Rejecting Terrain Theory

″‘When I use a word,’ Humpty Dumpty said, in rather a scornful tone, ‘it means just what I choose it to mean – neither more nor less.’

‘The question is,’ said Alice, ‘whether you can make words mean so many different things.‘”

Lewis Carroll

Many people expound on terrain theory being a replacement for or perhaps a refinement of germ theory, although the notable lack of theoretical rigor catches one’s eye at every occasion. If one concedes that optimal health is dependent on both the presence of nutritional elements and a resilient body as well as the absence of pathogens that may disrupt those things, then surely both “theories” of disease are crucial to a more comprehensive understanding. Is there not a happy middle ground here to be negotiated and explored? Well, not really, not if we’re interested in formulating a theory of disease that is scientific or useful.

Terrain theory posits that the unique biological “terrain” of the individual host is the crucial consideration in the appearance and progression of pathogen-mediated disease. It is therefore worth pointing out from the beginning that it is not exactly a theory per se, but rather an interpretation of the body of scientific scholarship we refer to as theory. It should more properly be called the terrain interpretation of germ theory. That the human body is understood with a high degree of mechanistic detail and specificity can not be credited to terrain theory, but is part of the larger body of scientific scholarship underpinning terrain interpretation. Moreover, the idea that the terrain is what determines the etiology of disease — true in many cases — does nothing to change the obvious domain of clinical action. If every patient has “terrain” in different relative states of fitness, then it implies the germ as the locus of clinical action. No doctor is adequately resourced to holistically determine the unique character of a critically ill patient’s “terrain,” let alone make recommendations regarding how to improve it in the time afforded to a declining patient. Thus terrain theory implicitly holds, as germ theory explicitly does, that the pathogen is the common feature between patients in a clinical setting, and therefore the essential consideration.

In short, even if a pathogen may not necessarily cause a decline in health, it remains a fact that it is sufficient to do so in many cases. The terrain theory is therefore clinically irrelevant, and is meaningful only as a general principle guiding recommendations for wellness. Since such recommendations are useful under any circumstance, the “theory” adds nothing rigorous and may be quite properly regarded as useless.

It is the rigorous description of the germ that offers a scientific platform for the treatment of certain diseases. Under germ theory, the biological processes of the pathogen can be understood at any level of resolution, and can therefore be targeted and disrupted to aid the patient. If a virus is known to have a protease necessary for its own replication, then that protease can be targeted to disrupt the viral life cycle.

Stated more precisely, germ theory is specific, mechanistic, and quantitative. It is specific in its characterization of the illness down to the molecular level; it is mechanistic in its description of the step-wise biological processes involved, how they affect both the body and the pathogen, and the kinetics and dynamics of drugs; it is quantitative in that it offers a platform for determining how much “cause for illness” is present, how much drug is required, and what parameters can be measured to determine if a patient is responding favorably. Terrain theory, by contrast, offers none of these advantages. It is neither specific, nor mechanistic, nor quantitative. It describes terrain and associated processes only in the most general terms associated with the release of “toxins” or of general terrain integrity inhibiting disease progression.

Since terrain theory is not specific, not quantitative, and not mechanistic, we may conclude that it is not a scientific orientation toward scholarship of disease. In plain terms, it is functionally no different from the humours theory of disease posited centuries ago by the ancient Greeks. There is functionally no difference between telling a patient he has an imbalance in one of the four humours and telling that same patient he has an imbalance in his terrain. Neither is specific, neither is mechanistic, neither is quantitative, neither is scientific, and therefore neither is clinically useful in terms of offering a reasoned and systematic approach to resolution. It simply does not offer a scientific platform for medicine, it offers only an interpretation on which to recommend chicken soup and rest, good advice under any circumstance.

Perhaps the more important point, though, is that germ theory already affirms much of what terrain theory claims to radically propose, and therefore the misframing of terrain theory as a courageous and revolutionary departure from contemporary scientific scholarship is hubristic. There are thousands of papers — thousands of them — outlining the role of nutritional deficiency in the progression of disease, outlining the fact that there is an ecosystem of good bacteria in the body, which can become pathogenic if the natural balance is offset and any number of other considerations that might be considered in line with a terrain view of disease.

That people fail to live up to a scientific standard is not an indictment of scientific theory. Overemphasis on germ mechanism of disease to the exclusion of other considerations does not constitute living up to a scientific standard. Unnecessary and deleterious prescription of drugs does not constitute a scientific standard. Vaccine hysteria bordering on the lunatic does not constitute a scientific standard. That the medical establishment routinely fails to live up to a scientific standard is not an indictment of the germ theory of disease, but of man himself. Man, it seems increasingly clear, would fail even a perfect body of scientific theory.

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