Heaptology

Exhalation of14CO2 in breath has been used to assess the rate of hepatic demethylation of (14C-dimethyl)aminopyrine, but due to the complexity of aminopyrine metabolism the pharmacokinetics of the procedure are insufficiently understood. Therefore, studies were performed in five individuals after oral administration of (14C-methoxy)glycodiazine, a model substance with relatively simple kinetic properties. Plasma concentrations of the drug and urinary output of its metabolites measured by high pressure liquid chromatography were analysed by a two-compartment open model. The terminal disappearance of14CO2 from breath was practically identical with the terminal disappearance of glycodiazine from plasma, which could be correlated with the plasma clearance of free glycodiazine. The mean transit time of14C-atoms from plasma to breath was 3 h. These results contribute to the pharmacokinetic basis for use of14C-demethylation breath tests. In particular, they are consistent with the hypothesis that14CO2-breath analysis may be used to assess certain pharmacokinetic parameters of appropriately labelled test compounds. These parameters may not necessarily be a direct reflection of the rate of demethylation.

We have studied the systemic availability of oral albendazole in 6 patients with echinococcosis either fasting or with breakfast. Albendazole sulphoxide, the pharmacologically active principle, was assayed by HPLC. Mean plasma concentrations and AUCs were 4.5 times higher when albendazole was given with breakfast than when administered in the fasting state. We conclude that therapy of echinococcosis with albendazole requires the drug to be taken with meals and that administration on an empty stomach might be more appropriate when intraluminal effects are desired, e.g. for intestinal parasites.

A multifactorial and growing crisis of health care systems in the developed world has affected medicine. In order to provide rational responses, some central concepts of the past, such as the definitions of health and disease, need to be updated. For this purpose physicians should initiate a new debate. As a point of departure the following definitions are proposed: Health is a dynamic state of wellbeing characterized by a physical, mental and social potential, which satisfies the demands of a life commensurate with age, culture, and personal responsibility. If the potential is insufficient to satisfy these demands the state is disease. This term includes sickness, illness, ill health, and malady. The described potential is divided into a biologically given and a personally acquired partial potential. Their proportions vary throughout the life cycle. The proposed definitions render it empirically possible to diagnose persons as healthy or diseased and to apportion some of the responsibility for their state of health to individuals themselves. Treatment strategies should always consider three therapeutic routes: improvements of the biologically given and of the personally acquired partial potentials and adaptations of the demands of life. These consequences favourably contrast with those resulting from the WHO-definition of health.

Abstract The Millennium Development Goals (MDGs) mobilized global commitments
to promote health, socioeconomic, and sustainable development. Trends
indicate that the health MDGs may not be achieved by 2015, in part because of
insufficient coordination across related health, socioeconomic, and environmental
initiatives. Explicitly acknowledging the need for such collaboration, the Meikirch
Model of Health posits that: Health is a state of wellbeing emergent from conducive
interactions between individuals’ potentials, life’s demands, and social and environmental
determinants. Health results throughout the life course when individuals’
potentials – and social and environmental determinants – suffice to respond satisfactorily
to the demands of life. Life’s demands can be physiological, psychosocial, or
environmental, and vary across contexts, but in every case unsatisfactory responses
lead to disease. This conceptualization of the integrative nature of health could contribute
to ongoing efforts to strengthen cooperation across actors and sectors to
improve individual and population health – leading up to 2015 and beyond.

This paper explores the diagnostic and therapeutic potential of a new concept of health. Investigations into the nature of health have led to a new definition that explains health as a complex adaptive system (CAS) and is based on five components (a-e). Humans like all biological creatures must satisfactorily respond to (a) the demands of life. For this purpose they need (b) a biologically given potential (BGP) and (c) a personally acquired potential (PAP). These properties of individuals are embedded within (d) social and (e) environmental determinants of health. Between these five components of health there are 10 complex interactions that justify viewing health as a CAS. In each patient, the current state of health as a CAS evolved from the past, will move forward to a new future, and has to be analyzed and treated as an autonomous whole. A diagnostic procedure is suggested as follows: together with the patient, the five components and 10 complex interactions are assessed. This may help patients to better understand their situations and to recognize possible next steps that may be useful in order to evolve toward better health by themselves. In this process mutual trust in the patient-physician interaction is critical. The described approach offers new possibilities for helping patients improve their health prospects.

Das Meikirch-Modell definiert einen Menschen als gesund, wenn er in der Lage ist, die Anforderungen des Lebens zu erfüllen. Um dies zu realisieren, verfügt jeder Mensch über Ressourcen, d.h. über ein biologisch gegebenes und ein persönlich erworbenes Potential, die beide dauernd mit der Gesellschaft und der Umwelt in Verbindung stehen. Politik, Forschung und Therapie haben sich bisher vorwiegend auf das biologisch gegebene Potential konzentriert und die anderen Aspekte der Gesundheit mehr im Hintergrund gelassen. Wird das sowohl in der Public Health als auch in der Individualmedizin ausgeglichen, darf erwartet werden, dass sich die Gesundheit der Menschen deutlich verbessert und sich die Gesundheitskosten ent-sprechend vermindern.