Qua Deus hanc mundi temperet arte domum,
Qua venit exoriens, qua deficit, unde coactis
Cornibus in plenum menstrua luna redit;
Unde salo superant venti, quid flamine capet
Eurus, et in nubes unde perennis aqua?

[ Michel de Montaigne, Essays, 1580.]

[ By what artifice God governs this world, our home; where the moon comes from, where she does go and how she does bring her horns together month after month and grow full; whence the gales spring which rule the salty sea, and what domain does the South Wind enjoy; whence come the waters which are ever in the clouds?- translation by M.A. Screech 1987 ](1)

Written in the sixteenth century by a great French philosopher, Michel Montaigne, this sums up life so beautifully. He goes on to add " No knowledge of mine will bring it to change its course; it will not take a different road for my sake. It is madness to wish it so".(1) We in medicine " have been predicting the unpredictable all these years" was the opinion of Professor Firth, of the University of Strathclyde in Glasgow in a beautiful article, in the British Medical Journal.(2) If you are alive and healthy at a given time it is because of chance, if you are not well, or if you have lost a near and dear one unexpectedly, it is again because of chance, I wrote in my book Holistic Living.(3) This has been now ratified by a computerised analysis, where all the controlled studies data were fed, and chance could not be ruled out as the cause of the results.
On Friday noon, July the twentieth, 1714, the finest bridge in all Peru broke and precipitated five travellers into the gulf below. "Why did this happen to those five?" " If there was any plan in the universe at all, if there was any pattern in human life, either we live by accident, or die by accident, or we live by plan and die by plan", wrote Thornton Wilder, the great American Novelist, in his best classic, The Bridge of San Luis Rey, first published in 1927(4)
Time evolution in any dynamic system like the human body, does not depend on the partial knowledge of the initial state of the organism. Changing the initial state for the good of the future course of the organism may not hold good as time evolves. The future depends on the total knowledge of the initial state of any given organism. This , in our present state of knowledge, is impossible to obtain in man.(5) Our risk factor hypotheses, on which we solely depend for most of our work will not work that way, as we are only dealing with man’s phenotype( shape), without knowing his genotype. Our predictions could only generate more anxiety in society, which medicine is trying to allay in the first place. So it has been a self defeating exercise.(6).
The usual mathematics used in medicine is called the linear Euclidean mathematics where relations are straight forward. I call this as the "banana logic"- banana has yellow skin and, therefore, anything having yellow skin must be banana. There is a new science in the horizon of non-linear mathematics based on fractals, and that is called the science of Chaos. Chaos, in this context, does not mean the usual literal meaning of the term, confusion. Chaos is the name of the science. (7)
" The greater the ignorance the greater is the dogmatism; said Sir William Osler; in the Montreal Medical Journal (September 1902. page 696). Medicine abounds in dogma and many times the lay public is fed with these half truths and dogmas, in abundance that they get carried away. Isaac Newton published his Mathematical Principles of Natural Philosophy in 1687 and gave this world the laws of deterministic predictability. This view soon spread to medical science, and since then order in biology was supposed to be health and disorder disease. There can not be a bigger mistake than this, but this dogma seems to have taken root so deeply that it will take a medical Gorbachev to uproot it. Although Newton’s views have been challenged by, first, the Einstein theory of relativity, and later, by the quantum mechanics, medicine is still deep down in Newtonian physics and Euclidean mathematics of linear relationships.
Sir Thomas Burnett in 1681 published his history of the earth called, Telluris Theotia Sacra, wherein he saw the earth initially as a chaotic liquid, which evolved over the years to this earth that we know now. The new concept of chaos has a lot to do with the dynamic system, called the human body, which is continuously driven by food and oxygen. (8) Our ancient system of Ayurveda looked at the human body as a whole and treated diseases in that background. Modern science is heading for a crisis due to specialisation; looking at the body in bits and pieces. The human organism works as a whole and never independently, as envisaged by the organ based specialties. "Chaos appears to be an intrinsic part of normal physiological control and with increasing application of this chaos theory to research our previous concepts have to be reexamined ". (9)
Man has two definite attractors in phase space. One is the complex chaotic state (attractor) called health, where there is so much flexibility and irregularity that this state is very robust. The built-in mechanism of chaotic irregularity keeps the organism going, despite wide variations in the external atmosphere. The other attractor is the static state called death, where there is no irregularity and it is totally static. When man falls out of the usual health attractor due to disease, infection, cancer, alcohol or tobacco, there is a tendency to fall back into the health attractor. (10) If, for any reason, he gets thrown out too far into space due to any of the above causes, he may not come back to the health attractor, and may be pulled towards the attractor called death. Doctors and medicines are needed when one falls off the health attractor, but how far are they effective is anybody’s guess.
This concept not only explains how individual cells act and function in tandem, but it can also be extended to examine the function and behaviour of the individual as a whole, or even to the growth of a whole population. A certain level of chaos is needed before an individual can function effectively. In the very young there is increasing complexity and flexibility of controls, and, as age advances, there is loss of this complexity, leading to steady downhill course leading to death. Our old concept of stability in health is only a myth. So there is nothing like steady state of blood pressure, cholesterol, heart beat, sugar or, for that matter, any other biochemical parameter. They must, perforce, be fluctuating in a healthy person. The idea of an executive check up, to predict the future, therefore, is unscientific.
In a beautiful book entitled "Does God play dice ?" Stewart asks the question and explains how there should be chaos in all healthy systems in place of the conventional order . (8) " Unfortunately God’s game is not fully understood; but the whole lot is always a mystery" said Feynman, Nobel Laureate physicist, in 1957. In medical science we have been getting the wrong signals so far, and with the emergence of the chaos theory, things are clearing a bit.
Systems in this world behave in different ways. The conventional thinking is that if we know the inputs into a particular system, we will be able to predict the outcome using a particular formula. This is how we have been predicting the tides, sunsets and sunrises, and sending rockets to moon. In these systems we do not expect small changes in the inputs to make drastic changes in the output, although we now know it does occur. (11) Lorenz, a Nobel Laureate physicist, made a simple model of the weather predictions using a few questions of temperature, humidity, wind-flow, pressure and so on. To his surprise, he found even a very small variation produced different end points. He was so surprised when his predictions did not come true, that he propounded the "butterfly effect". If after taking all the possible initial conditions, one is predicting the weather; if a butterfly were to swing its wings in Beijing in China, there could be storms in New York after a month. This is true even today. The most sophisticated computers in Japan did not predict the disaster in Kobe recently; this took a heavy toll of men and materials.
In medicine we have been using this kind of linear relations to predict everything as time evolves; never realising that linear relations do not hold good in the dynamic human system at all. The long term follow up Study shook the medical world for once.(12) Two cohorts (groups) of men between the ages of 30 and 50 years were taken for this prospective study and divided into two identical groups of 2500 each and these were followed up for as long as five to twenty long years. (a difficult job indeed !). One group, called the study group, was given all the known medical interventions like, lowering the blood pressure, changing the blood chemistry and also giving exercise, yoga, psychotherapy etc regularly. They were also examined every three months by experts, with all the gadgets needed. The other group, called the control group, was left alone without any intervention, unless they had symptoms to see a doctor as anyone else in society would do. The results at the end of twenty years were shocking to the conventionalists. The study group had twice as many deaths due to all causes, and thrice as many deaths due to heart attacks, compared to the control group. But, according to the new concept of chaos this result is not surprising at all. Time evolution in any dynamic system does not follow the initial conditions in toto; unless we know the total initial state. Altering the initial state need not necessarily give a beneficial result, as expected (13). Simple explanation is that the true initial state of a human organism should include the genetic coding of the individual. Without knowing that a few parameters like, sugar, cholesterol, and blood pressure have no meaning at all. Therefore executive check ups have no scientific validity. Doctors should do their best, although knowledge keeps changing, for any one who comes to them with symptoms, with the best possible methods available at the time, to give relief. We must know much more about human beings, before we venture to screen the apparently healthy, with a view to improving their health status, or to give them better prospects of longer life. In the latter field we only have opinions so far and no facts, to support the hypothesis that mass screening helps. On the contrary, the American shopping plaza screening methods and the resultant labelling led to a sudden increase in sick absenteeism in society with depression and anxiety levels rising steeply. Screening is good for special risk groups, like prostitutes for AIDS, or siblings for certain hereditary diseases.
Man lives or dies based on so many factors: of which his genes play a vital role, with the environment being as important. Predicting the future by studying a few features of his system like ECG, stress ECG, blood chemistry and blood pressure, is as useless as not studying at all. (11) Happiness is living dangerously, said a genius of yore . Eat less, work hard, have no hatred and jealousy at heart and love everyone for a healthy and happy life was the advice of Ayurveda. Even in the world of politics and economics the theory of chaos works wonders. Adam Smith’s rule of stock market, based on linear equations, stated that a single person can not upset the stock market because of the inbuilt safety measures. This was proved wrong both in 1984, (New York crash) and in 1993 in India (Harshad Mehta Crash). May, in a beautiful article in the journal Nature, had to say the following on this theory. "Not only in research, but also in everyday world of politics and economics, we would all be better off if more people realised that simple non-linear systems do not necessarily possess simple dynamical properties.
Doctors and medicine have a very vital role to play. They "cure rarely, comfort mostly, but console always." It is not for nothing that our ancestors said

"God and doctor we adore,
On the brink of danger, not before
The danger past, all is requited;
God is forgotten, the doctor slighted."

[index]

B. M. Hegde
MD., FRCP( Lond)., FRCP( Edin.)., FRCP(Glasg.)., FACC
Professor of Medicine and Dean,
Kasturba Medical College, Mangalore.
Visiting Professor of Cardiology,
The Middlesex Hospital Medical School,
University of London.

Bibliography.

1) Michel De Montaigne. The Essays.(trans. Screech MA ) Penguin Classics, Harmondsworth, England, 1987.
2) Firth. WJ. Predicting the Unpredictable. BMJ 1991; 303:1565-1568.
3) Hegde BM. Holistic Living. Bhavan’s Publications, Bombay, 1993.
4) Thornton Wilder. The Bridge of San Luis Rey. Longmanns, 1927.
5) Hegde BM. Chaos-A New Concept in Science. Jr. Assos. Physi. India. 1996; 44: 167-169.
6) Hegde BM Unconventional Wisdom. Bull. Roy Coll Physi and Surg. Glasgow. 1995; 83: 292.
7) Hegde BM. Vivacitas. Jr. Assos. Physi. India 1995; 43: 88-90.
8) Stewart I. Chaos from order in Does God Play Dice with the World? London, Penguin Books, 1989.
9) Bisset WM. Chaos- a mechanism for human disease. Proc. Roy Coll Physi Edin. 1994; 25: 96-104.
10) Gleick J Chaos- making of a new Science. London. Sphere Books 1988.
11) May RM Simple mathematical models with very complicated dynamics. Nature 1976; 261: 459-67.
12) Goldberger AL Fractals and Chaos in human Physiology. Sci. Amer 1990; Feb: 35- 41.

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