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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,
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4
the development of epigenetics,
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the
change of physiology with the concept of “Allostasis”,
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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
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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.
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Health appears based on a semantic hologram. The epistemological change
of medical science has brought to the birth of Person Centered Medicine paradigm (1998)
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, the
derived Person Centered Medicine Clinical method
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and the Person Centered Health concept
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that in
2011 I proposed to WHO
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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
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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.
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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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2
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Montagnier L., Aissa J., Del Giudice E. , Lavallee C., Tedeschi A., Vitiello G. DNA waves and water. Journal of Physics: Conference
Series 306 (2011) 012007 doi:10.1088/1742-6596/306/1/012007
4
Rein G. Effect of conscious intention on human DNA. Proceedings of the International Forum of New Sciences. October 1996
Denver.CO.USA
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Meaney MJ, Szyf M. Maternal care as a model for experiences-dependent chromatin plasticity? Trends Neurosci. 2005 Sep;
28(9):456-63
6
McGowan PO, Sasaki A, D'Alessio AC, Dymov S, Labonté B, Szyf M, Turecki G, Meaney MJ Epigenetic regulation of the
glucocorticoid receptor in human brain associates with childhood abuse. Nat Neurosci. 2009 Mar;12(3):342-8
7
Szyf M and Meaney J.M Epigenetics, Behaviour, and Health. Allergy Asthma Clin.Immunology 2008;4(1):37-4
8
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Annual Meeting and Exposition; Proceedings of 136 Meeting; 2008 Oct. 25-29,San Diego,USA;APA;2008
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Biava P.M Reprogramming of normal and cancer stem cells. Curr.Pharm.Biotechn.2011 Feb.1;12(2):145
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
10
Sterling P.,Eyer J. Allostasis: a new paradigm to explain arousal pathology. In: Fischer S Reason J. editors. Handbook of Life
Sciences, cognition and Health. New York 1988 : J.Wiley and sons; p. 629-649
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Ader R., Felten L ,Cohen N. Psychoneuroimmunology. San Diego,NewYork,Boston,London,Sydney,Tokyo,Toronto:Academic
Press;1990.
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Ryff C.D and Burton H. Singer The role of emotion on pathways to positive health. In.: R.J.Davidson, K.R.Scherer&H.H. Goldsmith
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of Biological Reactions. Milano: Università Ambrosiana;1996
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for medical science and its application in clinical research and medical education. Medicine, Mind and Adolescence. 12, 1-2: 7-1
15
Laundeslangers M.L., Ryan S.M.,Drugan S.F.F et al. Coping and immuno suppression : inescapable but not escapable shock
suppresses lymphocytes proliferation. Science. 1983, 221 :568-570
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Liu D., Dorio J., Tannembaum J. (Maternal care, Hypocampal Glucorticoid Receptors and Hypotalamic-PituitaryAdrenal Responses
to stress. Science 1997; 277:1659-1662
17
Brera G.R. Epistemology and medical science: change of the paradigm. Paper presented at Return to Hippocrates Quality and
Quantity in Medical Education. Proceeding of the second Conference on New Perspective in medical Education; 2005 May 27-28,
Milan, Italy , Università Ambrosiana ; 2005. p 19
18
Fawzy F.L ,N.Y.Fawzy, and al. Short term psychiatric intervention for patients with malignant melanoma: effect on psychological
state, coping and the immune system. In: C.E. Lewis, C.O’Sullivan, and J. Barraclough eds. The Psycho-immunology of cancer.
Oxford, New York, Tokio : Oxford University Press; 1994. p. 291-320
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McGowan PO, Sasaki A, D'Alessio AC, Dymov S, Labonté B, Szyf M et al Turecki G, Meaney MJ Epigenetic regulation of the
glucocorticoid receptor in human brain associates with childhood abuse. Nat Neurosci. 2009 Mar;12(3):342-8
20
Svensson T, Inoue M, Sawada N, Yamagishy K, Charvat H, Saito I,Kohuko Y et al. Coping strategies and risak of cardiovascular
disease incidence and mortality: the Japan Public Health Center-based prospective Study.Eur.Hearth J. 201 Mar 14; 37 (11):890-9
doi: 10.1093/eurhearthj/ehv724
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Svensson T, Inoue M, Sawada N, Charvat H, Iwasaki M, Sasazuki S et al. Coping startegies and cancer incidence mortality: the
Japan Public Health Center-based prospective study. Cancer Epidemiol. 2016 Feb; 40: 126-33.doi 10.1016/j,caneo.2015.12.003
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Brera G.R. The manifesto of Person Centered Medicine. Medicine, Mind Adolescence ,1999; Vol. XIV, n. 1-2:3-7
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Brera G.R. . Person Centered Medicine and Medical Education in third Millennium (with the introduction of Iosef Seifert The
seven aims of Medicine it.) Roma- Pisa: IEPI ;2001 (Italian)
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Mezzich E.J. The Geneva Conferences and the emergence of the International Network for Person Centered Medicine. Journal of
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Brera GR. Person Centered Medicine: Theory,Teaching,Research. Int.J.Pers. Cent.Med 2011; 1 (1):69-79
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Brera G.R. and ITFOP Education in Person-Centered Clinical Method and Perceived Quality of Person-Centered Clinical method. In
: GR Brera, C. Violato editors. Proceedings of the first International Symposium on New Perspectives in Medical Education; 2003
October 23-25;Assisi,Italy, p 34. DOI: 10.13140/RG.2.1.3374.5447. Available from
http://www.unambro.it/html/pdf/Person_Centred_Clinical_Method_Teaching.pdf
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
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Brera G.R and aa. Reliability and validity of Person Centered Medicine Clinical Method for a Person and People Centered
Care: a survey on 144 clinical reports of physicians prepared to apply Person Centered Clinical Method to adolescents from the
Academic Year 1997 to 2002 at the Milan School of Medicine of the University Ambrosiana . Proceedings of the Vth Geneva
Conference on Person Centered Medicine . 2012 April 30-May 2 Geneva , Person Centered Medicine International Network
2012. DOI 10.13140/RG.2.1.4699.0568
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Brera G.R. The Person Centered Health Paradigm and its impact on health sciences.(Internet) Research Gate 2015
DOI:10.13140/RG 2.1.2594.1925 2015-05-21 T 15:42:05 UTC. Available from
https://www.researchgate.net/publication/277010325 The Person Centered Health Paradigm and its impact on health sciences
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from http://www.unambro.it/html/pdf/All_Symposium_Education_People_Centred_4May2011.pdf
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Brera G. R The adolescent as person. Person centered adolescence theory. Medicine Mind and Adolescence 2001; XVI (1-2): 5-19