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Clinical review
In search of “non-disease”
Richard Smith
The BMJ recently ran a vote on to identify
the “top 10 non-diseases.1Some critics thought it an
absurd exercise,2but our primary aim was to illustrate
the slipperiness of the notion of disease. We wanted to
prompt a debate on what is and what is not a disease
and draw attention to the increasing tendency to
classify people’s problems as diseases.
In 1979 the BMJ published a study that did
something similar.3Non-medical academics, medical
academics, general practitioners, and secondary school
students were invited to say whether 38 terms did or
did not refer to a disease. Almost 100% thought that
malaria and tuberculosis were diseases, but less than
20% thought the following to be diseases: lead poison-
ing, carbon monoxide poisoning, senility, hangover,
fractured skull, heatstroke, tennis elbow, colour
blindness, malnutrition, barbiturate overdose, drown-
ing, or starvation (figure). People were split 50:50 over
whether hypertension, acne vulgaris, or gall stones
were diseases. The doctors were more likely to view the
terms as referring to diseases. The authors of this study
included Guy Scadding, who spent much of his life
spelling out to doctors that no general agreement
exists on how to define a disease.
Fourteen years earlier, the New England Journal of
Medicine had published a paper arguing the case for
“non-diseases.4Better, argued Clifton Meador, to
describe a patient in whom a diagnosis could not be
made as having a “non-disease” rather than make “the
common error of continuing to label such patients
with non-existent diseases.” He produced a classifi-
cation of non-disease and concluded that “the
treatment for non-disease is never the treatment
indicated for the corresponding disease entity. In this
statement lies the ultimate value of the science of
What is a disease?
Thomas Sydenham (1624-1689) thought that diseases
could be classified just like plant and animal species.In
other words, diseases have an existence independent of
Percentage of respondents classifying condition as disease
Barbiturate overdose
Colour blindness
Tennis elbow
Fractured skull
Carbon monoxide poisoning
Lead poisoning
Piles (haemorrhoids)
Duodenal ulcer
Hay fever
Gall stones
High blood pressure
Coronary thrombosis
Acne vulgaris
Muscular dystrophy
Multiple sclerosis
Diabetes mellitus
Cancer of the lung
Cirrhosis of the liver
10 20 30 40 50 60 70 80 90 100
Non-medical academics (reference group)
Secondary school students
Medical academics
General practitioners
Results of survey in 1979 in which a range of subjects (non-medical
academics, secondary school students, medical academics, and
general practitioners) were asked which of 38 conditions they
considered to be diseases3
Summary points
The BMJ conducted a survey on the web to
identify “non-diseases”
and found almost 200
The notion of “disease” is a slippery one and the
concept of non-disease is therefore similarly
Health is equally impossible to define
To have your condition labelled as a disease may
bring considerable benefit
both material
(financial) and emotional
However, the diagnosis of a disease may also
create problems
you may be denied insurance, a
mortgage, and employment
A diagnosis may also lead you to regard yourself
as forever flawed and unable to “rise above” your
BMJ, BMA House,
London WC1H 9JR
Richard Smith
BMJ 2002;324:883–5
883BMJ VOLUME 324 13 APRIL 2002
the observer and exist in nature, ready to be
“discovered.” In complete contrast, others see the
notion of disease as essentially a means of social
control.5Doctors define a patient’s condition as a “dis-
ease” and are then licensed to take various actions,
including perhaps incarceration. “Each civilisation,
wrote Ivan Illich, “defines its own diseases. What is sick-
ness in one might be chromosomal abnormality, crime,
holiness, or sin in another.6
The Oxford Textbook of Medicine wisely stays away
from defining a disease. The Chambers Dictionary
defines disease as “an unhealthy state of body or mind;
a disorder, illness or ailment with distinctive symptoms,
caused eg by infection.”Neither definition is operation-
ally helpful, especially as health is even harder to define
than disease. Imre Loeffler, surgeon, essayist, and wit,
says that the World Health Organization’s famous defi-
nition of health as “complete physical, psychological,
and social wellbeing” is achieved only at the point of
simultaneous orgasm, leaving most of us unhealthy
(and so, by the Chambers Dictionary definition, diseased)
most of the time.
Disease is often defined as a departure from
“normal,” and helpfully David Sackett and others offer
six definitions of normal in Clinical Epidemiology, “the
bible of evidence based medicine”(table 1).7One com-
mon definition is that you lie more than two standard
deviations from the mean on whatever measure is
height, weight, haemoglobin concentration, and
tens of thousands of others. By definition,5% of people
are thus “abnormal” (and we might say diseased) on
each test. Run enough tests and we are all abnormal
(diseased). Or, on a definition of increased risk, we
might define almost the entire population of Britain as
diseased if we consider all those with a blood
cholesterol concentration that carries an extra risk of
mortality compared with the cholesterol concentration
of those living in less developed communities.
The pluses and minuses of having a
disease label
To have your condition labelled as a disease may bring
considerable benefit. Immediately you are likely to
enjoy sympathy rather than blame. You may be
exempted from many commitments, including work.
Children learn very young that saying you have a
headache will bring sympathy and a hug, whereas say-
ing, “I can’t be bothered to go to school” will bring
anger and punishment. Having a disease may also
entitle you to benefits such as sick pay, free
prescriptions, insurance payments, and access to facili-
ties denied to healthy people. You may also feel that
you have an explanation for your suffering.
But the diagnosis of a disease may also create many
problems. It may allow the authorities to lock you up or
invade your body. You may be denied insurance, a
mortgage, and employment. You are forever labelled.
You are a victim. You are not just a person but an asth-
matic, a schizophrenic, a leper, an epileptic. Some dis-
eases carry an inescapable stigma, which may create
many more problems than the condition itself. Worst
of all, the diagnosis of a disease may lead you to regard
yourself as forever flawed and incapable of “rising
above” your problem.
Consider the case of alcoholism, a hotly disputed
diagnosis. Better perhaps to be “an alcoholic” than a
morally reprehensible drunk. But is it helpful to think
of yourself as “powerless over alcohol,” with your prob-
lem explained by faults in your genes or body chemis-
try? It may lead you to a learned and licensed
Illich puts it like this this6:
“In a morbid society the belief prevails that defined and
diagnosed ill-health is infinitely preferable to any other
form of negative label or to no label at all. It is better
than criminal or political deviance, better than laziness,
better than self-chosen absence from work. More and
more people subconsciously know that they are sick
and tired of their jobs and of their leisure passivities, but
they want to hear the lie that physical illness relieves
them of social and political responsibilities. They want
their doctor to act as lawyer and priest. As a lawyer,the
doctor exempts the patient from his normal duties and
enables him to cash in on the insurance fund he was
forced to build. As a priest, he becomes the patient’s
accomplice in creating the myth that he is an innocent
victim of biological mechanisms rather than lazy,
greedy, or envious deserter of a social struggle over the
tools of production. Social life becomes a giving and
receiving of therapy: medical, psychiatric, pedagogic, or
geriatric. Claiming access to treatment becomes a
political duty, and medical certification a powerful
device for social control.”
“There is no disease that you either have or don’t
except perhaps sudden death and rabies. All
other diseases you either have a little or a lot of.”
Geoffrey Rose epidemiologist
Table 1 Six definitions of “normal” in common clinical use7
Property Term Consequences
Distribution of diagnostic test results has a certain shape Gaussian Ought to occasionally obtain minus values for
haemoglobin, etc
Lies within a preset percentile of previous diagnostic test results Percentile All diseases have the same prevalence. Patients are
normal only until they are “worked up”
Carries no additional risk of morbidity or mortality Risk factor Assumes that altering a risk factor alters risk
Socially or politically aspired to Culturally desirable Confusion over the role of medicine in society
Range of test results beyond which a specific disease is, with known
probability, present or absent
Diagnostic Need to know predictive values that apply in your
Range of test results beyond which treatment does more good than harm Therapeutic Need to keep up with knowledge about treatment
“I don’t know why you say that making a diagnosis is
the most important thing a doctor does. As a general
practitioner I hardly ever make a diagnosis.
General practitioner north London
Clinical review
884 BMJ VOLUME 324 13 APRIL 2002
The BMJ s vote
We began our search for non-diseases by generating
our own definition and list. By “non-disease” we meant
“a human process or problem that some have defined
as a medical condition but where people may have
better outcomes if the problem or process was not
defined in that way.” This exercise prompted an
internal debate about whether we were insulting those
who might regard themselves as having what others
might classify as a non-disease.
We responded by making clear that we were not
suggesting that the suffering of people with these
“non-diseases” is not genuine. The suffering of many
with “non-diseases” may be much greater than those
with widely recognised diseases. Consider the
suffering that might come from grief, loneliness, or
Having generated our own list, we then invited sug-
gestions from our editorial board. We were surprised
that we quickly achieved a list of nearly 100. Next,
readers were invited to add to the list, boosting it to
nearly 200.
Paul Glasziou, a general practitioner from Queens-
land, Australia, and a member of the BMJ editorial
board, has used most of these to produce an ICND
international classification of non-diseases (table 2).
Deliberately, but perhaps unwisely, we allowed almost
anything to be added to the list, including some “non-
treatments” like circumcision. A list of non-treatments
might be even longer than a list of non-diseases. Then
came the vote for the top 10 non-diseases, and the box
shows the top 20.
The complete list is interesting, and I was surprised
that we could generate so many non-diseases.Some of
these non-diseases already appear in official classifica-
tions of disease, and perhaps those that do not
currently appear will be appearing soon. Disease
classifications are likely to grow not shrink, particularly
as genetics begins to allow the separation of what are
currently single diseases into many.
What mattered most about this process, however,
was not the list but the debate. Rapid responses to the
debate are summarised on p 913. Surely, everything is
to be gained and nothing lost by raising consciousness
about the slipperiness of the concept of disease.
Competing interests: None declared.
2 Bailey M.How to use an esteemed medical journal to increase suffering.
3 Campbell EJM, Scadding JG, Roberts RS. The concept of disease. BMJ
4 Meador CK. The art and science of nondisease. N Engl J Med 1965;
5 Foucault M. The birth of the clinic. New York: Pantheon, 1973.
6 Illich I. Limits to medicine. London: Marion Boyars, 1976.
7 SackettDL, Haynes RB, Guyatt GH, Tigwell P. Clinical epidemiology: a basic
science for clinical medicine. Boston: Little, Brown: 1991:59.
Table 2 International classification of non-diseases, based on non-diseases suggested to
Aesthetic discomfort Current discomfort or dysfunction
Possible future discomfort,
dysfunction, or death
Misattribution or
Anxiety about size Allergy to 21st century; chronic candida infection; false memory
syndrome; flat feet; Gulf war syndrome; multiple chemical sensitivities;
total allergy syndrome
Universal Ageing; skin wrinkles Ageing; ignorance; loneliness; menopause; teething; unhappiness; work Menopause
Usual response Acne; bags under the eyes;
borborygmi; stretch marks
Adjustment reaction; bereavement; boredom; childbirth; jet lag;
hangover; pain; pregnancy; whiplash
Ends of spectrum Big ears; dandruff; gap teeth; grey
or white hair; halitosis; obesity;
Air rage; alcohol dependency; anorexia; attention deficit disorder; bed
wetting; burn out; chronic fatigue syndrome; colic; domestic violence;
dyslexia; fibromyalgia; personality disorder; perimenstrual dysphoric
disorder; procrastination; road rage; seasonal affective disorder; stress;
teenage pregnancy
Variant of normal Baldness; cellulite; freckles;
skin tags
Chinese restaurant syndrome; conduct disorders in childhood; ear wax
accumulation; food intolerance; infertility; nail chewing; teeth grinding;
tension headaches; tics
Deviation of nasal septum;
Top 20 non-diseases (voted on by
readers), in descending order of
1 Ageing
2 Work
3 Boredom
4 Bags under eyes
5 Ignorance
6 Baldness
7 Freckles
8 Big ears
9 Grey or white hair
10 Ugliness
11 Childbirth
12 Allergy to the
21st century
13 Jet lag
14 Unhappiness
15 Cellulite
16 Hangover
17 Anxiety about penis size/
penis envy
18 Pregnancy
19 Road rage
20 Loneliness
The best part of the cure
He consulted a new physician . . . who bluntly
diagnosed all his symptoms as “evils produced by
the use of narcotics.” He prescribed mercury in the
form of Corbyn’s Blue Pills, nitric acid in water, and
a “known & measured quantity of Stimulant, with
an attempt to diminish the Opiate part of it little by
little, if it were only a single Drop in two days.”But
Coleridge felt the sickness was in his heart, and the
best part of the cure lay simply in talking to the
doctor and trying to put him “in possession of the
whole of my Case with all its symptoms, and all its
known, probable and suspected Causes.
Richard Holmes. Coleridge—Darker reflections.
London: HarperCollins, 1998
Submitted by Iona Heath,
general practitioner, London
Clinical review
885BMJ VOLUME 324 13 APRIL 2002
... [11][12][13][14] The approach to naming and defining disease is much debated, including what even constitutes a disease. [15][16][17][18][19] However, no standardized framework has emerged. Diseases can be known by descriptive terms or proper nouns, including eponymous names. ...
... 29,47,48 Likewise the choice of terminology has implications for how a disease is perceived or prioritised. 19,49,50 Whilst previous evidence has suggested this is more likely for descriptive terms ("chronic fatigue") as opposed to those that are perceived as a disorder ("chronic fatigue syndrome"), this is also informed by the perception of the disease itself, with chronic conditions, affecting multiple systems, of uncertain aetiology and without treatment or requirement for a doctor, less likely to be prioritised. [51][52][53] An example of well adopted change is overactive bladder syndrome, previously known as 'urinary incontinence' or 'detrusor instability'. ...
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Study design: Modified DELPHI Consensus Process. Objective: To agree a single unifying term and definition. Globally, cervical myelopathy caused by degenerative changes to the spine is known by over 11 different names. This inconsistency contributes to many clinical and research challenges, including a lack of awareness. Method: AO Spine RECODE-DCM (Research objectives and Common Data Elements Degenerative Cervical Myelopathy). To determine the index term, a longlist of candidate terms and their rationale, was created using a literature review and interviews. This was shared with the community, to select their preferred terms (248 members (58%) including 149 (60%) surgeons, 45 (18%) other healthcare professionals and 54 (22%) People with DCM or their supporters) and finalized using a consensus meeting. To determine a definition, a medical definition framework was created using inductive thematic analysis of selected International Classification of Disease definitions. Separately, stakeholders submitted their suggested definition which also underwent inductive thematic analysis (317 members (76%), 190 (59%) surgeons, 62 (20%) other healthcare professionals and 72 (23%) persons living with DCM or their supporters). Using this definition framework, a working definition was created based on submitted content, and finalized using consensus meetings. Results: Degenerative Cervical Myelopathy was selected as the unifying term, defined in short, as a progressive spinal cord injury caused by narrowing of the cervical spinal canal. Conclusion: A consistent term and definition can support education and research initiatives. This was selected using a structured and iterative methodology, which may serve as an exemplar for others in the future.
... Not only has there been confusion and inconsistencies in conceptualizations of SWB, but the definition(s) of health continue to be debated in both medical and behavioral sciences (e.g., Evans, 1988;Peto & Doll, 1997;Smith, 2002;Spiro, 2007; for an overview see Larson, 1999). While difficult to define, physical health can broadly be described as the systems of the body carrying out physiological functions properly (Larson, 1999). ...
Das subjektive Wohlbefinden (SWB) spiegelt die Gesamtbeurteilung des Lebens (globales SWB) und die Höhen und Tiefen des täglichen Lebens (erfahrungsbezogenes SWB) wider. Eine Fülle von Belegen deutet darauf hin, dass gesundheitliche Herausforderungen die langfristige Aufrechterhaltung des globalen SWB älterer Erwachsener sowie ihre Emotionsregulation vor Ort gefährden (Barger et al., 2009). Gleichzeitig behauptet die Lebensspannenpsychologie, dass sich das SWB als Ergebnis gesundheitlicher Anfälligkeiten entfaltet, die in ein System von Kontextebenen eingebettet sind, das vom Individuum bis zur Dyade reicht (Baltes & Smith, 2004). Allerdings haben nur wenige Studien mehr als eine Facette der Gesundheit oder des SWB untersucht, noch haben sie typischerweise individuelle Unterschiede (Persönlichkeit) oder sozial-kontextuelle Antezedenzien (z. B. die Gesundheit von signifikanten anderen Personen) untersucht. Um diese Lücken zu schließen, untersucht diese Dissertation: (i) die langfristigen Verläufe mehrerer Facetten des globalen SWB im Alter und ihre Vorhersage durch den objektiven Gesundheitszustand; sowie die kurzfristige Variabilität der Facetten des erfahrungsbezogenen SWB älterer Erwachsener als Ergebnis (ii) anlassbezogener Abweichungen des Gesundheitszustands und (iii) anlassbezogener Abweichungen des Gesundheitszustands des Ehepartners. In jeder Studie wird zusätzlich die Rolle des Neurotizismus untersucht. Zu diesem Zweck verwenden diese Studien fünf unabhängige Datensätze älterer Erwachsener, die objektive, leistungsbezogene und subjektive Maße der Gesundheit und des SWB über drei zunehmend feinere Zeitskalen erhoben haben. Die Ergebnisse dieser Dissertation zeigen, dass es älteren Erwachsenen gelingt, gesundheitliche Herausforderungen zu überwinden, um das SWB über kurze und lange Zeiträume aufrechtzuerhalten. Dabei werden die Kontexte hervorgehoben, in denen dieser Erfolg versagt (angesichts der gesundheitlichen Gefährdung des Ehepartners).
... Uden en diagnose kan vi ikke behandle patienten rationelt -vi må vide, hvad patienten fejler, og vi må forstå baggrunde for, at andre tandlaeger stiller andre diagnoser, end vi selv gør. D (6,7). Mange af de problemer, man som tandlaege har i klinikken, stammer således fra den udbredte opfattelse, at der til diagnosen hører veldefinerede sygdomsforløb. ...
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... Health care professionals may be uncertain of specific diagnoses, and people living with chronic pain conditions can be resentful that their symptoms are doubted (2,3). Fibromyalgia syndrome (FMS) is a classic example of this, where despite significant evidence and recognition of it as a primary pain disorder, debate on its legitimacy was still common in the recent past (4,5). This has left a legacy whereby people living with FMS report feelings of de-legitimization, betrayal, and anger toward the medical system (6,7). ...
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Background Environmental sensitivity is commonly reported by people with fibromyalgia syndrome. People living with fibromyalgia syndrome frequently report hypersensitivity to noxious and non-noxious sensations. To date, there has been little empirical validation of sensory disturbance to non-noxious triggers. Environmental sensitivity is used as a diagnostic feature only in Bennet's alternative criteria for diagnosis of fibromyalgia, where it was ranked the second most important of the components for diagnosis, after number of pain sites. The aim of this study was to use a validated sensory measure to determine if people with fibromyalgia have greater sensory disturbances compared to people with other chronic pain conditions. Methods This study used the Sensory Perception Quotient (SPQ) 92 question survey in adults with chronic pain conditions. A fibromyalgia group ( n = 135) and a non-fibromyalgia chronic pain control group ( n = 45) were recruited. All participants completed the SPQ as a self-report measure of sensory processing. In addition to the original SPQ scoring method, the Revised Scoring of the Sensory Perception Quotient (SPQ-RS) method was used to investigate self-reported hypersensitivity and hyposensitivity and the vision, hearing, taste, touch, and smell subscales. Chi-squared tests were used for categorical variables and Mann Whitney U, or Kruskal-Wallis H test were used to compare groups. Results The fibromyalgia group reported significantly more sensitivity compared to the control group ( p = 0.030). The fibromyalgia group reported significantly greater hypersensitivity ( p = 0.038), but not more hyposensitivity ( p = 0.723) compared to controls. The average fibromyalgia SPQ score (92.64 ± 23.33) was similar to that previously reported for adults with autism (92.95 ± 26.61). However, whereas adults with autism had broad range hypersensitivity, the fibromyalgia group reported significantly more hypersensitivity compared to the control group, but the range was restricted to vision ( p = 0.033), smell ( p = 0.049) and touch (0.040). Conclusions These findings demonstrate greater sensory hypersensitivity in people with fibromyalgia compared to people with other chronic pain disorders. Greater hypersensitivity was restricted to touch, vision, and smell, all of which have previously been demonstrated to crosstalk with nociception.
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El artículo problematiza los procesos contemporáneos de medicalización con el doble propósito de consolidar un enfoque teórico en clave filosófica, sociológica y semántica de estos fenómenos, y de aportar evidencia empírica sobre el modo en que la discursividad de la medicalización se estructura y circula socialmente, así como los efectos subjetivos que genera. Se afirma la premisa que la problemática de la medicalización requiere concebir al cuerpo, la salud y la vida como entidades complejas, tejidas de discursos e imaginarios, posiciones subjetivas y materialidades corpóreas que manifiestan síntomas y malestares. La medicalización y la construcción de enfermedades son comprendidas en la articulación de tecnologías bio-noo-políticas de gobierno de los cuerpos, los signos y las subjetividades. Se adopta una perspectiva discursiva que lleva a primer plano la construcción significante del cuidado de la salud como problemática central del campo de Comunicación y Salud. La indagación empírica que sustenta el trabajo tiene el objetivo de identificar y comprender las significaciones asociadas al cuerpo y la salud en discursos que contribuyen a la medicalización y patologización de procesos normales de la vida. Con este fin se efectúa un análisis de discursos publicitarios de laboratorios farmacéuticos y dermocosméticos, atendiendo particularmente a los referidos al embarazo, el parto y el envejecimiento, principales procesos vitales considerados “no-enfermedades” que resultan medicalizados. Los emergentes del análisis enfatizan las operaciones significantes relativas a nociones como cuerpo, salud, vida, bienestar, enfermedad, malestar, dolor, para cada uno de los tres procesos vitales mencionados, así como su integración e interpretación conjunta.
... Sad to say, that model still awaits to be vindicated beyond any reasonable doubt, especially for degenerative diseases or mental illness [79]. Moreover, such framework becomes problematic when considering in the perspective of "preventive" medicine [80]. Are presumptive markers of a "future" disease condition reliable enough to ask for a "preventive cure"? ...
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The agenda of pharmacology discovery in the field of personalized oncology was dictated by the search of molecular targets assumed to deterministically drive tumor development. In this perspective, genes play a fundamental “causal” role while cells simply act as causal proxies, i.e., an intermediate between the molecular input and the organismal output. However, the ceaseless genomic change occurring across time within the same primary and metastatic tumor has broken the hope of a personalized treatment based only upon genomic fingerprint. Indeed, current models are unable in capturing the unfathomable complexity behind the outbreak of a disease, as they discard the contribution of non-genetic factors, environment constraints, and the interplay among different tiers of organization. Herein, we posit that a comprehensive personalized model should view at the disease as a “historical” process, in which different spatially and timely distributed factors interact with each other across multiple levels of organization, which collectively interact with a dynamic gene-expression pattern. Given that a disease is a dynamic, non-linear process — and not a static-stable condition — treatments should be tailored according to the “timing-frame” of each condition. This approach can help in detecting those critical transitions through which the system can access different attractors leading ultimately to diverse outcomes — from a pre-disease state to an overt illness or, alternatively, to recovery. Identification of such tipping points can substantiate the predictive and the preventive ambition of the Predictive, Preventive and Personalized Medicine (PPPM/3PM). However, an unusual effort is required to conjugate multi-omics approaches, data collection, and network analysis reconstruction (eventually involving innovative Artificial Intelligent tools) to recognize the critical phases and the relevant targets, which could help in patient stratification and therapy personalization.
In everyday medical settings in Japan, physicians occasionally tell an elderly patient that their symptoms are “due to old age,” and there is some concern that patient care might be negatively impacted as a result. That said, as this phrase can have multiple connotations and meanings, there are certain instances in which the use of this phrase may not necessarily be indicative of ageism, or prejudice against the elderly. One of the goals in medical care is to address pain and suffering that develops with age in elderly individuals, and whether or not aging is a disease is inconsequential. However, assuming that an individualized and thorough examination has been performed, there are some conditions that can be attributed only to age. Accordingly, physicians must acknowledge the merits and drawbacks of using the phrase “due to old age,” and exercise caution when using it. Both physicians and their elderly patients must share a common awareness of the incomplete and limited nature of modern medicine and its scope, and physicians must help their elderly patients accept and live with the aging phenomenon.
Current studies on “personalized medicine” focus prevalently on network-based models of genome function. Since the eighties, the agenda of pharmacology discovery was dictated by aiming at discovering key, causative targets. In this perspective, genes assume a fundamental “causal” role while cells simply act as causal proxies, dispensable because they represent an intermediate level between the molecular input and the organismal output. However, the heterogeneity of the genomic profile within the original tumor and its metastasis has broken the hope of genomic-base personalized treatments. Current personalized models only partially explain the unfathomable complexity behind the outbreak of a disease, as they prevalently rely on cell biochemical and genetic pathways, thus discarding the contribution of non-genetic factors, microenvironmental constraints and the interplay among different levels of tissue organization. We posit here that a comprehensive model should consider the disease as a “historical” process, in which different spatially and timely distributed factors interact each other in a complex, non-linear way. The disease is properly a dynamic process and treatments should be tailored according to the “timing-frame” of each disease. This approach can help in detecting pre-disease state or critical transitions from which the illness might access different attractors, leading ultimately to different outcomes.
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The connotations of the term "a disease" were investigated by studying the ways in which both medical and non-medical people used the word. A list of common diagnostic terms was read slowly to groups of non-medical academic staff of a university, secondary-school students, medical academics, and family practitioners, who then indicated whether they thought each word referred to disease.All groups rated illnesses due to infections as diseases, but the doctors, and particularly the general practitioners, were more generous in accepting as diseases the terms for non-infectious conditions. Apart from the nature of the cause, the most influential factor in determining whether or not an illness was considered to be a disease was the importance of the doctor in diagnosis and treatment.These findings provide further evidence that there is ambiguity about the meaning of the term disease. To the layman a disease seems to be a living agency that causes illness. Doctors have obviously accepted more heterogeneous defining characteristics but remain reluctant to adopt unequivocally nominalist ways of thought. The position is not unlike that in the physical sciences, in which there is a good precedent for distinguishing between the formal scientific and the everyday uses of terms such as "force" and "power."
I might have guessed that a book dedicated to "H.L. Mencken, Kurt Vonnegut, Jr., Douglas Adams, and the Emperor's New Clothes" would be fun to read. It was! Readers will sense the authors' enthusiasm for their subject on each page, from the preface to the final chapter. The authors prepared this book for "users" rather than "doers" of clinical research. Physicians and others who wish to recognize key clinical epidemiologic features of the diagnosis and management of patients will benefit from reading Clinical Epidemiology. Those who wish to conduct actual research studies will need to look elsewhere for a detailed discussion of clinical epidemiologic methodology. In this review, I will mention some strengths and limitations of the book and recommend it to particular audiences. The book's primary strengths are the clear and practical explanations for an array of epidemiologic concepts ranging from sensitivity and specificity to "zero-time shift" and "inception
FOR the physician accustomed to dealing only with pathologic entities, terms such as "nondisease entity" or "nondisease" are foreign and difficult to comprehend. This paper will present the background for the development of this new science, a classification of nondisease and finally the important therapeutic principles based on this concept. Since disease is an abnormal state that lends itself to classification into syndromes and entities, one tends to think of health or nondisease as all encompassing and without specificity. This is not the case, since it is now clear that "nondisease" may be used in quite a specific manner; furthermore, . . .
How to use an esteemed medical journal to increase suffering
  • M Bailey
Bailey M. How to use an esteemed medical journal to increase suffering.
Clinical epidemiology: a basic science for clinical medicine
  • D L Sackett
  • R B Haynes
  • G H Guyatt
  • P Tigwell
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