Owen Yang
The entire medicine has been dominated by discrete categories and definitions.
Diabetes is defined as blood glucose or glycated haemoglobin levels above a certain cut-off point level. Hypertension is defined a blood pressure above a certain level. Liver function is abnormal when it is above a certain level.
Lack of natural boundaries in the definition of many diseases
Those with blood glucose near the level of diabetes definition are found to have some diabetic feature and therefore is again ‘re-defined’ as pre-diabetes. The association between blood pressure and cardiovascular outcomes is more or less linear, and therefore taking antihypertensive medications to lower blood pressure can reduce cardiovascular risks even when the blood pressure is already normal before antihypertensive medications are taken. Statin seems to reduce cardiovascular risk regardless of the cholesterol level before statin.
Human brain to process categories: is it nature or just a historical phase?
Many definitions are given mainly because we are educated in a way that we can only process categorical questions. Who is responsible for this? Is this right or wrong? Are you guilty? Do I or do I not have the disease? Is this really what human is naturally born to process? Throughout the history, we have learned to become literate and numeric. Will be ever be educated to stop assuming everything is naturally categorical? How to we evolve quickly so that we can process multiple contributing factors and multiple risks?
Because if we don’t, the AI (artificial intelligence) could get ahead of most of us very quickly. I see no reason AI needs to follow our categorical rules to make sense of the world. It will be up to the AI to create the concepts that will become beyond our comprehension, and reason the world with these hidden concepts that we cannot comprehend.
The definition of definition
I do feel the word ‘definition’ in English implies creating the boundary of a concept, but I can tell you at least in Chinese it does not imply anything about the boundaries of a concept.
I would say it is helpful to understand and define categories when they are extremely typical. It is generally not helpful to argue about where the boundaries of a definition or a category is. For example, when someone has a very high blood sugar for a period of time, has typical symptom of diabetes, has no other causes that may explain diabetes, and seems to respond well to diabetes management, this person is typical for having diabetes. By contrast, there is really of little point arguing whether someone sometimes has borderline blood sugar levels has diabetes. Not being able to ‘categorise’ this person should not affect the quality of the definition of diabetes. This goes the same with many other physical or mental definitions, such as depression, anxiety, or cognitive impairment.
However, with the current framework of logistic sanity, they have to either have diabetes or not have diabetes, which determines the algorithm they have to follow in the medical universe.
