The Principle of Optimality in Human Life, Health and Disease

INTRODUCTION

A Universal Logic of Optimality from the Physics of the Universe to the Human Being

This book is, above all, a worldview framework rather than yet another compendium of clinical protocols or algorithms. The physician who takes it up already possesses a substantial body of knowledge, professional intuition, and years of experience, and therefore does not need ready‑made templates or elaborated “recipes.” We do not seek to impose technical solutions, but instead propose a new lens: a deep philosophical justification of why the familiar strategy of “normalization at any cost” so often leads into a dead end. We deliberately allow the exposition a certain degree of poetic and metaphorical expression, because this creates a particular atmosphere that facilitates the intuitive apprehension of complex systems ideas that lie beyond dry technical description. This guide is intended to help us learn, in most cases, to see disease not as an enemy to be fought until the organism’s last reserves are exhausted, but as a complex, evolutionarily grounded process of adaptation governed by the general laws of nature. Disease should be regarded as a genuine enemy only when deviation from the optimal trajectory has reached a level at which the possibilities for optimization are effectively lost.

The Universal Logic and Mathematical Language of the Universe

The universe appears to be structured as if it were governed by a guiding Mind. We discern this not only in the beauty of forms but in the fact that processes obey certain laws, one of which—the principle of optimality—is arguably among the most fundamental. Light in an inhomogeneous medium follows the path of least time; mechanical systems realize a principle of least action. Nature does not expend more than is necessary to achieve its ends. This is the fundamental pragmatism of being: attaining the required result by the most efficient feasible path. In mathematics and engineering, this law receives a rigorous formulation in Pontryagin’s maximum principle. Any controllable system has trajectories that are superior to others for a given objective. Whether the problem is minimal time or minimal resource expenditure, the same principle specifies the conditions for optimal control, describing how a system must vary its inputs to traverse its path in the least costly way.

Biological Design in the Work of Rashevsky and Rosen

In biology, Nicolas Rashevsky formulated the principle of adequate design: if a given function can be carried out by different structures, the structure actually realized in the organism is the simplest and most adequate for the prevailing conditions. Nature does not build superfluous elements. Robert Rosen went further by demonstrating that living systems possess a logic of organization that cannot be reduced to mechanics alone. He treated the organism as a system of relations in which form and function are coordinated to ensure persistent existence with minimal redundancy and maximal capacity for self-maintenance. Here, optimality is not mere economy but a harmony of construction and purpose, where each element "knows" its role in sustaining the whole. This is a biological form of optimality in which every detail is functionally warranted.

The Theory of Functional Systems as an Operational Scheme of Optimality

P. K. Anokhin described how a living organism organizes its activity around a useful result. A functional system performs an afferent synthesis, selects a goal, develops a program of action, executes it, and then compares the actual result with the "acceptor of the result of action." If the result proves unsatisfactory, the program is adjusted until the system identifies a variant that delivers an acceptable result at the lowest feasible cost. This is an operational description of optimality in living nature. The organism appears not as a passive object, but as an active subject of control whose internal subsystems operate in a regime of continual search for better responses to environmental challenges. The human being represents the apex of this architecture: psyche, will, meanings, and decisions emerge as higher levels of control.

The Principle of Disease Optimality and the Economy of Repair

On this foundation rests our Principle of Disease Optimality. Disease is not a chaotic breakdown, but a forced, internally coherent mode of an "economy of repair" in which the organism attempts to navigate a crisis via the best of its available pathways, paying the lowest possible price from its health resources. In the language of optimal control, disease is a specific course through which the organism solves strategic survival problems. In critical states, the dominant mode is minimal time—a rapid exit from the zone of imminent threat, where time becomes the primary resource. In other situations, the priority shifts to minimizing total costs—limiting damage, loss of function, and the depletion of reserves. Disease thus appears as an economy of repair: among all realistically accessible options, the organism adopts the least destructive one.

The Principle of Health and Life Optimality 

Implicit in the Principle of Disease Optimality is a corresponding the Principle of of Health and Life Optimality. If disease represents the optimal path through crisis, health represents the optimal regime of organization between crises. Health is not a static point of well-being, but a spectrum of states within a corridor of the best attainable functioning. A logical extension of this is the Principle of t Life Optimality (Wellspan). An optimal life is not identical to maximal duration; it is a configuration of choices and activities that yields the highest attainable level of subjective well-being and meaning. Wellspan is the art of filling the natural boundaries of life with maximal quality, ensuring that each unit of resource yields an increment in the quality of experience rather than a mechanical prolongation of existence.

Measures of Health and Disease

It is essential to distinguish the measure of health from the measure of disease as two distinct scales. The measure of health characterizes the quality of functioning under non-crisis circumstances, relative to the individual’s life context. The measure of disease characterizes the course of processes under crisis: the severity of damage and the degree of deviation from an optimal trajectory. Normative ranges derived from healthy populations cannot be mechanically applied to illness, because disease has its own dynamic norms. Contemporary medicine often conflates these measures, evaluating the ill on the scale of the healthy and thereby promoting the aggressive treatment of parameters instead of supporting the organism’s evolutionarily shaped pathway toward recovery. Understanding these measures allows the clinician to move from population "norms" to individualized criteria of optimality.

The Optimality Criterion as an Instrument of Medicine

The power of the principle of optimality lies in the criterion it provides for assessing deviations from an ideal trajectory. This opens three levels of practical work: diagnosing the degree of departure from the optimal corridor, identifying pathways of return, and designing preventive strategies. For medicine, this entails a shift from abstract desiderata to a concrete science of optimizing the architecture of health and the course of disease. We move from statistical norms to individualized guidance, where success is judged not only by survival but by Wellspan and quality of life.

From Individual to Society: The Social Organism

We then widen the frame to the social organism—society. It possesses its own anatomy (institutions), physiology (flows of resources and trust), and nervous system (networks of connection). The same principles of optimality apply: the social organism seeks optimal exits from crises through acute and chronic phases. Understanding these dynamics allows us to speak of a "medicine of society"—strategies that reduce the cost of inevitable crises and sustain the Wellspan of communities. The individual, as an inseparable part of society, finds an optimum only when social structures help minimize the adaptive cost of that person’s life.

The Logic of Life as a Foundation for a Philosophy of Action

This perspective renders the present work foundational in scope: we do not teach how to treat a specific pathology; we teach how to understand the logic of life. This empowers the physician to make sound decisions in unique situations where standard protocols may be inadequate or even harmful. It is, in essence, a philosophy of action in which every medical intervention is evaluated by the extent to which it preserves and augments Wellspan—the period of qualitatively rich and coherent human existence. This guide returns the physician to the roots of understanding human nature while equipping them with an intellectual toolkit for managing complex adaptive systems. In this way, we outline the foundations for a medicine of the future, in which biology, philosophy, and clinical art converge into a unified strategy of optimal living.

 

PART I. OPTIMALITY AS A LAW OF LIFE

Chapter 1. The Principle Of Optimality In Nature

Optimality is commonly perceived as a human construct: we “optimize” time, resources, and technologies. In reality, however, the world itself is structured in such a way that its fundamental processes rest on principles of minimal “cost.” Paradigmatic examples include the path of light, the motion of mechanical systems, and the self-organization of matter. Life simply adopts this universal order and realizes it in a specific form: every cell, organ, organism, and ecosystem is compelled to solve the same problem—how to sustain a maximum of order, stability, and reproductive capacity with limited resources. In this sense, optimality is not our invention but a universal property of the world which, in living systems, manifests as the basic “language” of life—one that can be used to describe health, disease, and aging alike.

In technical systems, the optimum is often specified from the outside: the engineer decides what exactly is to be minimized—time, fuel, or financial cost—and then selects an appropriate algorithm for that task. In living systems, the situation is entirely different: here, the optimum emerges as an internal law of survival. An organism does not “decide” to be optimal; it simply has no chance to exist otherwise under conditions of finite resources.

Optimality as an inner law of life rather than an external goal

Any cell that expends too much energy on maintaining its structure, or conversely, economizes excessively on molecular repair, is doomed either to perish or to be displaced by more efficient competitors. Hence, optimality in biology is not an external objective but an embedded filter: out of the full spectrum of possible configurations, only those are realized that can sustain order in a chaotic world. The principle of optimality may thus be formulated as follows: living systems are inevitably organized so as to minimize the overall “cost” of their existence while preserving their capacity for reproduction and adaptation. Life did not invent this principle; it inherited it from the architecture of the universe, in which the path of light and the motion of mechanical systems are always subordinated to a principle of least action.

Biological and physiological examples of optimization

At the cellular level, this law is expressed in the strict allocation of energy: metabolic pathways are arranged to extract the maximum energetic yield from minimal amounts of substrate; protein synthesis is tightly regulated to avoid wasting resources on superfluous molecules; and transport across membranes is balanced between passive and active mechanisms so as to maintain necessary concentrations with the least possible effort.

At the level of the whole organism, we encounter even more remarkable engineering: respiration and cardiac output adjust almost instantaneously to tissue demands, avoiding useless pumping of blood; thermoregulation functions as a fine compromise between heat loss and the energetic expenditure needed to generate heat. A particularly striking illustration is Murray’s law, which describes the architecture of the vascular tree. Instead of complex calculations, nature employs a simple rule: when a large vessel bifurcates into two smaller ones, their diameters are selected so as to achieve an ideal balance. On the one hand, vessels must not be too narrow, otherwise the heart must work excessively hard to overcome high resistance. On the other hand, they must not be too wide, otherwise the organism would expend too much energy on maintaining and nourishing a large volume of “excess” blood. Nature finds a “golden mean” at which the total cost of driving blood and maintaining vessels is minimized. This turns our circulatory system into a masterpiece of logistics in which every bend and every branching is “calculated” in favor of overall economy of resources.

Even ecosystems operate according to this principle: energy flows and food webs are organized so as to utilize the available environmental resources as fully as possible, leaving no empty, wasteful niches.

From evolutionary to functional expediency

Classical evolutionary theory explains optimality through selection: structures that fit their environment better leave more offspring. This is evolutionary expediency—the historical “justification” of any trait by its contribution to reproductive success. Yet in real time, the organism operates at another level—functional expediency. A functional system, in Anokhin’s sense, does not merely execute a pre-given program; it continually reorganizes its components so as to maximize the success of a concrete action. Here, optimality becomes an immediate problem: how to redistribute blood between organs at this very moment, or how to modify a motor program when an obstacle appears. Evolutionary expediency provides the “basic architecture,” whereas functional expediency governs the current configurations of that architecture, producing a two-layer optimization of life.

Limits and paradoxes of the optimal

Optimality in living systems is never absolute; it is always local. What is beneficial under one set of conditions may be destructive under another. Glucose levels or immune activity are not cases of “the more, the better,” but narrow corridors of optimum beyond which adaptation turns into disease. Conflicts between levels arise as well: what benefits an individual cell (for example, uncontrolled proliferation) becomes catastrophic for the organism in the form of cancer. Moreover, evolution is not a global mathematician but a blind search for the “good enough,” which generates its own paradoxes: the vulnerability of the spine owing to bipedal posture, or mechanisms that are advantageous in youth but predispose to disease in later life. In this context, health is a coordinated optimization across all levels, whereas disease is a breakdown in this delicate calculus of costs.

You can learn more by reading our e-book 

Mykola Iabluchanskyi together with Andriy Yabluchanskiy