The Calicut Medical Journal

Converging upon the Scientific Object of Individual's Health:
A Cosmist Perspective in Biomedicine

Konstantin S. Khroutski
Institute of Medical Education, Novgorod State University after Yaroslav-the-Wise,
Novgorod Velikiy, Russia

Address for Correspondence:
IME NovSU, A/B 123, PO-25, Novgorod Velikiy, 173025 Russia
Tel., Fax: +7(81622)38262 +7(8162)660950
E-mail: hrucki@mail.ru hks@novsu.ac.ru

Abstract:

In this paper an attempt is undertaken to advance and substantiate an original theoretical - cosmist - approach to reaching the true humane and integrative biomedicine. The Cosmist hypothesis in biomedicine and bioethics stems from the original basis of philosophic cosmology, ontology of Absolute Cosmist Wholism, Cosmist epistemology, anthropology, and ethics. Now, developing the Cosmist system of assumptions, I endeavour to substantiate the original notions of man's 'basic functionality', 'the norm of an individual's health', 'an individual's health passport', and the triune essence of doctor-patient interrelations. To my firm belief, the further successful development of the Cosmist person-centred medicine is solely realisable within the free and open access to scholarly communication on the internet.

Key words: Cosmist hypothesis in biomedicine and bioethics, individual's health, norm, functionality, Internet

"Philosophy is a science and therefore, like every other science,
it seeks to establish truths that have been strictly proved and are
therefore binding for every thinking being and not only for a
particular people or nation."

Nicolei O. Lossky [1] (This fragment opens the chapter 'Characteristic Features of Russian Philosophy' in N.Lossky's book 'History of Russian Philosophy')

Introduction: The Need of a New Scientific Methodology in Biomedicine and Bioethics

Biomedicine lacks a true individual approach to a person - modern biomedicine individualise, but "depersonalise" the man [2]. Although modern medicine admits the uniqueness of man's individual bio-organismic or psycho-social characteristics, it sees them exclusively as variables within the common range of a given trait, i.e. as the biostatistical norm and its possible deviations. Therefore, in so far as a modern medicine treats a person exclusively as an abstract statistical unit - contemporary philosophy and science obviously do not consider individual's health as a major philosophic and scientific problem.

This problem is especially acute in current Russian conditions of surviving the severe health crisis. "Health in Russia is broken." [3] The dramatic worsening of the epidemiological situation, the negative dynamics of mortality and the sharp drop of life expectancy in Russia are connected with various factors, including the rise of death rates from chronic and degenerative diseases. Today, as before, Russia holds two somber records: the lowest life expectancy among males for a developed country in peacetime (59 years) and the largest gap between male and female life expectancy in the world (13 years). The recent mortality increase has been especially dramatic among working-age men.

Factually, we are to stress some difficulties in the development of modern biomedicine. At first glance, it may seem like an odd way. Indeed, we are witnessing nowadays the tremendous success of biomedical sciences' theory and practice. It is really a biomedical revolution comparable with the revolution in physics in the beginning of the 20th century. However, although modern biomedicine continues to break new frontiers daily and extends scientific benefits, still biomedical philosophy, theory and practice are unable to elaborate a true etiological approach to the treating of chronic diseases - chronic non-infectious and non-traumatic diseases: firstly, cardiovascular diseases (coronary heart disease, arterial hypertension, infarctions, strokes, congestive heart failure, etc), and malignant tumours. The absence of true etiological approach means the lack of the possibility of the radical treatment of chronic diseases and, hence, the lack of a true humane (personal) approach to disease. "Modern biomedicine individualises, but 'depersonalises' the man" [4], treating him or her as an abstract statistical unit.

I fully uphold the aforementioned thesis: Modern rational medicine depersonalises man. The address of a man as the whole personality still has not received the due attention (in the terms of her/his normal vital activity, health and wellbeing). Factually, in the current biomedicine, the 'individual' approach on a biological level means strictly the use of statistical methods: Physiological data either fall into the determined range (of normal values) or fall outside the tolerable limits - thus providing a pathologic interpretation. In turn, psychological illnesses are seen as being the result of an individual's failure to cope with the requirements of the society. Hence, the conclusion about a man's mental health depends on his/her behaviour in the society and, thus, is derived from the norms elaborated by the society. This fact directly proves that modern medicine is sociocentric in principle.

Characterising further the modern medical methodology (focusing on its hi-tech power), I stress its categorical pathocentrism and the use of a subject-object pattern: each man becomes the object of exploration (the patient) for clinical medicine (for the doctor) only after the appearance of her/his subjective complaints or of the objective symptoms of the disease. Likewise, public health care explores pathogenic factors, which might cause the pathogenesis of the particular disease. As a corollary, modern medicine is undoubtedly pathocentric and impersonal in principle. Hence, there is no fundamental difference between veterinary and curative medicine at present. "That is to say, biomedical science was very successful so long as it did not stray too far from the same theoretical position as veterinary science… Nobody would argue that reductionist science has not serve us well... What we need is a new methodology... A new scientific methodology, however, will only work in a new scientific arena: if we wish to move beyond crude biologism garnished with well-meaning humanism, we need a new concept of science." [5].

The WHO defines health as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity (1946)". In my opinion, if we consider health as 'a state', then health is a 'chronic' state of 'complete physical, mental, and social well-being', which lasts throughout a person's ontogenesis. A person is born to be healthy equally at all stages of his/her ontogenesis: embryogenesis and the genesis of the foetus, early childhood, childhood, adolescence, adulthood, and older adulthood. In other words, an individual's health is a process, but not a state. Therefore, I claim, we must resolve the problematic situation in medicine described above: 1) To complement the existing traditional scientific 'impersonal' approach in biomedicine - pathocentric, sociocentric, and with a subject-object essence - with the advancement of a 'person-driven, Cosmist' approach - personcentric, health-centric, and with a subject-subject essence; 2) To complement the existing levels of medical 'norm' - biological norms (physiological health of man) and sociological norms (mental wellbeing of man) - with the substantiation of the personal level of medical norm i.e. the individual wellbeing of man, and his/her personal health. All this calls for the advancement of a novel wholistic concept of biomedicine through higher order philosophical principles: cosmological, ontological, epistemological, axiological, and ethical.

Cosmological Fundamentals of the Cosmist Person-Centered Medicine

That is precisely the approach of mine - to put forward an original system of philosophical assumptions (principles), sufficient to substantiate the deduction of new theoretical and methodological propositions, which, in turn, will form the basis for the required further development of science (biomedicine). The primary characteristics of the Cosmist hypothesis that I am developing were given in previous publications [6-13]. Here, I want to represent and develop in-depth some core principles, categories and notions, which might be crucial for an understanding of the whole concept. (Short characterisations of some basic notions are given at the end of the paper - to make it easier for the reader to find out the meaning of them, firstly of the abbreviations used in the article).

First of all, there is the cornerstone notion of CEPLE: cosmic evolutionary process of the life on Earth (my abbreviation is - 'Process'). Process - an objective phenomenon of reality verified by numerous scientific disciplines, including comparative anatomy, biochemistry, etc., related to evolutionary history and, chiefly, to molecular biology. Therefore, naturally Process is an a posteriori notion (of objective, empirical, and descriptive essence). Simultaneously, Process is an a priori notion, for it is only revealed through intuitive rational cognition. Hence, the notion of Process integrates a posteriori and a priori thinking (despite the latter being frequently considered to be a greater philosophical sin), disclosing an approach for the universal comprehension of the phenomenon of the life on Earth. Essentially, Process, understood universally in terms of a growing degree of complexity, exists and emerges in the Past, Present, and Future, in order to integrate the entirety of living matter and - functionally - every living subject on Earth. In other words, Process embraces all processes (ontogeneses) of the all subjects (i.e. living active organisms: biological, personal, and societal) of the life on Earth, determining - through the functional membership of (and usefulness to) CEPLE - the healthy ontogenesis of any living subject on Earth. In my opinion, in this aspect, the scientific value of Process may be comparable with such fundamentals as Newton's 'Universal Gravitation' or Maxwell's 'Electromagnetic Field'.

The other basic notion, which stresses the universality of the life on Earth is 'subject'. In Cosmist philosophy 'subject' means the integrated functional subject, which integrates autonomously and hierarchically other subjects (to be a functional whole) and, simultaneously, is always functionally integrated by a higher organised subject (organism). In other words, from the Cosmist point of view subject means every living organism on the Earth: molecule, cell, biological organism, biosphere, human being, family, community, social body, society, mankind, and, ultimately, Process itself (CEPLE) - which is to say, the single common whole cosmic evolutionary process of the life on Earth.

Another cornerstone notion is that of an 'emergent future', which means the successive appearance of the integrated macro-level of a subject's (man's) wellbeing ontogenesis: for example, the university for a schoolboy; the vocational body for a graduate and so on. In this, the term 'emergence' substantially has the meaning that is accepted in evolutionary thinking - that of the rise of a system that cannot be predicted or explained from antecedent conditions.

Further, I would like to stress the cosmist meaning of the term 'society'. This has no prevailing political meaning, but precisely relates to any community, structure, organisation, or any other socially functioning body of people expressing a common purpose through their organisation.

It is also important to discern the meaning of my terms 'cosmist' and 'cosmic': the former stresses two points: a) the intrinsic subjective origination of the primary perceptions of man's creative activity; b) the deliberate character of a person's creative activity, aimed at the achievement of the most desirable possible state of adaptation on the current level of her/his existence and, simultaneously, of the gratifying ascent on the successively higher level of the man's entire 'wellbeing' ontogenesis. In other words, a person performs cosmist creative activity basically on his/her own. In turn, the term 'cosmic' puts a particular emphasis on the fact that a subject is ultimately the function of Process. Finally, by typing the word 'Cosmist' with a capital letter or using Italics I intend to accentuate its reference to my original philosophical system.

Finally, I stress the definition of contemporary civilised man as the equal (in comparison with the Nature-Biosphere and Society), autonomous, and determining evolutionary element, who is solely capable of preserving life on Earth and of continuing the whole Process (CEPLE) to its emergent future wellbeing. The most significant quality of man is his/her Basic Cosmist Functionality (this notion is defined below in the text).

Ontology of Absolute Cosmist Wholism and the Cosmist Definition of Individual's Health

Original cosmological principles lay down a foundation for the advancement of the framework of ontological assumptions - the so-called system of Absolute (relative to all-embracing evolutionary Process) Cosmist (universal, functionally intentional realisation of the ascending satisfactory ontogenesis of any subject - i.e. any living organism, be it biological, personal or societal, including primarily man) Wholism (with reference to universal functional integration of any subject into one whole - i.e. self-unfolding and evolutionary ascending - Process).
Here, I have the space to highlight only the three primary principles of the entire ACW system:

1) Principle of the universal functional integration - 'all living is a whole - an integrated functional subject';
2) Principle of the universal emergent evolutionism - 'all living - any subject - is an evolutionary process'. This principle has equally both the micro-evolutionary essence (of adaptational, reflective, current, constructive, developmental individual creative activity) - for reaching the optimal stableness on the given environmental (societal) macro-level of a subject's (man's) ontogenesis, and the macro-evolutionary essence (of inherent, personalist, transcending creative activity, which intends to surpass the achieved state of adaptational stableness and is aimed at the integration into the wholeness of the successively superior macro-levels of the subject's ontogenesis);
3) Principle of the evolutionary selection from above - 'evolutionary selection from the emergent future'. Basically, evolutionary selection is not exclusively the 'survival of the fittest' in the present environment, but it is chiefly the realisation and application of a subject's specific ability to gratify it/her/himself, along with corresponding activities (and the effects and results of these activities), for the use of the coming congenerous superior level of its/his/her integrated wellbeing. We thereby get the 'natural' selection of a functionally suitable subject out of the lower level, for the satisfaction of the needs and requirements of the superior (higher) organised level of reality - 'from the future'. Herein, for example, the reality of a certain school is absent along the current life of a child (although this school exists in reality), but, soon, the school administration will select (or will refuse) this child; similarly, the university board will select (or not) our future school student; likewise, the manufacturer manager will further select (or not) the graduate for employment, etc.
Finally, I will present the cosmist definition of individual's health. The latter refers to the successful cosmist unity of adaptational and creative processes of the human organism and personality. In other words, individual's health is the 'process of processes' ('ontogenesis of ontogeneses') of the person's wellbeing. It comprises:
a) A man's successful ontogenetic macro-evolution: the process of the entirety of human vital activity culminating in the integration of the person's whole wellbeing ontogenesis into successively higher emergent hierarchical levels (in the evolutionary scale of complication); and, at the same time,
b) A man's regular and necessary micro-evolution: the process of the person's successful adaptational development from initial ('infantile', unstable) stages up to the mature ('homeostatic', stable) forms of the person's wellbeing on the given macro-evolutionary level.

Man's Healthy Ontogenesis - The Ontogenesis of Homo Sapiens Cosmicus

Process is the primary, basic, and ultimate (ever-evolving) organism on Earth. Process (cosmist) philosophy is an organismic philosophy. Significantly, 'Process' is an original rational (intuitive) notion. At the same time, to stress this once again, Process (CEPLE) is an objective phenomenon of reality. Empirically, relying on the natural sciences' verifications, Process possesses the following objective qualities:

1) Cosmic origin. This fact does not depend upon any of the existing hypothetical assumptions (more or less accepted in science, but which still are equally not validated by experiment: Evolutionism, Creationism, Pan-Spermia, Big Bang, etc.) of the origination of the life on Earth; in any case, Earth's life was originated from cosmic matter and energy.
2) Universality.
3) Evolutionary (self-unfolding) and ascending (in complexity) essence.
4) Essence of the emergent evolution.
5) Process is an autonomous subject. I mean primarily its evolutionary independence from our philosophical or theological explanations of its origin and self-unfolding: Process is, because it IS.
6) Cephalization. That is an evident law of Evolution, which has been proven as through the study of fossil records as, nowadays, on the molecular level.
7) The fundamental law of Process is the special evolutionary status of man. Since the appearance of man - i.e. the biological species of Homo sapiens - a qualitatively distinct stage of the world evolutionary process has been achieved: that is man's growing deliberate constructive interference in world evolutionary processes; undoubtedly, contemporary man steers the entire process of the current Earth's evolution. Man, in Process, is an equal element in relation to Nature (Biosphere) and Society. That is the main conclusion from my philosophical cosmology. Therefore, man, a subject of the society, is as capable of freeing her/himself from harmful influences of the physical and societal (ecological) environments, as of going beyond or rising above societies that do not suit his/her personal growth.

Herein, the historical figure of Aleksandr Solzhenitsyn (the winner of the 1970 Nobel Prize for literature) is relevant. Solzhenitsyn fearlessly transcended all societal constraints ('societies'), including an eight-year imprisonment, government pressure and censorship, and forcible deportation to the West (1974), in order to carry out ultimately his cosmist 'assignment' (responsibility) - i.e. to inform the world about the techniques of terror and resulting moral debasement in the USSR, and to expose the nature of the Soviet system. Eventually, he returned (in the 1994) to his native land as a much respected citizen. His life ontogenesis can be fairly considered as a wellbeing (healthy) one. At any rate, today, at 85, Aleksandr Isayevich is in good spirits, enthusiastic, active, and creative.

This example clearly shows that man ultimately is a function of Process, but not merely of biosphere or society. Hence, during a personal healthy ontogenesis, man equally transcends both the macro-levels of his/her biological evolution (embryo- and fetogenesis, and the postnatal stages) and the macro-levels of his/her social development: early childhood and childhood, school education, studentship, the given occupational activity, etc. In a Cosmist light, ultimately man is independent of society.

In my discourse, and in line with the goals of this exploration, I necessarily discriminate between three evolutionary macro-functions of humans:
Homo Sapiens animalis (HSA) - the direct function of Biosphere.
Homo Sapiens sapiens (HSS) - the direct function of Society.
Homo Sapiens cosmicus (HSC) - the direct function of Process.

Basic Cosmist Functionality - The Core Quality of Humans

The evolution of the life on Earth is a universal process (Process), for which there is scientific evidence. If this is a matter of fact, then I claim that all the subjects of life, including most importantly man, are reasonably the functions of Biosphere (regional ecosystem), Society (the societal structure) and ultimately the one whole evolutionary process (Process). In consequence, the recognition of Process as the absolute substance of the evolution of Earth's life logically permits the 'functional reduction' of any subject of life (of man, primarily) to his Basic (or in my terminology 'Cosmist') Functionality.

The notion of Basic Cosmist Functionality (BCF) precisely reflects this truth that every living subject (man) is ultimately the function of Process. Significantly, the proposed universal bio-reductionism has a functional essence. It means that universal functional bio-reductionism is opposed categorically to the common morphological (structural-functional) approach of reducing living phenomena from biosphere to populations, organisms, cells, organelles, genes, etc.; or of reducing mankind to societies, social bodies and individual humans (or members of society). On the contrary, Cosmist 'functional' bio-reductionism means that every living subject (organism) on Earth has a health-design: its/his/her BCF - i.e. basic, inherent and distinct functionality. In this course the core principle of CosmoBiotypology emerges. The latter establishes, by virtue of Cosmist functionalism, that the person's gratifying feelings and perceptions (of his/her vital activity), his/her appropriate social surroundings, and his/her physiological biotype (constitution) have a single basic functional meaning. In this functional triunity, the personal (subjective) perceptions of an individual have their decisive significance. Hence, Cosmist theory leads to a 'person-driven' scientific medicine, which is aimed at the integration of subjective and objective knowledge - i.e. of a man's personal experience and psychological, biological, and sociological data about the person (patient). Thus the Cosmist approach aspires to give back to rational global medicine its primordial idea of personcentric treatment of a patient. The words of Hippocrates, father of medicine, were "...the majority of all diseases do not come from without (like injury or infection), but from within... " [14].

BCF is, in essence, the intrinsic hierarchical program of a man's natural (healthy) successive and satisfactory transcending rise through the all macro-levels (biological and societal) of his/her ontogenesis, up to a personal mature creative one - for the realisation therein of his/her personal creative direct contribution to Process's wellbeing. This program has a cosmist functional essence - of the hierarchy of required (hence, originally virtual) results, effective realisation and accomplishment of which guarantee the person's selection and safe (healthy) inclusion in, and adaptation to, a successively higher macro-level of one's wellbeing ontogenesis (of a school student to the university, of a graduate to the professional body, and so on). Basically, BCF steers the entire ontogenesis of vital activity of any living subject (man primarily). Hence, the wholesome process (ontogenesis) of life's work for a person is essentially the extent of the realisation of her/his BCF. With respect to man the latter has the inborn and inherent character and hierarchically rules of biological and social needs, which are necessary and absolutely expedient, but having exclusively the 'service role'. Substantially, BCF exists equally as much in the present and the past as in the emergent future, realising itself in the satisfactory integration into the superior levels of the entire 'wellbeing' ontogenesis of the man.

In my opinion, Cosmist BCF notion has some similarity with Karl Jung's 'process of individuation' or Abraham Maslow's "a single end-goal" - "a single ultimate value or end of life" [15]. Furthermore, besides the parallels with Jung's individuation and Maslow's self-actualisation, an obvious similarity can be revealed with respect to the basic conceptions of classical pragmatism. Noteworthy, Charles Peirce, the American pre-eminent pragmatist, also was a strong believer in a 'selection from the future'. Therefore, the very characteristic 'purposive thought' of pragmatists fully correlates with the essential idea of the 'active evolution of a person' in Cosmist philosophy. Hence, generally speaking, philosophical cosmism is the pragmatism, which has 'turned into emergent future'.

Now, with the introduction of a Cosmist notion of BCF, I am able to characterise further the three evolutionary macro-functions of man, mentioned above. Homo Sapiens animalis and Homo Sapiens sapiens (HSA and HSS) are the object (and subject) of numerous natural, human, and social sciences, including philosophical anthropology, which originally treats individuals as both creatures of their environment and creators of their own values. Furthermore, it argues that human nature is complex and dynamic, thus being constantly able to rediscover and recreate itself within the confines of its biology and culture. In contradiction, from the Cosmist point of view, human behaviour and wellbeing are determined not exclusively by biological, social, and environmental factors, but, equally and ultimately, by the person's functional belongingness to Process.

At any rate, both HSA and HSS are always Bio-Social creatures, and never a Bio-Social-COSMIST person, as Homo Sapiens cosmicus (HSC) is. In other words, HSS is always a bio-organism, social actor, and unique person truly in his adaptation to the society. Conversely, HSC is likewise a bio-organism and social actor, but s/he is also a COSMIST agent of carrying out his or her inherent functional (personal, specific) contribution to the wellbeing of one common Process. As a corollary, Cosmist philosophy aims to replace 'being' (a basic concept that serves as a clear starting-point for any serious metaphysics) by 'functioning' as a more basic Cosmist concept, which indicates the necessity i) of active evolution for every living subject and ii) man's personal responsibility - for the realisation of his/her basic cosmist functionality.

Norm of Individual's Health and Individual Health Passport

Within the Cosmist theory, 'functional reduction' of any subject of life (man, primarily) to its/his/her basic functionality is at once subjective (personalist) and universal in essence, and lays the ground for the formulation of the notion of the 'norm of individual's health', or 'individual (personal) norm' of a man's vital activity. The latter meets precisely the requirements of the advanced categories of personcentrism, health-centrism, and subject-subject pattern of the relationship of a doctor to a patient, most of all by revealing the personalist rational approach to a patient in medicine.

What is a 'norm of individual's health'? First of all, it is a person-driven norm, in that primarily a person (patient) defines his/her personal life priorities and preferences, which deeply satisfy his/her vital activity, thus reflecting the realisation of the individual's Basic Functionality. Secondly, there is the universal norm of an individual's health, which establishes the functional unity of the entire triad of the principle spheres of the person's healthy vital activity: psychological, physiological, and sociological. In other words, the subjective (personal) level of man's basic functioning is universal in principle, because it can be reduced to the single meaning of both the man's personal (psychological) perceptions about her/his wellbeing, her/his biological (physiological) organisation (to the basic functional biotype), and to her/his societal wellbeing (i.e. to satisfactory social relations in the given surroundings). All this is embodied in the unity of a man's active wellbeing: psychological, physiological, and sociological, which is a complete 'vector' of the realisation of his/her basic (ultimate) functionality, i.e. of his/her healthy vital activity.

Among the three functionally united macro-spheres (which are: 1) of the man's personal knowledge about his/her wellbeing way ('route') of development, 2) of the psychosocial characteristic of her/his social 'wellbeing' existence, and 3) of the physiological typifying (constituting) of his/her basic functional organisation) the primary consideration ought to be transferred to humanistic psychological investigation, i.e. to man's independent self-research into his/her person and the most deeply satisfying motivations and perceptions of the activity of life. The psychosocial examination, further, might embody a man's personal ideas, leading to practical advice. Finally, investigation of physiological (biotypological) constitution might corroborate (or raise doubts about) the authenticity of the first two.

The Cosmist approach leads to the integration of previously incompatible spheres of scientific exploration: biological, psychological, and sociological. Now, a real vista opens up, by virtue of Cosmist functionalism, to the integration of the humanistic psychological unveiling of the subjective preferences of a person, the sociological elaboration of the optimal societal conditions for her/his development, and the physiologic identification of her/his basic functional biotype. All the results of these explorations, within the Cosmist paradigm, are functionally uniform (according to the single functional essence of the BCF) and, thus, have a functionally identical scientific meaning. The latter gives a 'green light' to the research project of making an 'individual health passport' for each person.

Likewise, a crucial point is that the Cosmist approach in biomedicine is designed to be 'person-driven' (personcentric) in principle. The scientific data just accompany the cosmist evolution of a man, endorsing (or falsifying) the personal convictions and supporting him/her in approaching, eventually and maximally, the realisation of their cosmist functionality (BCF), i.e. by disclosing the current actual possibilities of the BCF's implementation.

In turn, physiological components of the 'individual health passport' might establish a scientific bridgehead to uncovering the possible and factual deviations of physiological parameters from the normal values of the man's somatic health. The latter refers precisely to the given individual's physiologic status (biotype), but not to the average statistical values of the population. In other words, by virtue of information from the 'individual health passport' we might acquire the possibility of comprehending the primary individual (etiological) mechanisms which determine the pathogenesis of the chronic non-infectious (or non-traumatic) disease in relation to the given patient. Relying on the progress in this area (of the Cosmist paradigm operation in biomedicine), I do hope that possibilities will emerge to treat radically chronic non-infectious and non-traumatic diseases.

The Triune Character of Doctor-Patient Interrelations

Accepting the equality of the functional meanings of a man's normal vital activity in biological, sociological, and personal spheres, we are able to propose a reasonable transformation of the nature of a doctor's activity. From all that is stated above, the following conclusion follows: The 'Doctor of Tomorrow' ('Doctor of the man's individual health') ought to have the triune capabilities of physician, psychologist and philosopher:
1. As physician: physically to examine a patient and to make a diagnosis, based on the objective study of the signs and symptoms of a disease. Man here is an object, and the chief goals are to determine the nature of a disease, to give the course of adequate treatment and to achieve the full rehabilitation of a man's biological structures and functions - i.e. the recovery of the patient (the achievement of her/his 'physical wellbeing').
2. As psychologist: to examine a patient from the psychological and sociological standpoints (equally as an object), and to give the course of adequate rational psychotherapy, aimed both at the treatment of emotional, behavioural, and personality disorders, as well as optimising the patient's interpersonal and interactional skills thereby helping her/him to adjust to the existing requirements of the given society. This level includes necessarily the psychology of health and behavioural medicine, which lead a person to avoid or neutralise the existing harmful risk factors, and, simultaneously, to exploit the environmental healing factors. Hence, the second level of doctor-patient interrelations directly leads to the achievement of the person's 'social (mental) wellbeing'.
3. The third - philosophical - macro-level of doctor's activity is the level of precisely subject-subject ('philosopher-philosopher') interrelations and exactly the level of the application of the cosmist dialectical philosophy and the deduced theoretical proposals. Equally, the 'Doctor of the individual health of a man' uses here the already existing means of humanistic psychology and philosophical counseling. Likewise, this is the level of a person's necessary self-education with respect to his/her personal wellbeing (health). Naturally, this level provides the type of doctor-patient interrelations that lead precisely to the 'personal (psychological) wellbeing' of a person. It is essential that on the philosophical level a doctor and her/his patient are partners. Moreover, the subjective (autonomous) creating by a man of his/her personally gratifying perceptions and ideas, and the self-educational activity of the patient (person) have the decisive significance, relating to the choice by the person of current and wholly healthy route of wellbeing ontogenesis. At the same time, the activities of the doctor-philosopher acquire mainly the quality of delicate assistance and accompaniment.

Conclusion

In conclusion, I would like to draw attention to the so-called 'Anthropological Evolutionary Paradox' in relation to a person: Man is an uterine element of the one common whole cosmic evolutionary process of the life on Earth (Process), however we deny the search for universal evolutionary knowledge and rely on the plural (different and often incompatible) sources of knowledge in defining man's nature: biological, sociological, psychological, etc. This paradoxical situation urgently calls for the creation of an original philosophical basis, which could provide the integrated comprehension of man's nature and the elaboration of the effective universal theory in application to the biological, sociological, psychological (personal) issues. The Cosmist hypothesis is a real attempt towards achieving this purpose. In my way, I rely basically on the original universal bio-reductionism of true functional essence, and the key principle of CosmoBiotypology. Significantly, Cosmist theory leads to a 'person-driven' scientific biomedicine, which is aimed at the integration of subjective experience and objective knowledge: biological, psychological, sociological, etc.

I do hope that the proposed 'individual (personal) norm' of human health will be recognised as a object fully worthy of biomedical investigation. This personal norm, in the Cosmist light, primarily lies in man's ability actively to (re)discover (on every macro-level of personal ontogenesis) and realise his/her basic functionality (his/her cosmist functional 'assignment'). The 'individual's health norm' has, thus, primarily a person-driven character, but not a science-driven (i.e. related to scientific-statistical norms for the population) character, nor a society-driven (i.e. related to socially established norms for the whole society) character. The Cosmist personal norm of health has real universal sense, insofar as it expresses the single functional meaning of subjective and objective wellbeing in relation to each man: personally inherent gratifying feelings and perceptions, individual physiological constitution (biotype) and psycho-sociological wellbeing with respect to his/her realisation and carrying out the basic (ultimate, cosmist) functionality, i.e. his/her natural healthy vital activity.

To my firm belief, the successful development of the Cosmist person-centred medicine is solely realisable within the free and open access to scholarly communication on the internet.

A short list of notions and abbreviations

The ontological ACW system: of Absolute (relative to all-embracing evolutionary Process) Cosmist (universal, functionally intentional realisation of the ascending satisfactory ontogenesis of any subject - i.e. any living organism, be it biological, personal or societal, including primarily man) Wholism (with reference to universal functional integration of any subject into one whole - i.e. self-unfolding and evolutionary ascending - Process).

BCF: Basic Cosmist Functionality - a health-design of every living subject (organism) on Earth, i.e. basic, inherent and distinct functionality. BCF is the program of a cosmist functional essence, i.e. the intrinsic hierarchical program of a man's natural (healthy) successive and satisfactory transcending rise through the all macro-levels (biological and societal) of his/her ontogenesis, up to a personal mature creative one - for the realisation therein of his/her personal creative direct contribution to Process's wellbeing.

Man - this term is traditionally referred to the human race in general, or 'mankind'.

CEPLE (Process): cosmic evolutionary process of the life on Earth. Process (CEPLE) is clearly discerned in the well-known Gaia hypothesis. (With reference to J. Lovelock and L. Margulis, biosphere-'Gaia' is likewise viewed as a single, self-regulating organism.) Process has future emergent stages of evolution, while Gaia is a phenomenon of the present state.

Cosmist - a basic term in my theorising, which reflects the subjective (personal, responsible) and universal (in relation to a subject's 'Basic Functionality') integration of a subject (a person) into the surrounding world. The term 'cosmist' functions in the text both as an adjective and as a noun (although mainly as an adjective). An analogy can be drawn with the term 'personalist', which likewise functions both as an adjective and noun.

HSA: Homo Sapiens animalis - the direct function of Biosphere.
HSS: Homo Sapiens sapiens - the direct function of Society.
HSC: Homo Sapiens cosmicus - the direct function of Process.

Wellbeing - I would like to use my core term 'wellbeing' as 1) a noun - as a state of being contented, healthy, etc.; and 2) as an adjective, having the sense of 'successful, satisfactory, healthy, safe, happy, etc.'.

Wholistic - I prefer to use the term 'wholistic' to discriminate my Cosmist approach from the classic standpoints on holism.

Acknowledgements

I am deeply indebted to Professors Darryl R. J. Macer, University of Tsukuba; Andrew Edgar, Cardiff University; Vladimir B. Mouraviev, University of British Columbia, Vancouver; Juriy M. Khrustalev, Moscow Medical Academy after I.M.Sechenov; Georgiy S. Arkhipov and Viktor R. Veber, of Novgorod State University after Yaroslav-the-Wise - for their invaluable support.

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