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Blind Spots: The Failure of Contemporary Medicine to Recognise * an Epidemic of Energy Loss and ** Underlying Environmental Disruption

Blind Spots: The Failure of Contemporary Medicine to Recognise * an Epidemic of Energy Loss and ** Underlying Environmental Disruption

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Blind Spots: The Failure of Contemporary Medicine to Recognise * an Epidemic of Energy Loss and ** Underlying Environmental Disruption

Lunghezza:
494 pagine
6 ore
Pubblicato:
Aug 30, 2013
ISBN:
9781491875841
Formato:
Libro

Descrizione

In spite of increasing use of advanced technology, the patient-orientated field of medical science, clinical medicine, has by and large retained the mechanistic-substantial perception of reality inherited from the scientific communities of the eighteenth and nineteenth centuries. In contrast, physics bade farewell to this view more than a century ago and now conceives the world primarily as a dynamic continuum of energy. Biochemists now regard structural (substantially orientated) and dynamic (energetically orientated) aspects of biochemistry as complementary and equally important. As seen from the perspective of the history of ideas, the anachronistic world view of clinical medicine, a view that can be characterised as dogmatic substantialism, places it in an outdated position compared with physics and biochemistry a position from which the existence of biologically relevant energetic phenomena cannot be recognised as such, simply because they are not supposed to exist. During the latest three decades, the epidemic of energy loss, which comprises the diagnostic entities ME/CFS, fibromyalgia, multiple chemical sensitivity, consequences of whiplash injury, and several other conditions, has affected Western societies increasingly and caused significant humanitarian, social, and economical problems. It is no exaggeration to state that the confrontation between conventional clinical medicine and the epidemic of energy loss has created confusion and, all too often, absurdities. Isager attempts a thorough analysis of this situation and its historical and ideological roots, emphasising epistemological problems problems concerned with how we know and how or why we do not know.
Pubblicato:
Aug 30, 2013
ISBN:
9781491875841
Formato:
Libro

Informazioni sull'autore

Henrik Isager is a Danish physician, born 1934. He specialised in internal medicine and infectious diseases and in 1981 he became consultant and university teacher at Odense University Hospital, Denmark. In 1993 he left the university hospital and started a specialist practice with focus on “the epidemic of energy loss”. Has written articles and two books (in Danish) about ME/CFS and related illnesses.

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Blind Spots - Henrik Isager

978-87-7070-263-8

Contents

Foreword

Introduction

1. The Ideological Inheritance of the Medical Collective

1. Ideological building blocks for the foundation of contemporary medical self-perception and perception of reality

1.1 Cartesianism

1.1.1 The atomistic vision

1.2 Positivism

1.3 Physics bids farewell to substantialism

1.4 Philosophy and water pipe systems—and an objective for the first part of the book

2. Self-experienced aspects of medical culture—viewed and interpreted retrospectively

2.1 Attitudes to the infinite—vanquishing death

2.2 Objectivisation

2.3 Perception of cause

2.4 Diagnosis system and specialisation

2.4.1 The concept of diagnosis—viewed historically

2.4.2 The modern diagnosis system

2.4.3 Medical specialisation

2.5 Inquisitorial tradition and scholastic thinking

2.5.1 Roots in late medieval Europe

2.5.2 Inquisitorial/scholastic tradition in modern medical culture

2.5.3 Illness and sin

2.5.4 Rejection—viewed historically

2.5.5 The somatisation diagnosis: a contemporary rejection-like procedure

2.5.6 Attitudes to alternative forms of treatment

2.6 Status: the need for a supplementary explanatory model

3. Eurocentrism (Enrique Dussel’s philosophy) as a model for understanding interactions between medical culture and society and between doctor and patient

3.1 The totality of the Western world—the term fetishism—being within and outside the totality

3.2 The totality of the church

3.3 The possible cult function of the medical totality

Box 3a: The medical totality viewed as a secular cult

3.4 Is the relationship of the medical totality with the patient analogous to the relationship of Eurocentrism with the surrounding world?

3.5 The medical profession, the state and the totality of the Western world: where is cognition controlled?

4. Steering medical cognitive practice: mechanisms and the motives behind them

4.1 Some built-in steering mechanisms

4.2 Tertiary gain of illness—symbiotic or parasitic

4.3 The vulnerability of the medical totality to marketed fetishism

4.4 Ritualised research methods: fetishism about statistical significance

4.4.1 A historical perspective

4.4.2 The significance test as a research tool

5. The informative basis for cognition in the doctor-patient situation

5.1 An information-theoretical model of the optimum

5.2 The loss of information prevalent in medical practice

5.3 An initial summing up

Box 5a: The virtual (ideological) contents of the pockets in the doctor’s white coat

6. Examples of the selection and exclusion of subjects for cognition

6.1 High cholesterol—a postulated threat to health

6.2 COX-2 inhibitors and hormone replacement therapy during the menopause

6.3 Treating critical illnesses with high doses of vitamin C—an unacceptable area for cognition

6.4 Chronic mercury poisoning: two tracks for cognition

6.4.1 Exposure to mercury and how it is absorbed and deposited in the organism

6.4.2 Mechanisms of toxicity

6.4.3 Demonstration of accumulation in the organism and of manifest toxic effect

6.4.4 Symptoms of poisoning

Box 6a: A dentist’s clinical assistant who had to give up her occupation for health reasons after less than five years

Case 1

6.4.5 Mercury as a causal factor in illness and functional disturbance in the nervous system

6.4.6 Connection with medical illnesses

6.4.7 The cognitive divergence

7. Passive and active blocking of cognition regarding health-threatening toxins in the environment

7.1 Possible cognition-blocking fetishisms

7.2. A toxicological perspective at the millennium

7.3 Passive and active blocking of cognition are current cultural phenomena

7.4 Moving on

2. The Cognitive Challenge

8. An epidemic of energy loss

8.1 Prelude: living with a non-existent illness

8.2 The name of the illness

Box 8a: Overlapping diagnostic terms produce problems of cognition

8.3 Symptoms

8.4 Physical examination

8.5 History: possible components of a network of predisposing or causal factors

8.5.1 Genetic and gender-related vulnerability, accumulation of cases in same households and in the immediate environment

8.5.2 Female sex hormones toning down the hormonal stress response

8.5.3 A lifestyle influenced by extended stress reaction

8.5.4 Spinal column complaints and traumas—back-straining occupations

Table 8.1 Back problems before onset of multisystem illness in two groups of patients (summary from Isager 2001)

8.5.5 Chemical and electromagnetic influences

Case 2

8.6 The emergence of the illness

Table 8.2 Factors associated with the onset of multisystem illness in two groups of patients (summary from Isager 2001)

8.7 Course of events after illness breaks out

8.7.1 Infections

Case 3

8.7.2 Maximum multisystem illness

8.7.3 The canary metaphor

9. Framework for understanding multisystem illness I: cell systems with degeneration of mitochondria and increased apoptosis

9.1 Skeletal musculature

9.2 The heart muscle

9.3 Nerve cells

9.4 Intestinal mucosa

9.5 Blood cells

9.5.1 Fragility of erythrocytes

9.5.2 Increased methaemoglobin and 2,3-DPG in red blood cells

9.5.3 Markedly increased apoptosis in blood lymphocytes and neutrophile white blood cells

9.5.4 Quantification of mitochondrial dysfunction in neutrophile white blood cells: the ATP-profile test

9.6 A summing up: indications of a toxic effect

9.6.1 The toxic load

9.6.2 The phenomenon of non-acceptance

10. Framework for understanding multisystem illness II: nitrosative stress (NO/ONOO-cycle)

10.1 The NO/ONOO-cycle

10.1.1 Can the NO/ONOO-cycle be halted by medication that destroys B-cells?

10.2 A few perspectives

Box 10a: Martin Pall’s criticism of medical scientific culture

11. Two suggestions for bringing the medical perception of reality up to date

11.1 Recognising the otherness of women

11.2 Disturbed homeostasis or disturbed homeodynamics?

11.3 A homeodynamic framework for understanding the otherness of women indicates a problem concerning equality and equal status

12. Framework for understanding multisystem illness III: quantum coherence—the energy supply of the living organism

12.1 Being alive

12.2 Life with sufficient energy resources versus life on the edge

12.3 Sensitivity to weak electrical and magnetic fields

Case 4

12.4 Sensing and localising your surroundings

Case 5

Case 6

12.5 Light dependency

12.6 Perspectives

Box 12a: A summary framework for understanding multisystem illness

13. Recognising multisystem illness as an environmental problem

13.1 Evaluating the individual homeodynamic defect and the biological mechanisms behind it

13.2 Small-scale epidemiological observations as an investigative tool

13.2.1 Severe multisystem disease and other health problems in a family exposed to an organophosphate pesticide over several decades

13.2.1.1 Case 7 (referred patient)

13.2.1.2 The family’s history

13.2.1.3 Discussion

13.2.2 Manifestations of illness in a family exposed to mycotoxins over a period of eighteen months

13.2.2.1 Shared exposure

13.2.2.2 Case 8 (referred patient)

13.2.2.3 Health problems in the rest of the household

13.2.2.4 Discussion

13.2.3 Conclusions

3. Reactions to the Epidemic (The Danish Case)

14. Cognitive control

14.1 Producing, reinforcing, and maintaining lacunae in a pattern of recognition

14.1.1 The model: controlling recognition in the United Kingdom

14.1.1.1 Case documents regarding research into ME/CFS have been hidden in a classified archive

14.2 Recognition control in Denmark: an almost complete acceptance of the somatisation concept

14.3 The role of the somatic specialties

14.3.1 Recognition-restricting groupthink within medical specialties

14.4 A health-policy trend: environment-related system illness transformed into a behavioural disorder

15. Reorganisation of Danish social and health policy around the millennium

15.1 A case of prolonged disability denial (one of many)

Case 9

15.1.1 The feeling of being seen as one of those who exploit the system

16. Totalitarian exercise of power in a democratic framework

16.1 A structured analysis

16.1.1 Panopticon

16.1.2 Freedom

16.1.3 Relations of truth

16.1.4 The Self (and the other)

16.1.5 Bio-power (management of lives)

16.2 Summing up

16.2.1 A historical perspective

Epilogue

References

Endnotes

Foreword

Jesper Garsdal¹

This book contains a well-substantiated confrontation of the perception of reality which forms the background to large parts of the modern medical-scientific paradigm, and it also makes suggestions as to how medical science might develop in future. Isager’s medical background clearly shines through in the book, but he manages in a committed and engaging manner to combine detailed medical discussions with a wealth of specific examples and a philosophical and historical analysis of the origin of the central fundamental assumptions of medicine. He does this so vividly that a reader who has a general education but does not have specific medical knowledge will also be able to read the book and benefit greatly. As the book not only highlights questions which are relevant to medical science itself but also demonstrates extensive unreasonable treatment of ordinary people when they themselves or someone close to them are struck by illness, it should be assured of a large readership.

The starting point for the book is the author’s commitment, which springs from a conflict between a fundamental respect for the dignity of the individual and the lack of respect which he has observed in the way the healthcare system deals with (or perhaps rather reifies) patients who fall outside this system’s categories of recognition. The book argues convincingly that there is a pronounced tendency to view illnesses which cannot be explained within the medical paradigm as the manifestation of psychological conditions, rather than reflecting on whether the categories of the medical paradigm are sufficient to recognise the patient’s actual illness. This conflict—between a system which displays no humaneness towards those people who do not fit into its categories and a humanist accentuation of individual dignity—is a central theme throughout the whole book.

Another theme is the uncertainty concerning the fundamental assumptions upon which the modern medical-scientific paradigm is based. In a review of the origins of this paradigm, Isager shows that it operates according to rather dubious assumptions, dictated by cultural and historic ideas about the world, reality, and human existence. By drawing on cases from both the history of ideas and his own experience, he demonstrates that there is a close link between these fundamental assumptions and the way in which medical practice operates. This is a significant point in relation to medical thinking, which is strongly influenced by the assumption that science is neutral. The book demonstrates clearly that there is a difference between remaining balanced within what could be called a specific grammar (my expression, not Isager’s), which structures an attitude to the world or a section of it—in this case health and illness—and claiming that this grammar should apply universally, as the only way to understand health and illness.

Isager’s point that the medical-scientific discourse is also tied up in what I have called a specific grammar, claimed to apply universally, is closely linked to a fact which can be said to represent a third theme in the book—that there are a number of similarities between the role which medical science plays, both in society and for the individual, and the role traditionally played by religion (here Isager focuses on Christianity).

Both religions and medicine operate according to fundamental preconceptions about human beings—preconceptions which play an active role in relation to what the philosopher Karl Jaspers would call human boundary situations. These may be situations concerning illness and death in which the human being is not master of his or her own life and therefore has to turn to others for help—whether this is God, the clergy, or doctors. In other words, in the grammar of both religion and medicine, there is an interplay between human autonomy and submission to circumstances and powers over which one does not have any control, which immediately raises the question of the legitimacy of these powers.

We may think that as a science, medicine might be more open to questioning its own fundamental assumptions and its position of power than is the case for example with religion. However, Isager points out several significant obstacles to the development of such a reflective and self-critical attitude. Prominent among these obstacles is the close relationship between the medical profession and the pharmaceutical industry. He demonstrates that the participants in the medical discourse relate to their fundamental assumptions in a manner reminiscent of the way in which theologians within the various faith systems relate to their fundamental dogmas, and he comes up with an interesting observation which points to a surprising difference between religion and medical science concerning the degree of self-reflection:

During my first five years in specialist practice, when the work was quite modest in scope, I held a minor position as an organist in the Danish National Evangelical Lutheran Church. Here I discovered that dogmas were referred to in church circles and that their existence was acknowledged. In the medical university environment I had experienced the dogmas of the profession as taboo subjects which were not spoken of, even though they permeated the milieu.

Isager also points out that the development of medical science has featured a gradual toning down of what is unique about each individual patient. In diagnostics there is a devaluation of the idiosyncratic component of illness, of what is unique about the individuals’ experience of illness. The trend has gone towards ‘the patient’s illness’ being regarded as an obstacle to objective scientific perception. When this is combined with an unwillingness to discuss presumptions—indeed, an unwillingness to recognise and express that one operates according to presumptions at all—it is not a great leap to explaining away the difficult unique cases which hinder correct recognition and insight, and Isager points out through a series of powerful examples the marked tendency to use blaming the victim strategies within the healthcare system. This happens to a great degree by regarding the illnesses which cannot be explained within the medical paradigm as the expression of psychological disorders. Isager points out that female patients in particular are subjected to this, and here he draws a direct parallel between the treatment of these women and the witch trials of the Middle Ages, where the accused had to prove their innocence to the Inquisition.

As should be evident, the book expresses criticism of and a confrontation with some of the fundamental assumptions of modern medical science, including the consequences these assumptions have for the relationship with patients. However, Henrik Isager also points out alternatives with regard to how to relate in a forward-looking way to illnesses which are currently difficult to diagnose medically, for example chronic fatigue syndrome and related forms of stress. Instead of stigmatising the patients by neglecting or explaining away the symptoms as psychological problems in the individual, Isager discusses an established fundamental medical hypothesis—the idea that when functioning normally, a biological organism has the ability to maintain a stable, constant coherence in its internal environment through built-in adjustments and regulations in its system (homeostasis). Using this model, we understand illness as a breakdown in the organism’s ability to stabilise itself as the same, and Isager concedes that this model may explain quite a lot concerning feedback mechanisms which wear down the organism. However, he points out that a central problem with the concept of homeostasis is that it does not take into account that the organism is an organism in context, understood more specifically as a sequence in a time-related and spatial context to which the organism continuously adjusts and adapts. He illustrates what the consequences of such a shift in the fundamental assumptions of medicine might be, by discussing what significance this shift might have for the recognition of gender-specific causes with regard to chronic fatigue syndrome and related illnesses.

Isager therefore proposes that rather than a homeostatic model, a homeodynamic model, which focuses dynamically on how the organism constructs its future in interchange with the surrounding environment, should be used as a basis. A homeodynamic view paves the way for diagnosis of a biological system which develops over time, and it discourages a focus on the individual organism as a substance or thing, whose nature or functionality is independent of the organism’s context. Instead an argument is made for regarding the individual organism as a process in an open interplay with a unique set of changing surroundings. The behaviour of the organism must therefore be explained in relation to this unique process.

The first thing worth noting is that thinking about medical illness in this way could allow idiosyncratic diagnoses which take the life each patient has led seriously as individually lived lives. As early as 1486, the Italian Renaissance humanist Pico della Mirandola pointed out in his speech on human dignity that if man’s most distinguished characteristic is that he chooses himself, then the nature of an individual is something which cannot be known in advance. The individual does not exemplify a typical human nature which can be known before knowing the individual. If you want to know the individual you have to study the individual’s biography, the life script in interaction with its surroundings. Isager opens the possibility of adopting this general humanistic insight into medical science on the basis of a medical-scientific way of thinking which is consistent with the premises of medical practice.

The other point worth noting is that this humanistic way of thinking, which focuses on the individual, is also strongly linked to a change in the way of understanding an organism. It could be said that the homeostatic principle views the organism primarily as a living thing which certainly undergoes continuous internal adjustments but to a significant extent remains the same. In contrast, the homeodynamic approach understands the organism as an individualised process which remains itself precisely by being able continuously to change its nature and therefore its behaviour in an interplay with its surroundings in a joint dynamic field. We can therefore now speak of a form of procedural or field-dynamic view of medical science which not only allows further development of medical science but which could also provide a basis for unbiased debate with other medical traditions.

Taken as a whole, it can be said that the book deals with how fundamental philosophical ideas about life interplay grammatically with the way we relate to ourselves and to each other in everyday life, and the responsibility we therefore have both to clarify which assumptions we are in fact working according to, and to decide whether these are the assumptions on which we wish to base our work. More specifically, the examples and analyses demonstrate how a systematised view may cause problems in spotting each individual’s unique significance as an individual, something which must be distinguished from understanding the individual both as an abstract universal rights-and-duties subject and as a cultural subject fixed within one or more cultures. An alternative is to view the individual as a unique process in context which relates to itself and its surroundings in a way which involves its body, heart, and soul.

The necessity of integrating idiosyncratic perspectives and approaches is relevant not only in relation to medical science but also in other contexts where the individual’s development in dynamic contexts is at play. Isager points out the difficulties in defining the individual as unique independently of the process which the individual undergoes in its context, but, conversely, what stands out when we look at the individual in context is precisely the unique context of that person’s existence. It is worth noting here that there is a third way—a way between abstract universalism on the one hand and fixations with specific contexts on the other. It is constructed according to what could be called an artistic interest in ourselves and each other as unique processes in dynamic contexts.

What distinguishes a humanistic society is perhaps that there is a will to focus genuinely and specifically on each individual being’s continuing and unique developmental processes in interaction with others, and that this will is in the foreground in relation to political, economic, and technocratic ideologies. The book makes it clear that if this will is not to die out it must be fed continuously by critical and creative reflections regarding the basic assumptions which are expressed through our actions as the conscious or unconscious normative basis for the way we live.

Why did we become blind, I don´t know, perhaps one day we´ll find out, Do you want me to tell you what I think, Yes, do, I don´t think we did go blind, I think we are blind, Blind but seeing, Blind people who can see, but do not see.

—José Saramago²

Introduction

It´s certainly difficult to be deviant / but, I think, more difficult to be conventional!

—Gunnar Ekelöf ³

During thirty years’ work as a hospital doctor doing patient-focused work I felt at an early stage that there was something insupportable about the prevalent medical perception of the reality of illness. For many years this was an unquantified feeling, and it was only when I left the hospital service (in 1993) that I began to put my criticism of medical culture into words. In the years that have passed, I have found it essential to dig more deeply into the subject.

Although I am not qualified as a philosopher, like other doctors and therapists—and not least their patients—I make use of some principles of cognitive theory which govern the practice of medical science. Can these principles be expressed in words? Where do they come from? Against the background of my own experience of medical culture as a practising physician, I have applied both philosophy and the history of ideas in my analysis as the basis for drawing conclusions.

In my view, the medical and healthcare system is undergoing a transformation based to a large extent on epistemological qualities. This transformation originates from the grass roots rather than the top. I will attempt to characterise this transformation as I have experienced it and then suggest the direction in which it is going.

My basis for doing this is my experiences and impressions, seen from two vantage points in particular: three decades as a hospital doctor, mainly in internal-medicine departments linked to universities and as a consultant in infectious diseases at Odense University Hospital from 1981 to 1993, and thereafter specialist medical practice (internal medicine and infectious diseases), in which I mainly saw patients who either had become stuck in the conventional system or quite simply had been rejected by it. The majority of these patients had symptoms corresponding to the diagnosis chronic fatigue syndrome (ME/CFS) and associated conditions. The account of the conventional medical perception of reality which follows is based to a significant degree on the confrontation of these patients with the system. I discuss how the perception of reality of the system fails in many people’s opinion, and where the difference between patients’ and doctors’ perception of the reality of illness is greatest—that is, where the need to expose and challenge habitual medical perceptions is most urgent.

A non-medical vantage point must be added. During my first five years in specialist practice, when the work was quite modest in scope, I held a minor position as an organist in the Danish National Evangelical Lutheran Church. Here I discovered that dogmas were referred to in church circles and that their existence was acknowledged. In the medical university environment I had experienced the dogmas of the profession as taboo subjects which were not spoken of, even though they permeated the milieu.

In both church and medical circles, thinking based on dogma can produce epistemological lacunae. One of the main aims of this book is to describe the hidden dogmatism in standard medical culture and to map out the blind spots in its view of reality and the consequences which these blind spots may have for the perception of reality and patient treatment. The fortunate flip side of this coin is that the system functions well in many areas.

My interest in fatigue patients arose in the late 1970s, while I was employed in the Infectious Diseases Department at Copenhagen University Hospital, which was headed by Medical Professor Viggo Faber (1918-2006). I looked after Viggo’s out-patients for a period and noticed his preoccupation with people who developed disabling mental and muscular exhaustion after suffering an apparently benign infection. The fact that there was no immediate explanation for the phenomenon challenged his genuine and unrelenting scientific curiosity. This involvement, which also extended to the welfare of the individual patients, followed him for the rest of his days. Its intensity seemed to increase with the passing years as he came into conflict with the epistemological practice, which came to dominate the medical university milieu during those years.

In around 1993 I encountered a severely disabled fatigue sufferer whom I monitored as an out-patient. Gradually this patient improved during two years’ treatment with tendon organ stimulation to the extent that he could return to work as a tradesman.⁴ It is typical for these patients that the musculature—and in particular the musculature around the spine—is tense and painful and functions poorly. The tense muscles are shortened and can therefore pull the spine out of shape. The aim of this form of treatment is to normalise muscular tension and posture, in other words, the curvature of the spine. The good result of the treatment was surprising. In the medical milieu I knew, illness was by definition something which should be treated pharmacologically, and physical treatment was classified at the extreme edge of the medical sphere of reality. A physical treatment which was not officially approved was completely outside this sphere. This was a non-existent illness treated successfully with a non-existent form of therapy—a curious epistemological challenge.

This challenge initially led to a pilot project in which twelve out of fourteen patients (all with relatively short-term illnesses) achieved an unquestionable improvement in terms of pain levels and function during treatment with tendon organ stimulation over six to nine months. Three severely disabled patients achieved something close to a normalisation of function.

A book project followed later. This aimed to describe the symptoms thoroughly on the basis of two patient groups, to assess causal factors and possible disease mechanisms, and to describe treatment methods, in particular those based on physical principles. Nutritional therapist Eva Lydeking-Olsen provided a concluding chapter on nutritional aspects.⁶ In the middle of the book I put together a brief analysis of current medical attitudes to this category of illness. The analysis concluded that no rational bioscientific foundation could be found for the systematic discrimination which this group of patients was subjected to in the orthodox medical system. This discrimination was already having at this time a knock-on effect on the attitudes of the social system. My conclusion led to the idea that the increasing presence of fatigue patients in society could be thought of as a test of the medical system—a test which revealed defects in both its view of human nature and its perception of biological reality.

The commitment to verify and investigate this claim followed. The investigation has been a slow process which has led me to places other than I had imagined.

The structure of the book

The first part describes the traditional culture of medical science and analyses the perception of reality and the self which controls the epistemological practice of this culture.

Chapter 1 looks back on Cartesianism and positivism. Over a couple of centuries these two philosophies have shaped the view of reality of medical science. Is the need for this to be reviewed becoming urgent? The alternative image of reality which modern physics has formulated over more than a century points in this direction.

Chapter 2 is based on my personal impressions of the more or less hidden foundations of medical culture, its role as the vanquisher of death, and the pronounced effect of reductionism on the perception of causes, the diagnosis system, and the system of medical specialties. I attempt to trace the historical roots of the inquisitorial tradition, which I believe still shapes medical culture. The South American philosopher Enrique Dussel is introduced and Chapter 3 presents his perception of the Western world (Europe and North America) as a totality enveloped in fetishism, a pseudo-deification of itself. It is postulated that the medical community is included in this as an independent totality, which is significant for the whole and which is similarly enveloped in fetishism, and that this influences the relationship between doctor and patient.

Chapter 4 initiates a discussion about the control by market forces of the medical epistemological pattern and gives examples of control mechanisms. Chapter 5 returns to the doctor-patient situation. It argues that strictly enforced reductionist access to the recognition of illness—a procedure which is widely followed in standard university clinics throughout the Western world—can very easily lead to poor patient treatment because of its built-in loss of recognition. The current status of the hidden ideological inheritance in the medical-culture milieu is assessed at the end of the chapter.

Chapter 6 is lengthy and perhaps a little heavy for those who do not have previous knowledge of biological science. Detailed examples of the selection and rejection of subjects for recognition which (as far as I can tell) cannot be justified for public-health reasons are discussed here. If anything, financial or political motives appear to play a role instead. As a natural continuation of this, Chapter 7 deals with how recognition may be blocked in practice—how ignorance of a topic which major circles do not wish to see recognised can be maintained. Active blocking of recognition is something which must be taken into account, not only in medical science but also and not least when it comes to health-threatening environmental pollution.

The second part of the book is devoted to the spectrum of conditions involving function-impairing energy loss (ME/CFS, fibromyalgia, conditions resulting from whiplash and others). I have chosen to use the collective term multisystem illnesses for these conditions. This was launched by Martin L. Pall, who is also behind a groundbreaking conceptual model.

Chapter 8 reviews the symptoms of multisystem illnesses in depth. I think it is important that the reader gains an impression of what life with multisystem illness is like. A low threshold for the exhaustion of muscular and cognitive functions is central in the image of the illness. Next I say something about what precedes the illness—both heredity and environment are significant, as is accumulated stress—and there is an account of what the term stress involves. Spinal problems play a role. Everyday chemical and electromagnetic effects add to the stress burden. After the illness breaks out, which can occur very suddenly, the conditions of life are changed. Many people suffer frequent and long-lasting infections, and these are dominated by a specific spectrum of microorganisms. Existing research points towards stress-related immune deficiency.

Chapter 9 describes scientific facts which have been known since the 1990s. Cell changes affecting several tissues can be demonstrated in multisystem illnesses—firstly, indications of degeneration of the energy generator of the cell, the mitochondrion, and secondly, a marked increase in the occurrence of apoptosis, programmed cell death. It is precisely the combination of these two types of changes which points strongly towards toxic effects, and there is a discussion of what may be involved. Chapter 10 reviews Martin L. Pall’s scientifically well-founded model of the mechanism of cellular dysfunction in multisystem illness, the NO/ONOO-cycle, a self-perpetuating disruption of cellular metabolism which leads to mitochondrial degeneration. This can be induced by many types of stress and not least by a range of known environmental toxins. Pall’s model explains the chronic

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