289. Root Cause Analysis

Background
Food safety is a serious business. If a company produces a food item that is subsequently found to have harmed those who consume it, this is very bad news. Customers lose faith and sales are likely to suffer. Even worse, the retailer may terminate the supplier contract, which may mean that the business collapses. Hence considerable efforts are made to ensure that any breaches of food safety standards are kept to a minimum. When something does go wrong it is far too easy to blame an individual worker for a failure to follow procedures. However it is now recognised that there may be a lot more to the problem than this. The procedure may be difficult to follow, the operative may be confused or have other pressures. It is not uncommon for the need to meet a deadline to undermine the priorities that should be given to food safety issues. Hence many companies now emphasise the importance of “Root Cause Analysis” in order to address this aspect.
Coping with disease
In a previous blog, I compared diabetes, which is excess sugar in the blood with a flood of water in a house because of a leak in the water supply system (1). This illustrates very dramatically the failure of the conventional treatment of type 2 diabetes (T2D) because there is normally no attempt to stop the excess sugar entering the body. Any plumber who used this approach to cope with a house flood would be regarded as incompetent. I was simply trying to demonstrate the futility of treating the symptoms without any attempt to address the fundamental cause. So it follows that Root Cause Analysis is just as critical in the treatment of disease as it is in maintaining standards of food safety.
Unfortunately this comment is not limited to diabetes and is applicable to many diseases. Looking on the positive side, there has been tremendous success in the treatment of the infectious diseases with the use of antibiotics. There is no question that the cause is an infectious agent, which is usually knocked out by treatment with a specific antibiotic. By contrast, many of the common chronic diseases such as cancer, heart disease or Alzheimer’s Disease do not have an easily identifiable cause. To the best of our knowledge there are probably several different factors, which cause damage to various organs that may not be readily reversed. Hence, the predominant strategy is to focus on symptoms and/or surrogates such as cholesterol levels or blood pressure (BP).
The rationale, which provides justification for the use of statins, is that the cholesterol concentration in the blood (TC) is a risk factor for heart disease. Therefore it is argued that because statins lower the TC, then it must follow that the risks of developing heart disease are reduced and this is beneficial for the patient. In reality this “logic” is badly flawed. First, we now have comprehensive reliable evidence that the TC is not a valid risk factor for heart disease. Second, even if it was, the fact that a drug lowers it does not necessarily mean that the risk of heart disease has also been reduced. Third, we know that statins lower TC by suppressing the output of CoQ10. This is a substance that also plays a key role in the production of Vitamin D and some of the hormones. This fact alone ought to have thrown up warning signs to the regulatory agencies because statins may very well cause collateral damage (adverse side effects) that would have to be set against any benefits.
If we really wish to make progress then it is critical to identify the fundamental cause and take appropriate steps to deal with it.
Identifying the primary causes
Despite the apparent difficulties, there has actually been considerable progress in our understanding of how diseases are initiated and maintained. It is somewhat revealing that some of the major contributions have been made by engineers (2) who are regularly faced with producing answers to incidents that happen in the real world. Examples include the collapse of bridges, the failure of engines and the breakdown of manufacturing systems. When a person suffers from a disease there are lots of changes within the body that can be measured. The interpretation of this information is the key to understanding the disease and what causes it.
A good example: T2D
In T2D, a raised BG is a good reliable indicator of the presence of the disease. According to the official NHS Diabetes Prevention Programme here in the UK, T2D is defined as a:
“condition of insufficient insulin production”.
Hence this provides the justification for treatment with insulin, which is ultimately what happens with most patients that suffer from the disease. It seems unbelievable that there has been a complete failure to ask what caused the raised BG in the first place. In fact, the answer is obvious…..a diet that contains a high content of sugar and carbohydrates, which are broken down to produce the glucose that appears in the blood. Once that simple fact has been appreciated, it follows logically that the way to cope with T2D is to restrict the consumption of these dietary constituents. There is overwhelming evidence from reliable research and thousands of individual case histories that this approach is extremely successful.
However there is a lot more to it than this. We now know that it is not only the raised BG but also the high concentrations of insulin in the body that is damaging. This is because it causes the condition of insulin resistance (IR). Although insulin is essential, excessive amounts are effectively “corrosive” and so the various organs develop IR as a form of protection. Unfortunately this can be the starting point for a number of different diseases including heart disease, cancers, hypertension, stroke, Poly Cystic Ovarian Syndrome (PCOS), Non-alcoholic Fatty Liver Disease (NAFLD), sleep apnea and possibly Alzheimer’s Disease(3). This demonstrates the futility of treating the patient with even more insulin. It does not take a genius to work out that this will make things very much worse for the unfortunate patient.
The significance of IR from a conceptual perspective is that it provides a straight forward understanding of the relationships between many different diseases. If this can be tackled then the health benefits are enormous. Hence the totally convincing justification for adopting a diet that is low in sugar and carbohydrates.
Conclusion
This is just one example of how modern medicine gets the treatment of disease so badly wrong. We could speculate why this happens. Clearly there has only been a focus on a very limited part of the big picture but there must be very strong suspicions that any treatment involving the use of drugs is promoted very powerfully by the pharmaceutical companies. By contrast, a lifestyle change does not receive anything like the same backing. The good news is that a growing number of people are becoming aware of all these issues, which is helping to achieve change but there is still a very long way to go.
References
1. https://vernerwheelock.com/259-diabetes-is-a-flood-of-sugar/https://vernerwheelock.com/259-diabetes-is-a-flood-of-sugar/
2. https://vernerwheelock.com/285-the-contribution-of-engineers-to-nutrition/
3. G. M. Reaven (2009). Cell Metabolism 1 (1) pp 9-14