An introduction to pathology: get your dose of VITAMINS


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French fries, tater tots, baked potato, hashbrowns: which would you get rid of and why?

Unpopular opinion, potato edition. French fries. This question has ruined many of my friendships and shattered even the most stable relationships within my family. I just don’t like french fries that much and I’m going to stand firmly by my decision (sorry dad). On the contrary, though, if you were to give me a few beers and then put a large order of animal style fries from In-n-Out in front of my face... you might just get a different answer.
— Daniel Chapman

Photo credit: Goh Ray Yan

Photo credit: Goh Ray Yan

Since the dawn of humankind, those practicing medicine have sought to understand, and more importantly, to eliminate diseases of the human body. Human disease comes in all shapes and sizes and affects just about every part of the body. In modern day medicine, we often use the acronym “VITAMINS” to help us create a differential diagnosis when seeing patients.

Imagine you’re a third year medical student and a patient comes in with “a headache.” The attending physician that is supervising you asks you “what do you think it is?” How do you answer that? Where do you even start? Before you let naivety engulf you into failure, always go back to VITAMINS. Because much like politics or business, medicine is often boiled down to the art of nimble articulation (colloquially known as the art of bullshit).

VITAMINS stands for:

•V = Vascular

  • Disease of the cardiovascular system.

  • Example: stroke or aneurysm

•I = Idiopathic/Iatrogenic

  • Disorders that arise due to an unknown cause or from insults that happen in the hospital environment.

  • Example: Alzheimer’s (idiopathic) or a drug overdose (iatrogenic)

•T = Trauma

  • Any complications of mechanical force that may injure the human body.

  • Example: Head injury from a car crash

A characteristic example of, you guessed it, trauma. Photo credit: Eugene Triguba

A characteristic example of, you guessed it, trauma. Photo credit: Eugene Triguba

•A = Autoimmune

  • Includes a plethora of diseases in which the bodies immune system turns against certain tissues, cells, or organs.

  • Example: Multiple sclerosis

•M = Metabolic

  • Many inherited diseases that affect the bodies metabolism of nutrients or metabolites.

  • Example: Tay-Sachs or complications of diabetes

•I = Infectious

  • Bacterial, Viral, Fungal, or other infections.

  • Example: Meningitis

Masks such as these are worn to protect against infectious diseases. Photo credit: Jeremy Senuit

Masks such as these are worn to protect against infectious diseases. Photo credit: Jeremy Senuit

•N= Neoplastic

  • A fancy word for cancer.

  • Example: Brain cancer (Glioblastoma multiforme would be a specific example)

•S = pSychiatric

  • Some artistic liberties were used in the naming; these are diseases of the mind, often without clear biologically tangible manifestations

  • Example: Schizophrenia or somatic symptom disorders

(P.S. all of these can present as with headache as “chief complaint” ;). There’s med school for ya.)


So, rather than looking at attending physicians with a blank stare, you can always go back to VITAMINS and talk your way out of something you almost certainly don’t know the answer to. What experienced physicians don’t tell you is that they also probably use this acronym to help them out!

Between these 8 categories, there are thousands of diseases processes, many with completely unique characteristics, many that overlap with great significance. As such, pathology is certainly an overwhelming discipline, but it is one that is absolutely crucial to the practice of medicine as it is the discipline that guides treatment decisions. Medicine without pathology is like playing a video game with the TV turned off. It is a discipline that emerges from the amalgam of divergences in normal functioning of anatomy, physiology, and biochemistry of the human body. With its central role in medicine, it has been omnipresent throughout the history of human medicine dating back to the Greco-Roman era, through the Middle Ages, and into modern medicine.

Pathology lies at the heart of eastern medicine as well, however, the differences between different practices of medicine such as “western medicine” and “eastern medicine” arise from the differences in philosophies behind pathology.

Because those practicing medicine use pathophysiology to guide treatment for any given disease, treatment is subsequently only as good as one’s understanding of the disease process itself. For example, Ancient Greek medicine used a “humoral” epistemology for pathology that centered around four “humors,” or bodily fluids, whose ratios determined symptomology.

As such, much of their treatments centered around balancing out the humors and included therapies like “bloodletting” (intentionally removing blood from the body). Bloodletting originated after the era of Hippocrates and was advocated for by Galen, a titan figure in healthcare from antiquity who influenced western medical practices until the dawn of modern medicine during the Renaissance era. While the specifics of ancient medical practices is out of the scope of article, I have included some further reading on the topic if anyone is interested. For completeness, an example of an “eastern medicine” philosophy of pathology called (rough translation) “toxic wind” and subsequent treatment in traditional Vietnamese practices has also been included.

See this link for bloodletting history, and this one for the Vietnamese “Toxic wind.”

As an aspiring practitioner of contemporary “western medicine,” it would behoove me to have a philosophy behind my understanding of pathology. AKA: I would like to justify my belief in the medical practices I’m learning and why it is that you should try to listen to your doctor, their decisions usually aren’t baseless! VITAMINS embodies what contemporary practitioners know and understand about various disease processes and subsequently patients with a particular constellation of symptoms, history, medications, and lifestyle is painted into the VITAMINS framework to guide treatment and care.

As a researcher, frameworks for pathology are a bit different. Much more emphasis is put on understanding the context behind the emergence of certain pathophysiologies, i.e. why do they arise in the first place? How does this guide or search for novel therapies that reduce disease burden and improve quality of life overall while effectively targeting specific components of the disease etiology? Check out the “Adaptation and Disease: two sides of the same coin” article to find out more about some philosophy behind disease.

-Daniel


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