Special article Arch Argent Pediatr 2020;118(5):e449-e453 / e449

Biosemiotic medicine: From an effect-based medicine to a process-based medicine

Carlos G. Musso, M.D., Ph.D.a,b

ABSTRACT Such knowledge evidences the Contemporary medicine is characterized by an existence of a large and intricate increasing subspecialization and the acquisition of a greater knowledge about the interaction among interconnected network among the the different body structures (biosemiotics), different body structures, which both in health and disease. This article proposes accounts for a sort of “communication a new conceptualization of the body based on channel” among its elements, a true considering it as a biological space (cells, tissues, and organs) and a biosemiotic space (exchange of “dialogic or semiotic space” that is signs among them). Its development would lead conceptually abstract but experientially to a new subspecialty focused on the study and real, through which normal and interference of disease biosemiotics (biosemiotic pathological intra- and inter- medicine), which would trigger a process- based medicine centered on early diagnosis and parenchymal dialogs (sign exchange) management of disease. occur. Such dialogs determine a Key words: medicine, biosemiotics, diagnosis, balanced functioning of organ systems therapy. or the onset and establishment of http://dx.doi.org/10.5546/aap.2020.eng.e449 disease, respectively. The investigation and analysis of such phenomenon is the subject of a relative new discipline: To cite: Musso CG. Biosemiotic medicine: From an biosemiotics, which deals with the effect-based medicine to a process-based medicine. 1 Arch Argent Pediatr 2020;118(5):e449-e453. study of the natural world’s language. The objective of this article is to propose a new form of conceptualization of how live beings in general, and human beings in particular, are formed based on INTRODUCTION biosemiotics’ principles and also to Contemporary medicine is describe the potential benefits that characterized by a steep rise in this new perspective may bring to a. Instituto scientific knowledge, a phenomenon health care. Universitario del Hospital Italiano that has inexorably incited two de Buenos Aires, highly significant situations. Biosemiotics: Nature’s discourse Argentina. On the one side, an increasing In the early 20th century, biologist b. School of trend towards subspecialization, Jakob von Uexküll became the first Health Sciences, Universidad which is a direct result of human person to propose that every organism Simón Bolívar, inability to individually encompass establishes a vital information Barranquilla, the entirety of the vast scientific exchange with its environment Colombia. knowledge produced at present in (umwelt), which leads to an external E-mail address: a timely manner that would allow semiosis or information semiosis Carlos G. Musso, M.D.: for its effective implementation in process that von Uexküll called carlos.musso@ health care practice. On the other exosemiosis.1,2 Later, his son, medical hospitalitaliano.org.ar side, the progressive acquisition of doctor Thure von Uexküll, together Funding: an increasing knowledge about the with medical doctors Werner Geigges None. close dialogic interaction (semiosis) and Jörg Herrmann, extended that takes place among the different this concept to the inner body Conflict of interest: body cells, tissues, and organs, both (symptomatization semiosis), where None. in health (physiology-salutogenesis) information (sign) exchange takes Received: 3-26-2020 and disease (pathophysiology- place inside and among each of the Accepted: 5-20-2020 pathogenesis). different biological complexity levels e450 / Arch Argent Pediatr 2020;118(5):e449-e453 / Special article of the body: cells, tissues, organs, and organ unit is not a molecule in itself but its function as a systems. sign (Hoffmeyer).5,7 This process, which Thure von Uexküll et al. called endosemiosis, has vast semiotic proportions Biosemiotics: Levels of complexity if we consider that the human body alone is made Biosemiotics studies the natural world’s up of approximately 25 trillion cells, which is language by exploring its varying levels equivalent to more than 2000 times the world of complexity: from cellular semiotics population. Of course, both semiotic processes (cytosemiotics), where sign processes are (exosemiosis and endosemiosis) are delicately chemical, electrical, mechanical, and thermal, to coordinated, thus leading to a bidirectional vegetative semiotics (phytosemiotics), animal information flow between the body and its semiotics (zoosemiotics), and finally, human environment that Jakob von Uexküll called feedback semiotics (anthroposemiotics), at which level sign loop. Finally, Thure von Uexküll, together with processes can even reach, through words, the linguist Thomas Sebeok and medical doctor Giorgi representation of what is absent or even inexistent Prodi, standardized and extended these concepts (fantasy).7,8 In this regard, from an evolutionary and gave rise to a new interdiscipline: biosemiotics.1,3,4 perspective, biosemiotics is divided into three Semiotics is defined as the study of signs; major phases: an initial phase (primordial), where and a sign is anything that is used in place of a rudimentary biological semiosis is established something else and, since a sign is always tied with the emergence of life; a second phase to a meaning, semiotics also includes the study (hermeneutic), where beings with a nervous of meanings. Likewise, the association between system emerge and a more complex semiosis a sign and its meaning requires the presence of with certain level of interpretation is established; a third entity that establishes a relation between and finally, an advanced phase (symbolic) of them through a set of conventions or codes, which biological semiotics, where human beings appear is also a subject of study in semiotics. Finally, any and a language based on cultural codes is born.5 semiotic system requires, in addition to the sign- Therefore, in the biosemiotics universe, each meaning-code triad, a fourth factor that is the complexity level uses its own particular sign decoder.5,6 system; so, the system used by biosemiotics at Based on the preceding, biosemiotics is one level (e.g., tissues) is not necessarily the same defined as the study of signs, their meaning and used in the underlying level (e.g., cells) or in interconnecting codes in living systems. At the the overlying level (e.g., organs).1-4 However, it most essential level of life, such as cells, signs are is worth noting that, since the semiotic activity represented by the genotype; meanings, by the that takes place in each level of biological phenotype; codes, by the correspondence between complexity allows the semiotic activity to occur deoxyribonucleic acid (DNA) and ribonucleic at the remaining levels, it is therefore inferred acid (RNA) nucleotides; and decoders, by the that there is necessarily a conversion system in ribotype, i.e., the ribosome system responsible for place among the sign systems of the different DNA transcription and translation. levels that enables their dialog. The discovery of According to biosemiotics, as in the case of what would be the Rosetta Stone of biosemiotics, human language and mathematics, the rules i.e., the stone inscribed in three languages that governing semiosis in the biological world are allowed Champollion to decipher, by comparison, universal and predetermined, so they should be Egyptian hieroglyphs, is one of the greatest discovered by decoders in an exploratory manner. challenges of this discipline because it would Trifonov and other authors have stated that, in allow to decipher the equivalence (translation) addition to the typical genetic code, there are at between the different sign systems (languages) least twenty organic codes overlapping in the used at the different levels of the body’s biological genome. Other authors, like Peirce and Taborsky, complexity.1,9 have even proposed the concept pansemiosis, which It is worth pointing out that, when a molecule states that the semiosis process is inherent to the (e.g., a cytokine) plays a sign role in a biosemiotic universe functioning in general, thus governing process, analogous to the dyadic model of the even the inorganic level. In brief, biosemiotics is linguistic sing (word) proposed by Ferdinand de based on the idea that all live beings constitute a Saussure, such molecule-sign is considered to be semiotic system themselves, and semiosis is critical made up of an equivalent of what would be the for the phenomenon of life because its essential linguistic signifier (sound), which, in this case, Biosemiotic medicine: From an effect-based medicine to a process-based medicine / e451 would be the molecule-sign chemical structure (e.g., currently available about the dialogs (both peptide) and, on the other side, an equivalent of what normal and pathological) or crosstalks established would be the meaning of a linguistic sign (concept), between the different organs, e.g., between the which, in this case, would be the potential action of liver and the lung or the kidney and the liver, the molecule-sign (e.g., proinflammatory action). which take place through the nervous, endocrine, Finally, the object of the real world represented by and immune systems, is enough to develop a the linguistic sign (referent) would be, in this case, new discipline that furthers the study of these the actual effect of the molecule-sign’s action (e.g., interrelation channels or biosemiotic spaces based inflammation).1,10 on the interrelation of the respective disciplines, The main difference between the biosemiotics such as, in this case, between nephrology and of salutogenesis and pathogenesis and that of pulmonology or between nephrology and classical physiology and pathophysiology is that, hepatology, respectively.1,12,13 whereas the latter are based on a structuralist Therefore, as in the 19th century Claude perspective that believes in the existence of an Bernard established a new idea of organism organism as a sort of machine made up of parts based on a novel perspective by describing it as (organs) that work in a harmonious manner the sum of two compartments: intracellular and (health) or in a dissonant manner (disease) in extracellular spaces;9 nowadays, a new concept relation to the rest of the body, and that considers may be established from a novel perspective such structure as the one that develops processes, which considers that the organism is made up biosemiotics is based on an intermolecular dialogic of a biological space and a biosemiotic space. From perspective where cells, tissues, organs, and body this point of view, the biological space would have are the product of such dialogs and that considers several complexity levels or strata: intracellular, such structures as the result of semiotic processes. cellular, tissue, organic, and systemic. In this From this viewpoint, the ultimate reality would regard, the complexity level corresponding be made up of multiple intermolecular semiotic to organs and organ systems would be the processes that, in turn, lead to growing complexity one scientifically developed at present and dialogs (among cells, tissues, etc.) and dialogs implemented in the health care setting by the about the dialogs (metadialogs) that lead to different medical specialties, such as nephrology, biological sentences, including other subordinate pulmonology, hepatology, etc. biological sentences, thus leading to a flow of The biosemiotic space would be that where the biological texts and hypertexts. salutogenic and pathogenic dialogs among the Therefore, in biosemiotics, a semiotic components of the same biological complexity perspective (processes) takes precedence rather level (intrabiological) take place, such as among than a structuralist perspective (effects). In the cells from a single organ, and/or among the latter, structures are illusions resulting from the components of different biological complexity lack of subtlety in human perception, which is levels (interbiological), e.g., the different body not able to perceive, at first glance, the ultimate organs, whose study and development would true structure, which is its brevity or, as in the lead to a new subspecialty focused on information words of Heraclitus, no physician ever examines flows between the different organs, a discipline the same heart twice because both its physiology that may be called biosemiotic medicine. and anatomy account for two rates, fast and slow, In addition, the development of these interface respectively, of the same process: the cardiac subspecialties, which together would contribute process.5,6,11 to shape biosemiotic medicine, far from promoting a greater fragmentation of medical knowledge, The concept of the biosemiotic space would encourage its reunification precisely by At the organic level, dialogs within (intra-) and reconnecting the knowledge fields corresponding among (inter-) the different complexity levels, or to the different organs by focusing on the biosemiotic connecting circuits, are expressed biosemiotic space connecting them instead of on through a group of mediators of varying nature, the organs resulting from such dialogs. such as hormones, neurotransmitters, second messengers, cytokines, etc., the true “words” Biosemiotic medicine: Towards a process- of biosemiotics and whose type and amount based medicine vary depending on the nature of the dialogs Based on the famous experiments about established. Actually, the amount of information the physiology of vision, Maturana et al. e452 / Arch Argent Pediatr 2020;118(5):e449-e453 / Special article demonstrated that the characteristics of This means that biosemiotic medicine, i.e., not perception were determined by the eye based on diseased organs (biological space) but on structure, not by the outside world object. The the preceding pathological dialogs (biosemiotic object becomes the stimulus necessary to trigger space), would allow to go from the current effect- the perceptual phenomenon, and the reality based model (diseased organ-based medicine) to of its existence makes visualization become a process-based model (biosemiotic medicine). a perception, not a hallucination (perception The latter, which is based on processes, may without object). However, perception is be able to detect the presence of pathological actually a false representation of the object, an biosemiotics (pathogenesis) in an early manner explanatory argument developed by the observer (before the onset of structural damage) and as a result of structural determinism. Therefore, ensure its recomposition and redirection towards perception cannot be distinguished from illusion, normal biosemiotics (salutogenesis). In order because perception depends on the structural to establish such medicine model (biosemiotic characteristics and internal correlations of the medicine) in the future, it is critical to develop observer’s nervous system rather than on the interface specialties as well as new contributions object’s own characteristics.14 from biosemiotics and, above all, endosemiotics. Based on the preceding, contemporary Therefore, just like the anatomical model of epistemology states that the ultimate reality body compartments defined by Claude Bernard is made up of a continuous flow (dialog) of (19th century) allowed for a better interpretation Mendeléyev’s periodic table elements, which and treatment of electrolyte imbalances, which become aggregated and disaggregated in an was not possible with the classical anatomical eternal evolution; and the human mind model developed by Vesalius (16th century), skillfully reduces such chaotic complexity to the biosemiotic medicine model would be the a comprehensible set of forms (symbols) and biosemiotic space model, and would focus on linguistic categories (signs). This demonstrates the semiosis established within and among that there is no reality made up of forms and the different body levels.8,17 Such new model ideas (Platonism), but rather that it corresponds to would encourage the development of a human mind constructs (phenomena) developed deeper understanding of how salutogenic and based on its structural determinism grounded pathogenic circuits function, and would give on the primordial magma of dancing elements rise to a medicine that would promote the early (reversal of Platonism). diagnosis and management of disease processes Based on the preceding, it should be noted (biosemiotic medicine) and would attempt to that, between the symbolic forms and linguistic neutralize such processes by working at the categories outlined by the human mind, which biosemiotic space level before they become patent allow it to establish a representation (map) in the biological space (conventional disease). of reality, there is always a blind spot (foggy interstice) where there is no representation CONCLUSION and, therefore, no interpretation.15,16 Such The development of subspecialties focused on phenomenon, extrapolated to the field of the study of the biosemiotic spaces that exist at medicine, demonstrates that the disease model, the multiple body levels may give rise to a new based on the anatomical-physiological (structural) process-based medicine or biosemiotic medicine, perspective, does not take the biosemiotic with the subsequent advantage of an early disease aspect of pathogenesis into consideration, diagnosis and management. n because, actually, disease is the result (effect) of a pathological dialog (biosemiotic space) Acknowledgments established among body organs (biological space) I would like to thank Henry González- in an early manner, i.e., a pathological dialog Torres, MSc, for his valuable collaboration prior to the onset of structural damage. 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