Posts Tagged ‘Thomas Kuhn’

Vassar College, Paradigm Shifts, and Crohn’s Disease

April 15, 2012 12 comments

You can’t make this stuff up…so here goes:

In 1978 I was a junior at Vassar College. One of my favorite classes was “The History of Science” taught by James Challey. This was a high level seminar type class where about a dozen students sat around a table and had critical conversations about the books we were reading. The most important book we discussed in detail was The Structure of Scientific Revolutions (1962), by Thomas Kuhn. The core concept was the idea of Paradigm Shifts that have occurred marking the often rocky transition from one way of thinking about science to another. Key examples included the transitions from thinking that the world was flat…to round, that the earth was the center of our universe…to the sun. A modern example would be ulcers being caused not by stress, but by a bacterial infection. Deeply entrenched scientific thinking about the way the world actually works has been dead wrong before…and often.

These were interesting ideas and ways of thinking about the world that I had stuck somewhere in the back of my mind for decades. Then when my daughter was diagnosed with Crohn’s in 2004 and I read Elaine’s book, Breaking The Vicious Cycle….and learned that the medical standard of care for Crohn’s didn’t even consider diet all, I was conflicted. I wondered, could it be possible that Elaine was ushering in some kind of Paradigm Shift in medicine? Unfortunately, I couldn’t find much real scientific evidence at the time but her argument sounded logical…so we tried SCD, and it worked! From there I became an SCD evangelist, but much of it was on faith.

About 2 years ago I stumbled into the Paleo Diet world of Loren Cordain and Robb Wolf. Their diet plan was very similar to SCD, but their argument about why diet mattered was different. It was deeper. It was couched in the framework of evolutionary biology. The very idea that diet is a critical part of the evolution of humans and that key changes in diet since the agricultural revolution…and in the last 50 years, are the underpinnings for most chronic diseases was intriguing. Robb Wolf reminded us, with a great post he called “Framework Matters” that it was more than strange that modern medicine & nutrition is not viewed within the framework of evolutionary biology. He quoted Cordain who argueed:

“In mature and well-developed scientific disciplines there are universal paradigms that guide scientists to fruitful end points as they design their experiments and hypotheses. For instance, in cosmology (the study of the universe) the guiding paradigm is the “Big Bang” concept showing that the universe began with an enormous explosion and has been expanding ever since. In geology, the “Continental Drift” model established that all of the current continents at one time formed a continuous landmass that eventually drifted apart to form the present-day continents. These central concepts are not theories for each discipline, but rather are indisputable facts that serve as orientation points for all other inquiry within each discipline. Scientists do not know everything about the nature of the universe, but it is absolutely unquestionable that it has been and is expanding. This central knowledge then serves as a guiding template that allows scientists to make much more accurate and informed hypotheses about factors yet to be discovered.

The study of human nutrition remains an immature science because it lacks a universally acknowledged unifying paradigm (11). Without an overarching and guiding template, it is not surprising that there is such seeming chaos, disagreement and confusion in the discipline. The renowned Russian geneticist Theodosius Dobzhansky (1900-1975) said, “Nothing in biology makes sense except in the light of evolution” (12). Indeed, nothing in nutrition seems to make sense because most nutritionists have little or no formal training in evolutionary theory, much less human evolution. Nutritionists face the same problem as anyone who is not using an evolutionary model to evaluate biology: fragmented information and no coherent way to interpret the data.”

I was impressed. Not only in that concept of Paradigms discussed, but in holding up the framework of evolution as a guiding theory, it also calls into question the answers that come out of modern medicine that ignores it.  A plausible explanation of how and why modern medicine could be dead wrong about how chronic disease works…and how Elaine could have been right all along.

Then Robb Wolf introduced me/us to Alessio Fasano of UMaryland. For about a decade, Fasano, who focuses on Celiac disease, has been using the model of Celiac and the role of intestinal barrier function to explain the biologic door to not only Celiac, but virtually all chronic diseases. Fasano’s work is really blockbuster stuff. He makes his case using evolutionary biology as a key part of his framework…but he goes further. In his critical paper on Intestinal Barrier Function he reaches back to Kuhn and uses his language of paradigms to explain what is going on.

“Zonulin and Its Regulation of Intestinal Barrier Function: The Biological Door to Inflammation, Autoimmunity, and Cancer. — Together with the gut-associated lymphoid tissue and the neuroendocrine network, the intestinal epithelial barrier, with its intercellular tight junctions, controls the equilibrium between tolerance and immunity to non-self antigens.  When the finely tuned zonulin pathway is deregulated in genetically susceptible individuals, both intestinal and extraintestinal autoimmune, inflammatory, and neoplastic disorders can occur. This new paradigm subverts traditional theories underlying the development of these diseases and suggests that these processes can be arrested if the interplay between genes and environmental triggers is prevented by reestablishing the zonulin-dependent intestinal barrier function. This review is timely given the increased interest in the role of a “leaky gut” in the pathogenesis of several pathological conditions targeting both the intestine and extraintestinal organs.”

I knew with this study that we really were witnessing a true paradigm shift in the understanding of chronic disease. I knew that with this new line of research that I could be confident that the “standard of care” really is simply wrong and dangerous. And that I could be confident even when arguing with GIs about what is really going on and what to do about it. It really is amazing how much supporting research there is that explains the connections between intestinal barrier function and disease.

The next twist in the ongoing story is the fun part. We’ve been going through the college search process for our daughter for the last 2 years now. And last week, the decision was Vassar, class of 2016. When we visited Vassar last week she got to meet Jim Challey who is retiring next year – He’ll still be there for her Freshman year.  It turns out that Jim Challey was not only that professor that introduced me to the possibility of Paradigm Shifts, but he was a direct protege of Thomas Kuhn himself at Princeton. Like I said, you can’t make this stuff up.