HUMAN BODY'S INTELLIGENCE

Prof  B M Hegde
Vice Chancellor
MAHE University
Manipal - 576119

Human beings have lived on this planet for well over 9,00,000 years in 50,000 generations!  Man should have been extinct like the dinosaurs long ago; if what we hear today about drugs, preventive screening of the apparently healthy population and technology keeping people alive on this planet were to be true; as the latter have been operational at best for little over half a century!

Many studies have been looking at the reasons why we are still here despite the absence of modern hi-tech medicine being available to our forest dwelling ancestors over thousands of years of their existence on the planet. Evolution of man does not simply follow the naïve Darwinian laws. Environment, in addition, has a lot to do with our evolution. That is seen in many other species as well. One example would suffice. There is a type of butterflies which, when pregnant, accidentally coming in the close viscinity of a killer reptile, tries to escape from danger. In addition, it tries to so mutate the offspring’s genes that enable the foetus to develop much larger wing span, making it possible to get away from danger more effectively. The mother butterfly simultaneously mutates the genes of its offspring to be able to smell the enemy scent from a longer distance, by enhancing the child’s olfactory mechanism!

Similar evolutionary changes, based on our environment, kept us going for so long without the assistance of any hi-tech stuff. Let us call this “the intelligence of the body”.  Time was when man lived in the forests and the causes of death then were primarily senility or predation.   To keep man going despite injury in the likely event of an attack by larger animals, genetic mutation helped to develop the sympathetic system. This could keep one going in an emergency, say bleeding, by redistributing the circulation to supply blood to the vital organs in preference to the non-vital parts and also to help the blood to clot and the bleeding vessels to constrict, arresting blood loss. This friend of man could become his own enemy if used on a long-term basis, as happens in clinical heart failure!

The renin-angiotensin-aldosterone system was another boon to the hunter-gatherer man in the forest, who did not eat extra salt in his food. This prevented his blood pressure from falling to shock levels after injury and bleeding. Over the years, the same system has become our curse in the last ten thousand years, with lots of salt added to our diet, resulting in a novel disease, high blood pressure! In Nature extremes are detrimental. Whereas low sugar-high sugar, low blood pressure-high blood pressure, and low cholesterol-high cholesterol are all bad, constant fluctuations of all these parameters are a must. Stationary levels obtain only after death!

The story of man’s immune system being able to cope with adversity is also based on the experience of any hostile environment through genetic mutation. History of man in the New World is a good example. When Europeans landed on the American continents the virgin population of that landmass did not have any immunity against the diseases the Europeans were heir to, like small pox. Large chunks of the Natives died of such scourges that the white man brought with him, rather than his guns!

Medical world is learning the hard way the need to respect this capacity of the body and not to interfere too much too soon, hurting the native wisdom of the body and its in-built protective mechanisms, in our enthusiasm to intervene with modern gadgets and powerful drugs. Some examples would reveal the secret. Our present mindset of “a pill for every ill” and the “quick fixes” has to give place to our understanding that there is a self-regulatory compensatory phase inside the human body for every single alteration or accident!

Studies of sex workers in Nigeria and SanFrancisco have shown that there are many of them in the trade, on a regular basis, housed in the designated areas having “good business” who keep very good health, despite having more than 50% of their clientele with either full blown AIDS or, at least, the presence of the virus in the blood or semen! But the sophisticated classes of sex workers who operate from five-star outfits as and when they need an extra kick or buck do not enjoy this immune protection! The same calamity befalls the hapless victim of accidental exposure to AIDS virus! Oxford University has embarked on studies of the Nigerian prostitutes and the healthy ones from SanFrancisco to see if some sort of vaccine could be produced from the knowledge gained from such sex workers.

Children of migrant workers in Dakshina Kannada district originally from Northern Karnataka, whose parents have lucrative jobs to give them good food, mostly live on makeshift dwellings on the road side literally eating from the dirt, resist most of the communicable diseases much better than their cousins in clean and rich households! Extra clean surrounding might endanger children’s health by exposing them to new risks from ordinarily innocuous germs. Epidemics of viral appendicitis in British primary schools are one such example.

Caucasians exposed to falciparum malaria are likely to die most of the time, if not properly protected by drugs for prevention, as they had not been exposed this germ earlier. This is due to the lack of racial immunity. Similarly, when Europeans first come to the third world countries they would not be able to tolerate the drinking water that we all take without any harm.

Hostile environments make us acquire the capacity to genetically produce immunity against many adverse situations. The same mechanism could work against us under special circumstances.  East Africans living there have very little, if any, autoimmune diseases! The same people, who form the bulk of American blacks. There they live in a much cleaner environment without exposure to killer germs like malaria, filaria and others like in Africa. The one hundred-fifty odd genes situated in the long arm of the ninth chromosome exclusively looking after anti-body production against invading germs, at times, feel jobless in their new clean surroundings! They could unwittingly manufacture anti-bodies against body’s own cells, resulting in a very high percentage of killer autoimmune diseases in American blacks of East African origin! Strange are the ways of Nature!

Another glaring example is study of the death rate variations in grievously injured soldiers in the Vietnam War vis-à-vis the Falklands war. Whereas helicopter evacuations and immediate blood transfusions and warming were very common during the Vietnam War, during the wintry war in the Falklands those facilities were absent and the wounded soldiers were sometimes left to fend for themselves for long stretches of time in the cold! Curiously, the per capita death in the two groups showed that a much larger number of them survived the wounds in Falklands compared to Vietnam! One would not easily believe this, but this is the bitter truth.

While the body’s compensatory mechanisms, discussed above, helped wounded bleeding soldiers in South American Island front, effectively, the cold weather helped lower the basal metabolic rate thereby lessening the demand for oxygen to the tissues. In Vietnam the early human intervention with blood transfusion enhanced bleeding by displacing the clot and reducing vasoconstriction, the warmed up body increased the oxygen demand! This kind of mistakes occur many times in some other disease states in the intensive care settings.

Physiological heart failure is another good example. With its onset the sympathetic system remodels the heart and redistributes circulation, but chronic stimulation makes the same system destroy the heart muscle and enhance failure. If we use blocking drugs at the beginning to knock off the sympathetic system patients could die, but later use of the same drugs, when the body’s own protective mechanisms are exhausted, as in clinical heart failure, could save a lot of lives! One could go on and on. Every single intervention by man at the wrong time ends up killing more people than saving them.

It is high time that many of the hi-tech early interventions are properly and meticulously audited in the field before being sold in the market. One would be shocked to know that this does not happen most of the time because of the hype and greed. Newer interventions are touted as the new avatar of life saving God’s in technological form and are let loose on the gullible and demanding patients. It is better to remember the dictum that while it is the bounden duty of the medical profession to do its best for the suffering humanity, even when knowledge in that field is inadequate, it is a crime to intervene in the healthy segment of the population with newer technology or untried drugs, with the fond hope and assurance of averting long term danger when the latter interventions are not properly audited in that setting.

Times change and knowledge is bound to change, but wisdom lingers on. Study of this prayer of a wise physician of yore, Sir Robert Hutchinson, reveals it all.

Relevant today as it was then !