By recognizing that the body functions like a complex machine, one that is an integral part in the production process of any activity we engage in, it is possible to develop an improved understanding of the body’s role in the recovery process and the likely benefits and costs of any diagnostic or therapeutic intervention.
In order to survive, mammalians must able to adapt to the environment. Humans are no exception. Doing so requires getting enough pure air, clean water, food, rest, clothing and shelter to maintain their body temperature and perform other necessary functions. They must also be able to protect themselves and their offspring from the elements, any predators and poisonous or infectious agents. Survival requires being able to do that from day-to-day and year-to-year, over one cycle into the next and from one generation to the next. Survival also mandates that they adapt to changes in the physical, social and cultural environment. On a daily basis the first order of business is to provide ourselves with enough water, air, food, rest and shelter — the basic inputs — to sustain ourselves. As humans, we have developed mechanisms to help accomplish that. (See David Attenborough, The Life of Mammals)
First let us develop a clearer understanding of how the body is like a complex machine and how it is an input in any production processes of any tasks or functions we, as humans perform. From that perspective we will see how that influences the understanding of our interaction with and relationship to the health-care system.
As a complex machine
Let us, for the moment, treat the body as if it were isolated from the physical, social and cultural environments. That will allow us to better understand how it functions. As with all other mammals the human body is like a complex machine with multiple interrelated parts. To keep it constantly running requires the basic inputs be added over time in appropriate amounts. When that happens the system maintains itself and performs well. Inside the body the inputs are processed. They are broken down into their components — aka metabolized. The chemical entities are absorbed into the system and transported to the various parts of it. There they interact with the body parts, do what they do and to contribute to physical, psychological and emotional responses. Those responses are the favorable and unfavorable outcomes of the process. Any residual entities are stored for future use or excreted. For example, once food is taken into the body it must be digested — that is, broken down into its various chemical components; where they are then transported to the various parts of the body and can have their effect. They interact with those body parts, like muscle and the brain, and each body part does its job, like moving or thinking. Any component of the input that is not used — the waste products — is transported from the site and excreted. That is the production process that takes place within the body. It allows the body to sustain itself and perform its functions. Thus the body functions as a complex machine which utilizes the production process internally to sustain itself. It is also an integral part of broader processes, like preparing a meal or writing this paper. As with any production process it requires a flow of inputs over time that are ultimately transformed into the final output(s).
The body — a closer look
Let’s take a look at how the bodily machine functions and some of its unique attributes. As with all other mammals the body’s primary function is to sustain life. Being able to do that depends on the body’s requirements, its abilities and skills and whatever the environment has to offer. Once our bodies have accomplished that, with whatever time, energy and resources that are left we can do other things, perform other functions. One attribute that makes it easier for the body to do that is its ability to store inputs — like, energy from food and information from prior experience — and make them available for future use. In addition, warning systems and feedback mechanisms have been developed to let us know when the basic inputs need to be replenished.
Imagine walking into a smoke-filled room. The person who lit the fire in the fireplace forgot to open the flue or the chimney was clogged. You gasp. Your first reaction is to get out. Or, perhaps, to open up the window and let the smoke out. The smoke is an input into your body. It threatens your survival. You react immediately in order to get air. Other warning signals include thirst, hunger, drowsing off at the wheel, the sex drive, etc.When each of those signals comes up, if the body is preforming as it was designed to and if we pay attention, we know what to do. Without the inputs the body is signaling for, it cannot function at optimal performance. In order to return to that level additional inputs are required. (See The Internal Adjustment System: A closer look for an additional discussion of the body’s adjustment mechanisms.)
One of the interesting consequences of this way of looking at how the body works is to realize that it does not perform at its peak, or even at constant levels, all the time.When the body is low on food or lacks sleep, it simply cannot perform as well. Here are some examples.
Whenever my son, Paul, was hungry he couldn’t decide what he wanted for lunch. Or, like me, have you ever been unable to remember someone’s name at night when you were tired, but when you woke up in the morning it was right there? (See Variation in the Ability to Perform).
When the missing inputs are provided, functioning improves. That variation occurs during any time period, during each cycle — hour-to-hour, day-to-day or month-to-month, etc. Like any other machine the body can also breakdown. It could be the result of wear and tear or an accident or aging. When it does, unless it is repaired, it will not function at its previous level. Repair or preventive maintenance require additional inputs. It may be possible to partially compensate for some of the deficit by adding extra inputs. Hearing aids and nutritional supplements, like antioxidants are examples.
Unlike most machines the body has a special characteristic. It has the ability to repair itself. When dirt, debris or foreign matter gets into a machine that hinders its performance. In order to return to normal functioning the machine must be repaired. For some intrusions the body is self-healing. A simple cut or bruise is an example. All that is required is that the basic inputs be provided and in time the system returns to normal. Sometimes adding additional inputs can facilitate the process, speed it up or make it less painful.
Problem solving and decision-making
Problem solving and decision-making are important human functions. At different times in our daily cycle, and at other points in the lifecycle, when there are input deficiencies, we are less able to make those decisions. (See Variation in the Ability to Perform for some examples). We get what those who study decision-making call ‘decision fatigue.’ The choices we make under those conditions are less than optimal — poorer than they would be if the body were performing at higher levels. Remedying that requires additional time, energy and resources. Without them the outcomes are less satisfactory.
Adjusting to changes in the environment
If environmental conditions change, the body’s first priority is to adjust to them ensuring it gets the basic inputs. In the 1930’s for those in the Southern Great Plains innovative farm equipment made large scale farming practical and profitable, farming practices decimated the soil, seven years of severe drought, high winds and a major economic depression had devastating effects. Ken Burns’ documentary film, “The Dust Bowl” chronicles what happened. He shows what occurs when farmers were unable to provide the basic inputs for themselves or their families. The consequences were profound. Survival required adapting to the new conditions.
In the final analysis, the body is like a complicated machine whose internal workings are not yet fully understood. For example, just recently Drs. Lefkowitz and Kobilka were awarded the 2012 Nobel Prize for showing how protein receptors work. That improved our understanding of how the bodily machine functions. One of the things that is not well-understood is the role of sleep in the body’s recovery process. (‘I’ll Sleep When I’m Dead‘ … And Other Myths, PBS Newshour, November 15, 2012) There is still more to learn.
As part of any production process
Along with our mammalian cousins, adult humans have numerous functions and tasks to perform. The complex body machine is one of the inputs in the production processes of those tasks or functions. Before participating in them the first order of business is to do whatever is necessary to sustain ourselves, to ensure that we get enough of all the basic inputs and whatever others that are required. If the body requires any additional inputs to be able to perform the functions and tasks, they must be supplied as well.
The tasks could be the preparation of the family meal, driving a delivery truck, being a farmer, miner or computer programmer, giving birth to a healthy baby or any other of the multitude of tasks and functions we perform during our lives. Achieving the desired outcome requires the successful performance of the functions. All the while it is necessary to get enough water, food, sleep, etc. requires to sustain ourselves. Moreover, we must have enough time, energy and other resources left over to perform the other tasks. The more specialized we become, the more we must rely on others to provide the basic inputs. Blacksmiths, massage therapists or computer programmers have to trade for or buy their basic inputs. Some farmers, gardeners or cooks can provide some of them for themselves. When specialized skills are required to perform a task it is necessary to acquire and maintain them. Education and training are a prerequisite to successful performance. During training the basic inputs must be provided by working part-time, from funds that have been set aside or are borrowed or from a subsidy or gift.
It is important to remember, as we have shown above, that even when the body is performing normally it cannot and does not perform at a constant level. Its performance varies depending on the time of day, the day of the week or month, etc. When called on to perform, experience and enough stored energy are necessary prerequisites. Without them a lion would not be successful in making the kill and getting enough food to survive.
When the output of those tasks are not directly related to providing the basic inputs, two things must happen. First, and foremost, the time, effort and resources necessary to acquire the basic inputs, like food and sleep, must still be available. And second, the income and the other rewards a person receives from their contribution to the production process must be sufficient to obtain the basic inputs. The rewards must make it possible them to purchase or exchange for the goods and services necessary to sustain life. Hopefully, they can do a good bit better than that. Their share for that effort can either be provided in money or in goods or services. For example, if you are a massage therapist you can either be paid for your services or get a massage in trade. Based on our understanding of the body as a complex machine and how it is an input in the performance of subsequent tasks and functions, let us examine its interaction with and our relationship to the health-care system.
The body’s response to medical intervention
In addition to the goods and services doctors and other health-care professionals have to offer, they also provide information, advice, support and caring. Health-care services include blood draws, x-rays, CAT scans, ultrasounds, MRIs, surgery, adjustments, prescription or OTC drugs, supplements, etc. Each of those diagnostic tests or therapeutic procedures is an intervention into the body’s system. Let us take a closer look at how those interventions affect the body’s functioning.
Looking at it from the perspective that the body is a complex machine, any diagnostic or therapeutic intervention adds inputs. They modify the body’s functioning. After the input is integrated into the body, the system must adapt, adjust to or recover from the intrusions. Some interventions change the body’s structure, like the removal of the gall bladder or appendix. The first step is to recover from and adjust to the surgery. It alters the way in which the body functions. All other interventions, once they have been integrated into the system, affect the way in which the body performs. An example is taking an aspirin or Tylenol for a headache. Once it takes effect and relieves the pain, that makes you more comfortable and better able to focus on your tasks. If there are no side effects — no unfavorable outcomes — then until the medication wears off you are better off. Another simple example is any surgery. Once an incision is made, whatever else the system must do, it must recover from the incision. During recovery the body requires its basic inputs, and perhaps others as well. Before full recovery the body is unable to function as it did previously. After it, either the system returns to its previous equilibrium and can perform the functions and tasks it did previously or not. When a new steady-state condition, a new “normal,” is involved the body must adjust to the changes. Any diagnostic or therapeutic intervention brings along with it additional inputs. The body’s response to the intervention is an integral part of that process. It makes no difference whether the processing takes place inside the body or whether the production process is one in which the body machine serves as one of the inputs.
As with any production process there are a series of steps along the way. You move along the path to the next phase in the process. You get those inputs and the body responds by processing them into intermediate outcomes/outputs. Along with that output, at the next step other inputs are added. And so it goes until the system has recovered and you are back to your normal routine, your equilibrium state, or you arrive at a new normal. The diagnostic or therapeutic interventions are similar in other respects as well. Procedures alter the body’s structure and/or its performance. Tests provide information that helps in making subsequent decisions. Each affects the next step in the process. Each step becomes the decision point or node for the next phase. At each node there are typically a number of options. Each has its likely outcomes (and the probabilities associated with them.) Some outcomes are favorable, others unfavorable. Some are expected, others not. One outcome is the payments for any services that were provided. In order to decide which path to take, it is necessary to understand its likely benefits and costs. The best path is the one where the net benefits – that is, the benefits minus the costs – are the greatest from your perspective as the patient/consumer.
You are slicing potatoes for dinner. The knife slips and cuts your hand. You stop, go to the bathroom, rinse off the wound, apply pressure to help stop the bleeding, get and apply a bandaid returning to your task. You keep the cut clean and as dry as possible. In a few days it heals and there is no evidence that you ever had a problem.
Here’s a more complicated one:
The cut on your hand is deep. The bleeding is profuse. The pressure slows the bleeding but does not stop it. Gauze pads soak up the blood. The cut looks like it might require stitches.It is Saturday evening. Your doctor is not available. That means you must go to an urgent care facility or the ER. You call the friend who is coming over for dinner. She takes you to the ER. You wait and she waits with you. Finally you get to see a doctor. Sure enough, she says stitches are required to promote the healing. She sews up the wound and bandages it, gives you an antibiotic and a prescription to take it for 10 days to prevent infection. She tells you to keep it clean and dry for three days and sends you home.Your friend drives you back, finishes dinner preparations and serves it. She does the dishes, too.The cut and the bandage inhibit you for about a week. You continue on antibiotics and change the bandage every day but for the most part you can take care of yourself. The wound heals and you are back to normal as if nothing had happened. Except, of course, there is the bill for the hospital and for the prescription. And, perhaps the lesson that next time you slice potatoes you will be a little bit more careful.
For each of those experiences the process is the same. At each step along the way — at each node — there is a choice of which path to take. For example, you could have decided not to seek help or to go to the urgent care instead of the ER. Or you could decide not to take the antibiotic. Had you not sought help, the healing process, the interim debility and the likelihood of infection, would have been different. Certainly each choice has a different pattern of interventions requiring differing inputs and with differing intermediate, and potentially long-term, outcomes. In short, it would have been a different path along with different health-care services and goods and differing resources required to produce them. The amount you have to pay for the goods and services would differ as well. The benefits and costs of each path are different and once you take any path, those are the outcomes and the associated benefits and costs that you incur. While it might be difficult to determine the real and financial costs associated with any intervention, nonetheless they will be there and they could well be significant.
The system’s response to illness
Illness is any breakdown in the bodily system that impairs its functioning. It could be the result of trauma, failure to get enough of the basic inputs, disease, infection or aging. Whatever the cause the body is less able to do whatever it does and that includes taking care of one’s self. It can also lead to impaired decision-making, making it more difficult or even impossible. Interventions are intended to improve its functioning. Nonetheless, as we have shown, at least in the short term, any intervention must be integrated into the system, and requires the system to adapt to it. Consequently, it could be considered an induced illness. Even though it is intended to improve the situation, it is important to remember, that the intervention, by its very nature, is likely to have both favorable and unfavorable outcomes. That makes it necessary to decide whether having it is worthwhile — that is, whether the favorable ones are greater than the unfavorable ones. Being able to make that assessment beforehand is easier when the production process and its outcomes are well known. And even then there can be glitches. It is quite a different matter when they are not well understood. Under those circumstances it is hard to know beforehand what the outcomes of any intervention will be. That applies to the internal body processes and the others as well.
A realistic appraisal of the likely outcomes and their benefits and costs from the patient/consumer’s perspective is helpful in making that choice. It is important to remember that once a decision is made and the action taken, he/she will be faced with the favorable and unfavorable consequences. As with any illness the recovery process requires time and supporting the body in the interim. Along the path to recovery there are a number of factors that are involved:
- The medical interventions and self-healing that takes place.
- The extent to which the individual cannot take care of him/herself, perform household tasks or do one’s job and the assistance of others to fill the gap.
- During the recovery period the increase in expenditures and/or the decrease in income that affects one’s budget.
This happens in every recovery. It is all part of the recovery process and the consequences of any intervention. Importantly, every intervention requires additional inputs. They are supplied by the doctors and other health-care providers. In reality they are a part of the PhysicianFirm that they represent and are members of. The suppliers of alternative health-care services, like chiropractors, acupuncturists, massage therapists, herbalists and healers, provide their inputs. They are also supplied by hospitals, pharmacies, pharmaceutical companies and medical equipment manufacturers. Producing the inputs requires someone’s time and energy, and the materials and supplies. All that must be paid for. Each of those firms is interested in their bottom line — that is, ensuring that their revenue exceeds the costs of production and distribution. The patient/consumer’s payments to those firms are the financial or dollar cost of the intervention. There are other real costs as well. They include the pain, suffering and diminished ability the patient/consumer incurs during the recovery process. All are part of the cost of illness. In order to be worthwhile, the benefits must exceed the costs.
The relationship to other systems
With each input the body uses, it interacts with another system or subsystem. That is true for the air we breathe and the carbon dioxide we exhale, for the water we drink and the food we eat. With food, for example, we are hunter-gatherers, gardeners, farmers or buyers from firms in the economic system. In each of those cases the body is no longer functioning in isolation but rather as part of a larger system and as an integral part of its production process. That is equally true for the physical, social and cultural systems which we are a part of. The body is like a complex machine operating within a larger one where the final output depends on both working well.
In understanding the process of recovery it is important to remember that the body is a complex machine that is an integral part of the production process. Any intervention affects the system, its response and the outcomes. All are an integral part of the process. Some of its responses and outcomes are not predictable beforehand. In the end, however, the path that is chosen determines how successfully and rapidly we get back to our daily routine and the cost of getting there. This approach largely treats the body in isolation. Its principal interaction with other systems is with the health-care system since it delivers the services and goods involved. As with other mammals, to survive we live within, interact with and are influenced by the broader physical, social and cultural environments. In fact, each of us is an integral part of those systems. The decisions and choices we make are affected by our relationship with and understanding of those environments.