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“Normal” Versus “Normal” Criteria!
Published in the Journal of the International Academy of Preventive Medicine, Vol. IV, No. 2, Winter 1977.
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Doctor Cheraskin has been trained both in medicine and dentistry and is now Professor and Chairman of the Department of Oral Medicine at the University of Alabama in Birmingham, School of Dentistry in Birmingham, Alabama. He is the author of numerous publications and books, the latest being a lay book entitled Psychodietetics designed to relate food and behavior.
Doctor Warren Marshall Ringsdorf, Jr. is a native of Alabama. He received an A.B. degree from Asbury College (Wilmore, Kentucky) in 1951, a M.S. degree in 1956 from the University of Alabama Graduate School (Tuscaloosa, Alabama), and a D.M.D. degree in 1956 from the University of Alabama School of Dentistry (Birmingham, Alabama).
Doctor Ringsdorf joined the University of Alabama School of Dentistry faculty in 1960 following two years in the United States Air Force and two years in private practice. He is currently a full-time Associate Professor in the Department of Oral Medicine.
Perhaps the single most significant distinction between therapeutic versus preventive medicine is the area, if not the line, which delineates the healthy from the sick. The failure to properly distinguish between these two disciplines is, in part, a semantic trap. Thus, when the word “normal” is used, it means “average” to some people and “physiologic, ideal or healthy” to others.
There are today published standards of health ranging from height and weight to blood pressure and serum cholesterol to dietary recommendations. Without exception, these so-called health criteria stem from an assumption that the mean plus two standard deviations of the population is normal, meaning healthy. Thus, an examination of standard medical textbooks yields a normal, presumably healthy, fasting blood glucose of 60-100 milligrams percent. Likewise, pursuing the same logic (or illogic), the total white cell count should be 5000 to 10000 cells per cubic millimeter. The Recommended Dietary Allowances (RDA) for vitamin A is recognized as 5000 International Units.
In all of these instances, the assumption is that 95 percent of Americans are well when, in fact, 95 percent of Americans are sick. For example, 95 percent of Americans suffer with tooth decay, clearly a sign of illness!
If one begins with the hypothesis that relatively symptomless and signfree persons are healthier than those with clinical symptoms and signs, then the distinction between “normal” versus “normal” criteria changes. In fact, it becomes abundantly clear that traditional norms imply that since normal (average) and normal (healthy) prevail, and things equal to the same thing are equal to each other, then average and healthy are the same.
Table 1–fasting blood glucose in one hundred routine dental patients
We have developed a clinical model for distinguishing between average (normal) and healthy or physiologic (normal) health criteria. By progressive selections from a large group of people, subgroups are chosen with fewer and fewer clinical symptoms and signs of disease. Invariably, with this selection process, the standard deviation of whatever biochemical parameter is being measured will shrink (Table 1) (Cheraskin & Ringsdorf,1961). This model has also been used to develop the physiologic glucose and cortisone-glucose tolerance tests (Ringsdorf & Cheraskin, 1962; Ringsdorf, Cheraskin & Keller, 1962). Thus, much of the so-called “normal range” for health criteria is associated with the early stages of disease.
The same clinical model has also been utilized to distinguish between average (normal) and healthy or ideal (normal) daily allowances for nutrients (Table 2) (Cheraskin, Ringsdorf & Medford,1976a). For all nutrients evaluated, the progressively healthier samples showed a progressive change in mean nutrient intake (Cheraskin, Ringsdorf & Medford, 1976b, 1977a; Cheraskin, et al., 1977b).
With larger subject samples, this clinical model can properly delineate the ideal or physiologic values for a wide variety of health parameters. This will be of great value getting people well and/or keeping them well.
Table 2–relationship of reported daily vitamin A consumption (food frequency questionnaire) and reported total clinical findings (Cornell Medical Index Health Questionnaire) in a presumably healthy male and female sample
References Cited:
Cheraskin, E. and Ringsdorf, W. M., Jr., “Physiologic fasting blood glucose: range or point?” J. Dent Med., 16:2, 96-98, April 1961.
Cheraskin, E., Ringsdorf, W. M., Jr. and Medford, F. H., “The ‘ideal’ daily vitamin A intake,” Int J. Vit. Nutr. Res., 46:1, 11-13, 1976a.
Cheraskin, E., Ringsdorf, W. M., Jr. and Medford, F. H., “The ‘ideal’ daily niacin intake,” Int. J. Vit. Nutr. Res., 46:1, 58-60, 1976b.
Cheraskin, E., Ringsdorf, W. M., Jr. and Medford, F. H., “The ‘ideal’ daily lysine intake,” IRCS Med. Sci., 5:390, 1977a.
Cheraskin, E., Ringsdorf, W. M., Jr., Medford, F. H. and Hicks, B. S., “The ‘ideal’ unrefined carbohydrate intake,” J. Amer. Soc. Prev. Dent., 7:1, 6-7, January-February 1977b.
Ringsdorf, W. M., Jr. and Cheraskin, E., “Physiologic glucose tolerance test,” Dent. Progress, 2:4, 281-284, July 1962.
Ringsdorf, W. M., Jr., Cheraskin, E. and Keller, S. M., “Physiologic cortisone-glucose tolerance pattern: the development of blood glucose normality by analysis of oral symptoms,” J. Dent. Res., 41:4, 833-839, July-August 1962.