Summary :
The chapter presents a participatory medicine 2.0-3.0 conversation between 3 human online users, revolving around the concept of homeostasis in health and ill-health, with a focus on viruses and their critical illness effects on the body. It begins with a Web 2.0 query on email around how a virus may affect internal medicine homeostasis that is answered initially by human user 2, Hu2 , using Web 3.0, near semantic web driven LLM followed by Web 2.0 answers from Hu 3 and further questions and answers from Hu1 that appear to converge upon the fact that as medical educators, what we can do is to provide the foundations on the basis of which those who have the potential to become high caliber clinicians and researchers, can begin their journey towards the never ending goal of improving healthcare systems illness outcomes." Critical realist heutagogy CRH is a tool that enables one to practice life long self directed learning coupled with critical realism and can be utilised to focus on also developing a capacity for constructing and evaluating THEORIES in healthcare that would eventually go a long way to improving healthcare outcomes.
Abbreviations:
AQ: asked question
A: answer
Hu: human user
LLM: large language model
UDLCO glossary: https://
Web 2.0 conversational Transcripts:
Can someone help me (and possibly many others in this discussion forum) to understand the specifics of the causal mechanisms such that we can outline a theory of influenza?
Web 3.0 inputs through a human loop:
Hu2 AI LLM answer (concised):
Putting It All Together
Virus infects upper and lower respiratory epithelium → cell damage + PRR activation.
Cytokine storm (IL-1, IL-6, TNF-α) → fever, myalgia, fatigue, hea
dache, anorexia. Local inflammation in airways → mucus, vascular leak → runny nose, cough.
Hypothalamic reset via PGE₂ → chills → sweating.
This framework links the molecular virology of influenza to the systemic and local immune responses that manifest as its characteristic symptom complex.
Your entire email was the prompt :-)
Hu1) Oh!
I am beginning to see how we might be able to use ChatGPT as a Teaching Assistant for educators like us (if not as a Learning Assistant for prototypical students in schools and colleges.)
Would it be possible for you to generate a causal diagram to express what is said in prose by Chat GPT?
Hu2: Please see the diagram below -
My prompt was - " this is excellent. can you turn this into a mermaid causal diagram without sacrificing any info"
Web 2.0 conversational Transcripts:
Hu1: I just re-read the Chat GPT account. It uses the [X cause Y] relation, but not [X cause not Y] or [X prevents Y] relation. Nor does it use the feedback loop, negative and positive. As a result, it does not model the homeostasis of a healthy individual that remains healthy even after the viral inflection. Ill-health is deviation from homeostasis because of some dysfunctionality in the causal network.
We are working on a notation for causal logic and representation of causal networks, beyond what Chat GPT can currently do.
Hu 3: Good point to develop further:
"As a result, it does not model the homeostasis of a healthy individual that remains healthy even after the viral inflection."
Unquote from the previous email thread.
If you look at the left pathway (to the right of the reader) in the LLM's prompted diagram, it doesn't proceed to the adaptive immunity stage (as in the right pathway to the reader's left) but just stops at innate immunity.
"Ill-health is deviation from homeostasis because of some dysfunctionality in the causal network."
Unquote from the previous email thread.
I hope one can just read more about adaptive and innate from Google if one's not familiar with them but in this case (any flu like covid that can culminate in multi organ failure and death) , the major ill health is a deviation because of a hyperfunctioning causal network (particularly the adaptive immunity to the left of the reader viewing that diagram) and recovery is because for some reason in some individuals it doesn't get activated and doesn't function well.
Then there are individuals with comorbidities who we often find coming in with heart failure because of the increased demands made on it due to the fever causing tachycardia etc, sometimes even due to innate immunity and then doctors get foxed to think if they are dealing with a flu pneumonia or cardiac pulmonary edema, which is generally difficult to diagnose based on chest X-ray or HRCT alone.
Okay the above is just an apparent digression on one of our current projects, where we are trying to highlight this hitherto not well known , area of clinico radiologic dys-correlation in patients of influenza and heart failure with preserved ejection fraction (Hfpef ) due to metabolic syndrome comorbidities, masquerading as influenza pneumonia (more here: https://
but it was shared just to point out the clinical complexities with even something as simple as influenza (irritable bowel syndrome or fibromyalgia is much more complex).
We see these patients everyday in our practice and publish their data regularly but wish we could do more. The biggest problem in rational, data driven healthcare today is the lack of data capture tools and perhaps the near future will bring in Orwellian devices to reshape our current insights about real patient driven healthcare quite a lot.
Hu1 AQ: Could you tell me
1) what you mean by patient driven healthcare is, and
2) what kind of healthcare it contrasts with.
Given my understanding,
(a) medicine is shaped the need to heal patients, and(b) education is shaped by the need to help students learn.
So it is as odd to say
patient driven health care,asstudent driven education
Hu3 A: 1) Not sure if there's any such term called "patient driven healthcare," can't recall using it inadvertently but there are terms called patient centred healthcare aka person centred health care https://en.wikipedia.org/
2) Patient centered healthcare contrasts with doctor driven healthcare again to quote from one of our previous book's review rhetoric, "...as doctor-driven medicine sinks into disreputable old age, user-driven medicine is the hope of the future. This transition is already taking place across the world...and...a new kind of shared health care will emerge out of the current chaos not by the imposition of a single will, but through the shaping that emerges spontaneously from the creative efforts of many individuals and many different forces. The unprecedented privilege of our time is that we can each participate in this on a global scale. Unquoted from: https://www.igi-global.
Given my understanding,
(a) medicine is shaped by the need to heal patients, and it is odd to say "patient centered health care" as if healing could have had any other centre!
However as (b) education has increasingly been shaped by not the need to help students learn but to help the market forces to earn, these oddities as terminologies have slowly crept into our vocabulary as an expression of struggling patients voices globally.
In healthcare education, patient remains the primary beneficiary at it's centre while students, practitioners and other stakeholders driving healthcare remain secondary beneficiaries although this is not what modern market force driven healthcare and health education would want us to believe!
Hu1 A and AQ:
A: Okay, I understand now. Your contrast is in terms of who health care and education are for.
A) Patient centered health care, where patients are the only stake holders, and
B) Student centered education, where students are the only stake holders
both free of the market forces.
I am totally with you on this.
AQ background : I would now like to raise another question.
Please correct me if my impressions is wrong about this, but I get the impression that
your primary focus is gathering and documenting (and organising) data from a wide variety of patients in multiple contexts (e.g., in the context of interactions with clinicians, tests, interviews, self reports, reflections, ...).
Our goal on the other hand is to help students develop the capacity for inquiry and critical thinking in the domain of health, ill-health, diagnosis and prevention,- with focus on developing the capacity for constructing and evaluating THEORIES in this domain, such that- the students become high caliber clinicians and high caliber medical researchers.
AQ: Do you resonate to this perception?
A from Hu3:
High calibre clinicians and researcher have a higher quality of experience with rich contextual data surrounding the question that drives them.
Hence our focus on enabling our students to handle a rich tapestry of patient data using "critical realist heutagogy" CRH. More about CRH in the link below (recently accepted in the journal jecp, uk) where to quote, we try to illustrate a working solution to the current problem statement around fragmentation of medical education, research and practice bereft of contextual connections between it's real life primary beneficiaries (patients) and secondary beneficiaries (healthcare professionals). Unquote: https://
A from Hu1 beginning with a quote from the previous answer:
"High calibre clinicians and researcher have a higher quality of experience with rich contextual data surrounding the question that drives them. "
Hu1 A) Yes, but a single foundation course cannot ensure that. Not even an entire undergrad program. What we can do is to provide the foundations on the basis of which those who have the potential to become high caliber clinicians and researchers can begin their journey towards the never ending goal of becoming high caliber clinicians and researchers.
Hu1 AQ) May I recommend that YOU write a textbook for a course at an intermediate or advanced level, such that it includes all the data you have gathered, and takes the students through the kind of experience you expect of them?
Hu3 A ) Nailed it!
"What we can do is to provide the foundations on the basis of which those who have the potential to become high caliber clinicians and researchers can begin their journey towards the never ending goal of becoming high caliber clinicians and researchers."
This is exactly what CRH is all about in a nutshell! Practice life long self directed learning coupled with critical realism.
... is writing that book with our students. It will go into many volumes considering the amount of data we generate and archive regularly in it's current avatar as an open access online blog.
Hu1 A)
😀😀😀.
I will have a conversation with ... on how the book he is writing is connected to the book we have been writing.
Hu1 AQ in 3 parts:
Just one more question (Actually, three parts of a question).
In your earlier email, you talk about adaptive and innate immunities and co-morbidities.:
"If you look at the left pathway (to the right of the reader) in the LLM's prompted mermaid diagram, it doesn't proceed to the adaptive immunity stage (as in the right pathway to the reader's left) but just stops at innate immunity. "
"I hope one can just read more about adaptive and innate from Google if one's not familiar with them but in this case (any flu like covid that can culminate in multi organ failure and death) , the major ill health is a deviation because of a hyperfunctioning causal network (particularly the adaptive immunity to the left of the reader viewing that diagram) and recovery is because for some reason in some individuals it doesn't get activated and doesn't function well. "
"Then there are individuals with comorbidities who we often find coming in with heart failure because of the increased demands made on it due to the fever causing tachycardia etc, sometimes even due to innate immunity and then doctors get foxed to think if they are dealing with a flu pneumonia or cardiac pulmonary edema, which is generally difficult to diagnose based on chest X-ray or HRCT alone. "
My question in three parts, all tied up with homeostasis:
Part 1: Doesn't innate immunity come under the homeostasis of a healthy organism?
Part 2: Isn't adaptive immunity an instance of homeostasis resulting from an organism returning to homeostasis when there is an externally caused disruption of homeostasis, a return to a healthy balance after the loss of balance?
Part 3: Given that morbidity is illness, if we define illness as deviation from homeostasis (where homeostasis is one of the defining features of health), wouldn't co-morbidity be case of one already existing disruption of homeostasis causing another disruption in another domain in an interconnected system?
Hu 3 A :
Part 1: Doesn't innate immunity come under the homeostasis of a healthy organism?
Absolutely yes.
Part 2: Isn't adaptive immunity an instance of homeostasis resulting from an organism returning to homeostasis when there is an externally caused disruption of homeostasis, a return to a healthy balance after the loss of balance?
Yes and in the covid or other flu patients who die with multi organ failure, a return to healthy balance doesn't happen.
Part 3: Given that morbidity is illness, if we define illness as deviation from homeostasis (where homeostasis is one of the defining features of health), wouldn't co-morbidity be case of one already existing disruption of homeostasis causing another disruption in another domain in an interconnected system?
Absolutely nailed it with lots of room for thought!
Morbidity is an illness aka disease and one human system can have many morbidities like co authors authoring the system's journey/journal record as a team! Come to think of it every system, every life is a sexually transmitted disease with multiple life events representing a variety of it's morbidity spectrum also in an attempt to achieve homeostasis but this is a disease with 100% mortality. No one can survive life after a certain period.
Hu1 A:
Thank you.
All this has been helpful in constructing a theory of health and ill-health around the concept of homeostasis, which in effect is a specific case of dynamic equilibrium in the domains that are specific to life, mind and society.
Meta AI driven Thematic Analysis:
Coding
- *Homeostasis*: Central concept in the conversation, related to health and ill-health.
- *Immune System*: Innate and adaptive immunity are discussed in relation to homeostasis and disease.
- *Co-morbidity*: The concept of co-morbidity is explored in the context of interconnected systems and homeostasis.
Categorization
- *Theoretical Framework*: The conversation aims to construct a theoretical framework for understanding health and ill-health around the concept of homeostasis.
- *Immunological Concepts*: Innate and adaptive immunity are discussed in relation to homeostasis and disease.
- *Clinical Complexity*: The conversation highlights the complexity of clinical cases, particularly in patients with co-morbidities.
Learning Points
- *Understanding Homeostasis*: The conversation emphasizes the importance of understanding homeostasis in health and ill-health.
- *Interconnected Systems*: The discussion highlights the interconnectedness of systems in the body and the impact of disruptions on homeostasis.
- *Theoretical Frameworks*: The conversation demonstrates the value of theoretical frameworks in understanding complex clinical phenomena.
