column of 5 or 10
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mm of mercury. The rib cage, and the force of the diaphragm muscle, can maintain a negative pressure around the
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lungs, preventing their elastic collapse, but there is no such shell around the rest of the body; if elastic
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fibers of connective tissue could be anchored to such a shell, then such a suction/vacuum would be
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conceivable. Hydrostatic and osmotic pressures interact in tissues, but even the hydrostatic forces
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produced by the heartbeat are known only approximately, as estimates, on the microscopic level. The belief in
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subatmospheric interstitial pressure is unreasonable on its face, and measurements are so inaccurate in the
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microcirculation that its disproof would be somewhat like proving that fairies aren’t responsible for the
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Brownian motions seen under a microscope. The oncotic/osmotic behavior of proteins in the blood and
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extracellular (the term <strong><em>interstitial</em></strong> implies the presence of empty spaces
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which aren’t really there) fluid is usually, in medical physiology, assumed to be a fixed quantity determined by
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the nature of the polymer. Swelling and syneresis (contraction) of gels, with the absorption or release of
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water, are strongly influenced by the electrical properties of the system, which includes solvent water, bound
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water, and small solutes and ions as well as the polymers. Changes in pH and ionic strength and temperature, and
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the presence of solutes modifying the polymer’s affinity for water, affect the osmotic behavior of the polymer,
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and of gels formed by such polymers. Since the extracellular spaces are mainly filled with solid gels, Guyton’s
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image of simple fluids entering and leaving these “spaces” reveals a major conceptual error, and that error has
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been widely propagated by medical professors. If a person imagines open spaces, interstices, between cells, then
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the question of the fluid pressure in these chambers seems reasonable, and the factors that produce edema will
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be thought of mechanically. But if we call the material between cells the “extracellular matrix,” and recognize
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its relatively solid gel nature, we will see the problem of edema in physical-chemical terms, rather than as a
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problem of simple hydraulics. [*Biographical side-lights<strong>:</strong> Guyton graduated from Ole Miss
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in 1939, got his medical degree from Harvard in 1943, where the department of bacteriology had a grant to study
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the polio virus, and where he worked with people “involved in the war effort,” and then from 1944 to 1946 was
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involved in germ warfare research, mainly at Camp Detrick. Camp Detrick had been established as the center for
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chemical and biological warfare research, and a test site was established in Mississippi in 1943. Guyton’s first
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paper was on aerosol research (published in 1946), and studies at that time were being done to improve the
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spreading of germs in aerosols. Bacterial aerosols were tested on the public in San Francisco, in 1950. Guyton’s
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Harvard colleagues established a polio research lab at Children’s Hospital Medical Center. When he left the
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navy, after working at Camp Detrick, Guyton resumed work at Mass General, and contracted polio before he
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finished his residency.]
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<strong>Idols of medical physiology, foundations and cornerstones for the landfill, some things you shouldn’t
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know about physiology:</strong>
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Genes control the cell, the organism is its genome, the nucleus regulates the cytoplasm. Information flowing
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from the genes produces and maintains the organism. Acquired traits aren’t passed on; mutations are random, the
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genome doesn’t acquire information from the organism or environment, the germ-line is isolated. Physiology is
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bounded by the informational function of genes. The cell is a drop of water containing dissolved chemicals
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enclosed in a membrane. Random diffusion governs energy metabolism, gene induction, and other
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intracellular events. Enzyme reactions occur when dissolved molecules randomly diffusing come into contact with
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a suitable enzyme, as described by the Michaelis-Menton equation. The Donnan equilibrium explains cellular
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electrical behavior, and since ions are distributed across the membrane by active transport, the membrane
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potential is maintained by the expense of metabolic energy. Water is just a peculiar solvent. Water structure
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changes only at extremes of temperature. Cells are perfect osmometers. There are empty spaces between cells. The
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membrane regulates the composition of the cytoplasm, with pumps and pores and channels. Cells must produce
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enough energy to keep the pumps running. Membrane receptors regulate cell responses. Cells are activated by
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receptors, and physical forces for which there are no receptors have no effect on cells except when they are
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above a threshold at which they cause discrete chemical changes. The nervous system is hard-wired. Brain and
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heart cells don’t regenerate. There is an immune system, whose function is to destroy pathogens, with
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inflammation as one of its functions, and its specific reactions are determined by the selection of clones which
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were generated by random mutations; an autonomic nervous system, which regulates visceral reflexes by
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innervating, via receptors, smooth muscle, heart muscle, and glands; an endocrine system, regulated mainly by
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negative feedback, that produces hormone molecules that carry messages to the receptors in certain target
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tissues. Inflammation is produced by germs, and is a defensive reaction of the immune system, and so is good.
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(Sterile inflammation is too confusing to include within the ambit of medical physiology, since it is associated
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with serious harm to the organism. The roles in inflammation of the nervous and endocrine systems and kidneys
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and membrane pumps and osmoregulation aren’t discussed in polite books.) During development, cells are organized
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into systems, and they don’t change their type. In the case of germ cells, their type is determined before they
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exist. Cells are able to undergo only about 50 divisions, and most of those divisions are used up in producing
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an adult organism. The committed nature of the organism’s cells and anatomy make radical functional adaptation
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impossible. Hormones and transmitter substances act only through specific receptor molecules. High energy
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phosphate bonds in compounds such as ATP provide energy to molecular pumps and motors. Molecular forces
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act only locally. Pathologies are primarily local: Inflammations and tumors have local causes, and their effects
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are local. Specific and local treatments are ideal. Circulation is treated as a plumbing problem, tumors as
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clones of defective cells. Consciousness is produced by nervous signals that transmit information, and can be
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compared with the handling of information by computers. Excitation and inhibition are functions of cell
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membranes. Artificial intelligence research into computational and nerve net systems is as much a part of
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research into the physiology of consciousness as computer modeling of feedback systems is a form of research
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into endocrine physiology and immunology. Estrogen, testosterone, thyroid, prolactin, serotonin, adrenalin,
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prostaglandins, etc., are carriers of information in an informational system. Cyclic functions and behaviors are
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governed by genes. The existence of hard-wired informational receptor systems and gene-induction systems is
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necessary because of the random diffusional nature of the other cellular processes and materials.
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<strong><em>Essentially, an organism consists of random inert matter given form and activity by the imposition
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of genetic information accumulated through random mutations.</em></strong>
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(There are really people who still believe those things.)
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<strong><em>A NOTE ON SCIENTIFIC REVOLUTIONS:</em></strong>
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If scientific revolutions depended on "the authorities," then the Copernican revolution would be dated from the
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Pope's apology. The fact that the major journals are controlled by antiscientific dimwits helps to define where
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science exists. Gilbert Ling's revolution in cell physiology has been moved along by the existence of the
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journal, Physiological Chemistry and Physics (and medical NMR). Michael Polanyi, in <strong><em>Personal
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Knowledge,</em></strong> maybe even more than Thomas Kuhn did in his famous book (<em>Structure of
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Scientific Revolutions</em>), helped to solidify the belief that there is a real international monolithic
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"community of science." Even though Polanyi, working "in isolation" in Hungary created his general and elegant
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adsorption isotherm, he didn't teach it to his own students, because of his belief in that community of science,
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which ridiculed his work because it wasn't based on their (false) assumptions about the electrical nature of
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matter. The linguistic and cultural isolation of Hungary and Russia from Europe has permitted them to
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evolve distinctive scientific cultures. C.C. Lindegren, in Cold War in Biology, showed that political forces in
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the U.S. and England suppressed anti-Mendelian ideas by identifying them as subversive, imposing the Central
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Dogma of genetics. But even within an authoritarian national tradition, there are little communities of
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science, where the real development of thought can take place. Perceptions that are clear and useful are the
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real revolutions in science, and the rest of it has to do with social and financial commitments. Even in the
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short time since Kuhn wrote his book, the status of medicine has changed significantly, putting it right up with
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militarism and the energy industry as a source of political and economic power. The authoritarian monolith that
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has been known as the community of science has become increasingly (even in areas such as astronomy, where
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commercial interests aren't so crudely involved) a structure of cultural propaganda maintained by bullying and
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fraud. Since the "normal science" in these authoritarian settings is dedicated to evading the truth, it becomes
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almost a guide to where to look for the truth. It's sort of analogous to the "mystery" of why breast cancer
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mortality is lowest in the poorest part of the U.S., Appalachia, and highest in the richest regions: the medical
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industry goes where the money is, taking death with it. Science, like health, thrives on the neglect of the
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corrupt industry. I have always felt that the cybernetic definition of communication as the transfer of
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something that makes a difference should be applied to speech and writing. As a student and teacher, I saw that
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information which made a difference was the essence of intellectual excitement and growth. But making a
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difference is exactly what university administrators and journal editors don't want. © Ray Peat Ph.D.
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2014. All Rights Reserved. www.RayPeat.com
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