Australian Aborigines diagnose disease in a purely spiritual way, by 'seeing' the cause of an illness in a trance, or through magic rituals. Many of their cures were spiritual too, using pointing bones, beads, magic paintings, dancing and ceremonies. It therefore seems possible, although it's impossible to prove, that prehistoric shamans diagnosed and treated disease in similar ways.
Despite their lack of scientific knowledge, it's possible that prehistoric people knew and used plants and various substances to cure disease. The Native Americans of the 19th century knew of more than 100 herbs and substances that had healing properties. This, however, should not be seen as proof that primitive medicine had a 'practical', non-spiritual, side. Healers could well have used these medicinal substances as part of their spiritual practices and, if the healing proved successful, could certainly have ascribed the success to the spirits, not to the substances they had used in the cure.The With the completion of the Human Genome Project (2003), a new paradigm of medicine that focuses on molecular interactions is evolving. Researchers and physicians are now examining human health and disease in the context of the human genome, epigenome, transcriptome, proteome, and microbiome.2,3,4,5,6Furthermore, these “omes” are being integrated to create new network models of physiology and pathology.
There is a need to understand the multifaceted pathology that contributes to individual illness. 1take a number of factors into account at once bundling multiple risk factors, much in the same way researchers consider factors like diet, exercise, and family history when evaluating heart disease risk. |
testing the effects of combining multiple factors together1
Sepsis and ARDS, for example, are still poorly understood disease processes with multiple etiologies and phenotypes. Sepsis syndrome may arise from a number of sources all presenting differently in different patients. Consequently, there are many challenges in the conduct of sound clinical research in this field: critical illness is difficult to precisely define; patient populations may differ drastically with respect to severity of disease, treatment modalities, and other characteristics; subject recruitment may be difficult.
medicine that focuses on molecular interactions. . Researchers and physicians are now examining human health and disease in the context of the human genome, epigenome, transcriptome, proteome, and microbiome.2,3,4,5,6
The physician we want is a person deeply versed in pathophysiologic concepts, skilled in the art of physical examination, with extensive experience of cases similar to our own illness, and blessed with good clinical judgment. We expect that physician to base the decision (on which our life depends) on his or her clinical gestalt. And we recognize that the physician may not be able to articulate the precise reasons behind this decision in the form of words.
Why can’t our ideal physician express these thoughts in explicit terms? A wise physician standing at a patient’s bedside senses a great deal of worthwhile information—much more than can be expressed in words. In short, there is a very large tacit coefficient to clinical knowledge—physicians know much more than they can communicate verbally.294 There is an enormous difference between the assessment made by an experienced physician standing at a bedside and the assessment the same physician makes on hearing information (about the same patient) relayed over the telephone by a junior resident. An experienced and wise physician employs intuition rather than explicit rules in deciding what is best for a particular patient in a particular setting. A physician who regards such intuition as unscientific betrays a fundamental misunderstanding of the epistemology of science.286
Our failure to formulate a list of indications does not mean that we advocate a laissez-faire approach to instituting mechanical ventilation. Earlier we mentioned the absurdity of saying that mechanical ventilation is always indicated for acute respiratory failure, defined as a PaO2 of less than 60 mm Hg. This does not mean that we consider PaO2 unimportant. On learning that a patient has a sustained PaO2 of 40 mm Hg, a physician will take immediate steps to institute assisted ventilation. But it is not possible to pick a PaO2 breakpoint (between 40 and 60 mm Hg) below which the benefits of mechanical ventilation decidedly outweigh its hazards. It is futile to imagine that decision making about instituting mechanical ventilation can be condensed into an algorithm with numbers at each nodal point. In sum, an algorithm cannot replace the presence of a physician well skilled in the art of clinical evaluation who has a deep understanding of pathophysiologic principles.
Reference
1. http://www.smpdb.ca/toc (diagrams of metabolic pathways)