Discussion:
The global disease burden has steadily shifted from acute infections to noncommunicable diseases, most of which are chronic inflammatory in nature [11]. Continuum theory states that one of the reasons is the manner in which acute diseases, especially high fever, are handled at the population level [1].
Efficient acute inflammation is the hallmark of a healthy immune system and is characterised by high fever [1]. Fever is essential for the cellular and humoral components of host defence to be recruited into action against pathogens—a systemic alarm [4, 12]. Once recruited, these cells and chemical factors (e.g., cytokines and leukotrienes) go through a series of tightly orchestrated events whose ultimate goal is not just neutralisation of the pathogen but also restoration of tissue homeostasis [3, 13-15]. In the absence or malfunction of any of these checkpoints, inflammation does not resolve [2]. Failure to resolve inflammation has been discovered as one of the main mechanisms in the onset of chronic inflammation [16]. This would mean that the activated, persistent, low-grade inflammation will not have the same level of response as that seen in an immunologically intact organism. The response will either be absent/very minimal or exaggerated in a dangerous sense when the virulence of the pathogen is too high. In neither case will the response be efficient or optimal. According to the levels of health theory, those people with moderately severe chronic illnesses will react in an exaggerated way to a pathogenic challenge, while those with severe/terminal diseases may not respond to it at all [10], a fact that was emphasized in the recent pandemic of COVID-19 [17].
Furthermore, the phenomenon of ageing itself is a chronic inflammatory process [18, 19]. This implies that chronic inflammatory diseases increase with age and that concurrent acute and chronic inflammation must decrease accordingly. With this background, we must investigate whether the prevalence of chronic disease presupposes the absence of efficient acute inflammation. While immunological experimental studies are required to establish the mechanisms of this hypothesis, this study aimed to investigate whether such a phenomenon might be present in the population.
Our study showed that not only did the incidence of chronic diseases increase with age, but the concurrent acute and chronic inflammatory diseases decreased significantly with age. Allergic conditions, which, according to the levels of health theory, are some of the more superficial and less serious chronic diseases, were most associated with acute states when compared to the more serious chronic inflammatory disorders, such as chronic fatigue syndrome and hypertension. These diseases are more serious and more difficult to treat and cure homoeopathically than allergies.
Furthermore, the analysis of individual disease patterns in 21 patients indicated that efficient acute and chronic inflammation were likely mutually exclusive. In the sensitivity analysis, there was a strong pattern of decreased concurrent acute and chronic inflammation with age in this sample population as well. Considering ageing to be a chronic inflammatory process, our hypothesis is supported by our findings.
The study has a few limitations. We did not include case records that had incomplete data, and their bearing on the outcome cannot be ruled out; however, the sample size was still sufficiently large. We did not consider the effect of treatment or therapy of any kind in this study, and it will be interesting to examine this pattern in those with a history of treatment compared to those without to rule out the actual effect of drugs. The database is from a homeopathic medical practice that is sought mostly by people who have not found satisfactory results with conventional medicine, creating selection bias. This bias may be overcome by conducting the same analysis on medical records from a public hospital. The final limitation is the accuracy of the fever history given by patients. While homeopathic case documentation involves recording the minutest details regarding a patient’s health, there can still be discrepancies due to recall bias in the patient. This can be overcome by performing a longitudinal study and following people’s health status over time.