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Editorial
A new therapy?
C. Fernandez
There is a progressively increasing contrast between the exaggerated speed of the current technological evolution
– which leads us to believe in the existence of new, more or less radical solutions to everything, even to the
“disease” problem -, and the apparently static proposal put forth by Wald and Law (1), based on the attempt to
prevent both cardiovascular pathologies and contracted diseases by resorting – albeit in different manners – to
the knowledge and skills we already possess and daily apply on thousands of patients.
This article cannot and is not meant to discuss the details of the above mentioned proposal: we only emphasise
that it suggests anticipating and stimulating elements which could – in the near future – bring about a revolution
in our way of thinking and, consequently, of acting.
It is now many years that the scientific progress in the medical field has been constrained into very rigid rational
patterns, imposing the requirement to produce definite and continuous evidence concerning: 1) the diagnostic
capabilities; 2) the validity of performable operations; and 3) the effectiveness of pharmacological treatments.
It is likely that the limits which we are not able to surpass - such as those connected with the onset of the major
diseases (i.e. cardiovascular and neoplastic diseases) especially in the Western countries where research is particularly
advanced – are the very limits which seem insurmountable at the moment and have somehow clipped
the wings of any theory parallel to science, forcing us to think only within the conventional tracks.
In recent years, no new approaches have been suggested, but for the genetic assumptions, which aroused some
concerns in the researches, especially linked to the fact that – initially at least – it would be very difficult to
contrast the anomalies responsible for the onset of pathologies and, consequently, of diseases.
However, at the time being, we tend to treat any pathological event by administering drugs and/or surgery, with
or without the fitting of a prosthesis: to hypothesise a new, dominant factor unconnected with the traditional cause-effect
model could cause the collapse of the very certainties to which we have always clung and on which
we based all our scientific researches and/or “conquests” up to now. Also this framework contains new, “revolutionary,”
generally unclear and destabilising elements.
Actually, the adoption of such a certainty model in the past 50 years has driven away any “revolutionary” assumption,
thus bringing serenity and a solid basis to the scientific world, with far-reaching repercussions even at
the socio-economic and industrial level.
The proposal of Wald and Law (1) - revolutionary in a certain way -, contains similar destabilising elements, both in the
moral and in the economic context, and could push us to re-examine the cause-effect model, indirectly leading us to
put up new forms of defence, thus completely changing the medical approach to alleged or contracted diseases.
I do not think that we should presumptively reject this proposal, but rather, also due to its innovative features,
that we should carefully analyse and examine it, hoping that it will prevent us from considering our patients as
a homogeneous mass of individuals to be treated sic et simpliciter, and to always remember that the patient
who turns to us, coming into our office for help to overcome “his/her” disease, is a special human being.
REFERENCES
1. A strategy to reduce cardiovascular disease by more than 80%. N J Wald, M R Law. BMJ 2003;326,1419-24.
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