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Introduction to a medical science and health paradigm change

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Giuseppe R. Brera at Ambrosiana University
Giuseppe R. Brera
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Abstract

In the last forty years there has been a great change of medical science through the progress of neurobiology, the birth of quantum biology, the development of epigenetics, the change of physiology with the concept of “Allostasis instead of “Homeostasis”, the opening of new interactionist investigation fields like Psycho-neuro-endocrine-immunology and the consequent formulation of the Theory of the relativity of biological reactions. At the same time there has been the integration of Medicine with human sciences such as cognitive psychology, psychoanalysis, counseling allowing to discovery a teleology of human nature. The change can be considered an indeterminist revolution of medical science, similar to the shift to quantum physics, from the Newtonian determinism and mechanism happened in Physics at the beginning of the last century. The epistemological change of Medicine is based on an irrefutable interactionism of three orders of variables belonging to subjectivity, biology and environment and to a natural tendency to give an objective meaning to life, giving importance to quality of life and lifestyle for the health construction. The concept of health appears related before its expression in the human biology, in a symbolic work made by the person addressed to interpret the quality of possibilities perceived in the external and internal experience in analogy to the interpretation work of biological information made by the membrane cell for answering to the adaptation requests. Disease, suffering, physicians are a personal experience of life that call for a meaning and a question for an answer that can’t be explained by empirical variables but that interact with these. The health definition introduced to WHO in 2011 in such a way appears:” The choice of the best possibilities for the best being a human person”. There is a true risk that Medicine could be developed on schizophrenic epistemology dissociated from the progress of the basic sciences. The Milan Conference held on 13-14-15 October 2017 wants to formalize a determinant shift for Clinics, clinical investigation, medical education and public health policy.
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Medical Science and Health Paradigm Change
13-14-15 October 2017
Milan, Regione Lombardia,Italy, Ospedale Maggiore – Ca Granda
©Copyright Giuseppe R.Brera 2016-2017
Introduction to a Health and Medical Science Paradigm Change
Giuseppe R.Brera*
Socrates…… Well then, could we ever know what an art makes the man himself better, if we were ignorant of
what we are ourselves ?
Alcibiades: Impossible ! (Plato)
There is an urgent necessity to promote consensus in the scientific community for formalizing the
deep epistemological change happened in health sciences in the last forty years through the change of the
paradigm of neurobiology,
1
2
the birth of quantum biology,
3
4
the development of epigenetics,
5
6
7
8
9
the
change of physiology with the concept of “Allostasis”,
10
the opening of new interactionist investigation
fields like Psycho-neuro-endocrine-immunology
11
and the Affect science.
12
At the same time there has
been the integration of Medicine with human sciences such as cognitive psychology , psychoanalysis,
counseling. This change can be considered an indeterminist revolution of medical science, similar to the
shift to quantum physics, from the Newtonian determinism and mechanism created by the supremacy of
positivism (Claude Bernard) and the Descartes dualism and has been theorized by the Relativity Theory of
Biological Reaction,
13
14
built in 1996 in the light of the fall of the Selye’s mechanic stress-answer biological
linear causality and the neuro-endocrinological investigation
15
16
.The progress in the basic sciences and in
medicine epistemology, introduced two main concepts: the interactions between the three orders of
variables belonging to subjectivity, biology, and environmental physical - relational stimuli
17
and the
human nature teleology, the making meaning, that means the natural tendency to truth, love and beauty,
evidenced by the human sciences. The only human symbolic work of interpreting information creates an
analogy with the biological interpretation work made by the cell membrane for answering to the
adaptation requests. Health appears relative and related to human individual symbolic answers, impossible
to animals, which interpret internal and external possibilities received, correspondent to biological
information to the biological organism through biochemical and quantum signals, learnt and/or memorized
sent by the person, who pilots the interaction between the three worlds of variables naturally addressed to
look a unitary meaning: the being a human person, according to a mysterious quest for a true meaning of
life. Coping with a disease, suffering, physicians are a personal experience of life belonging to existence,
that call for a right or wrong meaning that can’t be explained by empirical variables that interact with
these, building in such way a relativity to this interpretation and to the consequent coping and behavior
possibilities and quality.
18
19
20
21
Health appears based on a semantic hologram. The epistemological change
of medical science has brought to the birth of Person Centered Medicine paradigm (1998)
22
23
24
25
, the
derived Person Centered Medicine Clinical method
26
27
and the Person Centered Health concept
28
that in
2011 I proposed to WHO
29
as “Person Centered Health”, re-assessed like “The choice of the best
Medical Science and Health Paradigm Change
13-14-15 October 2017
Milan, Regione Lombardia,Italy, Ospedale Maggiore – Ca Granda
©Copyright Giuseppe R.Brera 2016-2017
possibilities for being the best human person” , call the physicians to be “Person Centered Health
anthropologists” and to re-conceive medicine like an anthropology of the human nature. Clinicians, to
date, should be able to conceive their work like a “Maieutics” of the person’s individual nature, creating for
the patient possibilities for interpreting a clinical event like an existential one, reformulating the diagnosis
as “Person centered”, looking interactions among the three worlds of variables and the disease also like a
possibility for discovering a hidden meaning and to improve quality of life in a social and environmental
context, giving the right meaning to the perceived possibilities for it. The person in this way cannot be
reduced to an abstract bio-technological diagnosis, only necessary in a biological survival emergency not
only based on a stimulus-answer linear causality diagnosis and therapy, but this approach is a risk factor for
health if excludes the right multifactorial and teleological interactionism, to date right epistemological
reality of a person centered health and medical science , to date, in the light of the medical science
progress, obligatory in primary care, prevention, research and pre-post degree medical education. The
95% of pathologies from non-communicable diseases come from a lifestyle
30
built on the true or false
quality of being a person depending on the right or wrong quality of the interpretation of the perceived
possibilities and from right or wrong choices for the wellbeing.
31
Communicable diseases are epidemic
where there aren’t health policies addressed to create possibilities for health, changing environmental and
social conditions that create more vulnerability to infections and transmission of diseases, taking also in
account that peace is a necessary protective factor for health. To date we know that we cannot separate
existence from science and both from health and Medical science and the construction of a right society
where health and life are possibilities for all the human beings !
On 13-14-15 October in Milan, Lombardia Region, Italy the Conference “ Medical Science and
Health Paradigm Change” has been held , addressed to create a scientific consensus, discussion and further
confirmation of theories through scientific contributions about this revolutionary change for a new health
concept, impeding a schizophrenic evolution of Medicine, dissociated from basic sciences with a necessary
shift for building right policies oriented to the person’s freedom and human rights.
1
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Supplementary resource (1)

From the WHO Plenary Symposium on Education in Person -figure
Data
July 2017
Giuseppe R. Brera
New narration in practicing western integrative medicine: Linguistic, ecolinguistic, and biosemiotic aspects
Article
Full-text available
  • Apr 2021
Western science and academia have entered the new millennium with the growing realisation that their theoretical and utilitarian limits have been reached. A particular threshold is experienced across traditional academic disciplines, which is visible in the fact that, on the one hand, the intensity of social, environmental, psychological, health-related and communicational problems people deal with in their everyday lives is increasing; on the other hand, theoretical models and intervention programs that scholarly work provides do not meet the growing necessity. Our paper presents a research project whose starting-point aims are to explore the doctor-patient communication dyad, its functions in the healing process, and to propose a theoretical as well as applicative way forward. In the plans for our research, we aim to study the integrative medical approach and the ways in which language and communication processes allow healing to happen and optimal health to be preserved.
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Person Centered Clinical Method and its Teaching Results in Medical Practice
Research
Full-text available
  • Apr 2015
Results of the application of Person Centered Clinical Method in Clinical Practice
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THE RELATIVITY OF BIOLOGICAL REACTIONS AND THE FIRST FORMULATION OF AN INTERACTIONIST EPISTEMOLOGICAL PARADIGM FOR MEDICAL SCIENCE AND ITS APPLICATIONS IN CLINICAL RESEARCH AND MEDICAL EDUCATION
Article
Full-text available
  • Jan 1997
Abstract Studies on the interactions between the central nervous, immunitary and endocrinological systems, the mind and behaviour, permit a theory of medical science to be formulated . The variability of immunitary reactions to the experimental possibility offered to animals to escape - or otherwise - conditions of stress determined the obsolescence of Selye’s concept of stress and permitted the formulation of a theory on «the determinate relativity of animal coping» while, for the indeterminate human world, a theory on «the indeterminate relativity of human coping» was developed, where biological variables were related to psycho-sociological, anthropological and existential ones. The results of such studies made it possible to introduce a new theoretical paradigm of research and practice to medical epistemology, refounding it on new key words such as «biological reactions», «possibility of coping» and «quality of coping», and overcoming such concepts of the philosophy of science as « biological laws» only definable a posteriori by the greater or lesser variability of biological reactions. Biological reactions in non-humans appear to be subject to a foreseeable determinism that is explained by a theory of «general determinate relativity«, while human biological reactions appear to be subject to a theory of «general indeterminate relativity». These new theories seem to suggest that research, clinics and medical 1 Correspondence to: Prof. Giuseppe R. Brera MD, Milan School of Medicine, Università Ambrosiana, Vle Romagna 51, 20133 Milano (Italy) E-mail: gbrera@unambro.it
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Allostasis: A New Paradigm to Explain Arousal Pathology
Article
Full-text available
  • Jan 1988
homeostasis versus allostasis mechanisms of allostasis allostatic regulation of the immune response regulation of arousal pathology from chronic arousal definitions of health and approaches to therapeutics hypertension / psychoneuriommunology / iatrogenesis / health (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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The role of emotion on pathways to positive health.
Article
Full-text available
Many of the core questions in affective science (e.g., Are there basic emotions? What are the antecedents and functions of emotion? How do individuals differ in emotional reactivity?) have developed without explicit connection to the realm of human health. Alternatively, when emotion has entered the health realm (e.g., Does anger increase cardiovascular risk? Is optimism protective?), it has frequently been with little connection to mainstream research in affective science. This separation is not a state of affairs to lament, but rather represents opportunities for the future in which the fields of emotion and health can enrich and extend each other. Our objective in this chapter is to bring the nexus between these realms into focus via discussion of five guiding premises for relating emotion to health. These serve as conceptual guideposts for examining past, current, and future empirical studies, and do so with an emphasis on testable hypotheses. The five premises are: (1) emotions consequential for health are about something; (2) health requires a focus on co-occurring discrete emotions; (3) health is biopsychosocial in nature and necessitates integration of phenomenology and neurophysiology; (4) cumulative, chronic emotions are consequential for health; and (5) emotion can be protective and promote positive health. Each premise is illustrated via separate substantive studies, although a unifying theme across them is the need for integrative endeavors that put together psychosocial experience, underlying biological mechanisms, and health outcomes. A second generic observation setting the stage for what follows is the relative paucity of knowledge about positive emotion-health linkages. Our goal is to bring greater attention to salubrious connections between affective experience and health, mental and physical. An emphasis on positive health, we note, does not translate simplistically to a focus on exclusively positive affective experience. As we will argue, one of the intriguing challenges of future work is to unearth basic processes whereby negative emotions, ubiquitous in human experience, can be transformed into benign, or even beneficial, influences on health. Finally, while we seek to underscore the positive health theme, much in our chapter deals with the role of emotion in illness as that is where most prior work has been conducted. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Person Centered Medicine:Theory,Teaching,Research
Article
Full-text available
  • Apr 2011
Person Centered Medicine (PCM) is a new inter-actionist, indeterministic, extrinsic Paradigm of Medicine, born in 1999, based on the Theory of the determinate and the quality indeterminate relativity of biological reactions” (1996). Structuring a new health epistemological model, developed from Medical Science base interactionist investigations, consistent with the Allostasis and Epigenetics epistemological changes in Physiology and Genetics and with a new phenomenological hermeneutics of the human nature: Kairology, defining the person’s mystery and destiny. A complete epistemological definition of a “Person Centered Health inter-actionist and indeterministic health model” was presented by the author in 2005. Person Centered Medicine in 1998 was officially presented as the leading epistemological structure of the Milan School of Medicine, priority addressed to Physicians medical education in postgraduate courses, starting from the previous foundation of Medical Counselling and its teaching method. Since 1998 the Person Centered Clinical Method (PCCM), born as the PCM clinical application, was inserted and taught in all the PG courses and in the University Ambrosiana Quality system and applied to the physician’s preparation. Person Centered Clinical Method structure changes Clinics introducing a three dimensional, indeterministic structured work on the person, “ Diacrisis ” which in the “Person diagnosis” and the “Cross ratio” structured assessment of resilience and vulnerability, in the interlocutory physical examination, in the clinical objectives assessment and in a literary clinical synthesis and portrait, ensures that information about the subjective and objective person’s and hypothesis about their relations are depicted together. Learning objective of PCM and PCCM are theoretical and practical and PCM teaching requests a structured training in Università Ambrosiana organized in International Masters and in “Licentia Docendi” courses. In 2002 the first investigation on PCCM teaching effects on clinical practice by 20 trained physicians who assisted 16.000 persons was made. Results documented an amazing save in drug prescriptions, hospital admission requests, technical examinations and physicians professional gratification. Person Centered Medicine (PCM) is a new inter-actionist, indeterministic, extrinsic Paradigm of Medicine, born in 1999, based on the Theory of the determinate and the quality indeterminate relativity of biological reactions” (1996). Structuring a new health epistemological model, developed from Medical Science base interactionist investigations, consistent with the Allostasis and Epigenetics epistemological changes in Physiology and Genetics and with a new phenomenological hermeneutics of the human nature: Kairology, defining the person’s mystery and destiny. A complete epistemological definition of a “Person Centered Health inter-actionist and indeterministic health model” was presented by the author in 2005. Person Centered Medicine in 1998 was officially presented as the leading epistemological structure of the Milan School of Medicine, priority addressed to Physicians medical education in postgraduate courses, starting from the previous foundation of Medical Counselling and its teaching method. Since 1998 the Person Centered Clinical Method (PCCM), born as the PCM clinical application, was inserted and taught in all the PG courses and in the University Ambrosiana Quality system and applied to the physician’s preparation. Person Centered Clinical Method structure changes Clinics introducing a three dimensional, indeterministic structured work on the person, “ Diacrisis ” which in the “Person diagnosis” and the “Cross ratio” structured assessment of resilience and vulnerability, in the interlocutory physical examination, in the clinical objectives assessment and in a literary clinical synthesis and portrait, ensures that information about the subjective and objective person’s and hypothesis about their relations are depicted together. Learning objective of PCM and PCCM are theoretical and practical and PCM teaching requests a structured training in Università Ambrosiana organized in International Masters and in “Licentia Docendi” courses. In 2002 the first investigation on PCCM teaching effects on clinical practice by 20 trained physicians who assisted 16.000 persons was made. Results documented an amazing save in drug prescriptions, hospital admission requests, technical examinations and physicians professional gratification.
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Coping strategies and cancer incidence and mortality: The Japan Public Health Center-based prospective study
Article
  • Feb 2016
Background: Psychological stress is a modifiable risk factor for health outcomes and can be managed through coping mechanisms. Biological and behavioral hypotheses have been proposed to explain the association between stress coping strategies and cancer outcomes. Methods: The Japan Public Health Center-based study asked questions on coping behaviors in its 10-year follow-up survey. 55,130 subjects aged 50-79 without a history of cancer diagnosis and who provided complete answers on coping were included in analyses on cancer incidence and mortality. Hazard Ratios (HR) according to coping style were determined using Cox regression models adjusted for known confounders for cancer. Results: Mean follow-up time was 9.5 years for cancer incidence and 9.8 years for cancer mortality. The utilization of the approach-oriented coping strategy (HR=0.85, 95% CI: 0.72-0.99) and a behavior of positive reappraisal (HR=0.84, 95% CI: 0.72-0.97) was associated with a reduced risk of cancer mortality. The approach-oriented coping strategy was further associated with localized cancer incidence (HR=1.13, 95% CI: 1.01-1.27) and screening-detected cancers (HR=1.35, 95% CI: 1.15-1.58). The avoidance oriented coping strategy was inversely associated with cancer incidence (HR=0.69, 95% CI: 0.50-0.94) only after excluding events occurring in the first three years of follow-up. Conclusion: The results of this study may favor the behavioral hypothesis to explain associations between premorbid coping styles and cancer outcomes.
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A Revolution for the Clinical Method and the Bio-medical Research. The Determinate and the Indeterminate Relativity of Biological Reactions
Book
  • Jan 1996
Summary of the book A Revolution for the Clinical Method and Biomedical Research : the Determinate and the Quality Indeterminate Relativity of Biological Reaction Giuseppe R.Brera ©Copyright Università Ambrosiana 1996 The book introduces the concept of "Relativity of Biological Reactions" separating these from "Biological constants" necessary for survival., leading Medicine to an indeterministic paradigm against determinism and mechanism and limiting for clinics results of experimental investigations on animals. The book is the epistemological basis of Person Centered Medicine and introduces in Medicine the interactionist paradigm, causing the end of the Stimulus-Answer model, mechanistic and deterministic one of the Selye’s stress theory centered only on animals’ biological variables change determined by bio-chemical stimula . Humans differently through subjective symbolic affective ,cognitive resources related to emotions elaborate and interpret internal and external stimula, that are influent on the gene expression. The theory has been based on experimental studies on the interactions between central nervous, immunitary and endocrinological systems, mind and behavior. The core of this theory is expressed in 4 equations, A-B-C-D. The base of the theory has been the experimental evidence about the variability of immunitary reactions in relation to the experimental possibility offered to animals to escape - or otherwise - conditions of stress determining the obsolescence of Selye’s concept of stress and permitted the formulation of a theory on «The determinate relativity of animal coping» called “Equation C” . Equation C (Rb = Bc x Pt (a)) draws the relativity of animal biological reactions to coping possibilities determined by the probability of positive or negative social and/or environmental conditions in relation to drives, Individual genotype and biological homeostasis. Equation D differently draws for humans a different relativity. Equation D Pt x Qc HmRb = -------------------- Bc HmRB = Human biological Reactions PT= Possibilities of coping AC = Quality of coping The equation introduces the concept of the “Quality” of coping related to the indeterminate subjective possibilities of humans ( values, emotions, affects, relations, behaviors) which determine a “ Coping quality” (Qc) related to choices in experience. This unforeseeable possibility (Pt) of choice but like animals related to genotype, biological homeostasis, social and environmental conditions but in a only human way to cognitive and psycho-sexual structural stage of development, is the indetermination constant of the Equation D. Biological constants (Bc) appear inversely related to possibilities of choices. Less possibilities of coping there are more biological reactions are determined by a direct actions of biological constants on life, how physicians and surgeons know when they work in emergency. Different epistemological models for human and animals are dependent from the presence in humans of self-determined, cognitive and psychosexual levels, and indeterministic factors ( eg. : moral and religious thinking, hypothetic-deductive reasoning, meaning awareness and will, creativity, parents’ education ). which determine a ” quality” in cognitive and affective symbolic processes, emotions, behaviors, coping and consequently different biological reactions. These qualitative and subjective factors are strictly related to neuromodulators, hormones and immunitary system actions in a bidirectional way through a new gene expression and receptors synthesis. Quality of coping is caused by the only human quality to choose among perceived and interpreted possibilities according the cognitive and psychosexual level, like Piaget and Freud showed., but possibility of an experience is unforeseeable like a dream or an encounter. Persons give a meaning to these showing a transcendent not empirical teleology existent in human nature well described by kairological theory. Mechanistic theory of human nature is obsolete and wrong and introduces necessarily new variables in medical research, clinics and medical education if wants arrive to true results. A new concept of health related to protective factors played by human possibilities, quality of the interpretation of reality, existential choices corresponding to affective and cognitive processes and neuromodulations, hormones transduced messages to cell membranes, that is a new indeterministic universe to be explored and related to person is born. Health to date can be interpreted and defined in a new way : “ Possibilities and qualities for being an human person based on a balance between protective and risk factors, that is resilience vs/ vulnerability” The theory of the relativity of biological reactions to possibilities and quality of coping (RBR theory) appears to introduce a new epistemological chapter in human biology and medical science allowing a reformulation of the scientific method applied to human nature and a new clinical method based on a. the necessity of introducing into human biology and clinical research variables belonging to the subjective world of humans determining quality of life : values,beliefs,emotions, affects, coping, behaviour and level of cognitive and psychosexual development. b. the existence of a teleology in human nature and the importance of affective and cognitive symbolic world in a culture determining possibilities and qualities in reality interpretation, choices and behaviours. c. the impossibility to directly transfer and apply to humans experimental inferences, based only on results of experimental studies because of the difference between Equation C and Equation D d the change of the health concept and the introduction in Medicine and Medical education the concepts of Resilience and Vulnerability. e the necessity to change clinical method according RBR equations B and D f the necessity of introducing in the experimental method new RBR variables according equation A and C d. the existence in humans of a mysterious indetermination constant The RBR (Relativity of Biological Reaction) theory opens new perspectives in Medical Science and Medicine and at clinical level constitutes the basis of the Person Centered Medicine Clinical Method.
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