Facing a Shift in Paradigm at the Bedside

摘要: Our entire medical framework is based on the concept of disease, understood as a qualitative departure from normality (health) with structural substrate (lesion), and usually an identifiable cause (aetiology). This paradigm loaded problems, some which are discussed in text. Nevertheless, we study, diagnose treat diseases, while often painfully conscious dysfunctionalities this scheme, can hardly imagine how could practice medicine otherwise. However, most recent developments basic sciences, notably Immunology, Genetics -omics, inconsistent “health/disease” paradigm. The emerging scenario that complex networks, more spirit Systems Biology. In these settings difference between health disease loses its meaning, whole discourse becomes progressively irreducible to our conventional clinical categories. As research stagnates sciences thrive, gap widening, change prevailing seems unavoidable. all judgments (including Bayesian reasoning Evidence Based Medicine) rooted disease/health dichotomy, one conceive they work without it. shift will not be easy, certain turmoil expected.