It is not the responsibility of science to define health as its subjectivity makes it incompatible with the requirements of demonstration and proof. The few doctors who have tried, as René Leriche with his “silence of the organs” or Claude Bernard with his “normal activity of organic elements” within the historical anecdote. Some philosophers have taken this risk for Friedrich Nietzsche, it was an “ideal state where everyone can do what he does better the more likely” to Georges Canguilhem, an “ability to overcome the crisis,” for Alain Froment, a “to be”. What can be said sometimes comical institutional definitions as “steady state depending on the temperament” of Diderot and d’Alembert, or the famous “complete wellness” of the World Health Organization (WHO)?
Scientifically define the general concept of “disease” part of the same challenge as the Larousse and common sense define it as a health impairment. We’re going in circles.
However, for many disease entities experienced by patients and observed by clinicians Similarly, science can name and define “objects-disease” with sufficient accuracy. Strep throat, tibia fracture, rheumatoid arthritis, migraine, diabetes, insulin-dependent type 1, schizophrenia part of these quite compatible with the rigor of scientific terminology clinical entities.
The word “cure”, it can not have a precise definition that it refers to an acute illness such object previously defined. The healing of the fracture of the tibia and strep throat are easy to determine. For chronic and cyclical as those of our other examples diseases, the word cure is inadequate; medicine, which then tries to improve the “to be” patient, speaks of remission, stabilization or quiescence.
The current biomedical model describes new Medicare items, which are not experienced by the patient or observed by the clinician. These are “risk factors” or “anomalies” in pathogenic potential. High cholesterol polyp or colon are good examples of these new biomedical objects where the terms of healing and forgiveness become meaningless, since they have no correspondence with the patient experience.
DISEASES AND LIVED NOT LIVED
Oncology offers a new and unusual situation in the history of medicine and medical terminology. The word healing it has a very precise definition for all types of cancer, while the majority of this discipline disease-objects do not always have.
The “objects” cancers belong to two registers. On the one hand, experienced by the patient or detected by the clinician (lymph nodes, bleeding, fatigue, etc.). Diseases: they are objects-clinical disease. On the other hand, not lived, but discovered by screening diseases that are of biomedical objects Medicare.
The term healing, meanwhile, applies indiscriminately to these two types of objects. In cancer, healing is a five-year period without clinical symptoms without changing imaging and tumor biology, without local recurrence or metastasis. After this period of five years, cancer is declared cured.
Although arbitrary in its temporal component, this definition would be scientifically acceptable if the object had been previously defined disease with at least the same rigor.
CLINICAL MODEL OR BIOMEDICAL
But it is not. A cancer cell is it considered “abnormal” by the pathologist? Cancer is a tumor it became symptomatic for the patient or the doctor? Cancer is it a temporary cell clusters to spontaneous healing? Cancer is there a latent tumor or whose growth does not reduce the total life? Cancer is metastatic disease that it depletes the natural defenses of the patient and eventually kill him? Cancer is it a devastating disease that kills its wearer in a few months?
To date, no expert can answer these questions for any cancer or any carrier (although the genetics of certain tumors began to propose tentative prognostic tracks). Still, healing, as defined above, is the subject of a broad consensus among oncologists. Another unusual aspect of the cancer is what we might call “secondary equivalence lived.” Cancer patients live the same way, whatever may have been the original model defining their object disease: clinical or biomedical, diagnosed or detected. Strangely, the discovery of a virtual or potential disease creates a lived disease.
NO PRE-CLINICAL SELECTION
With screening “organized” that is open to all without clinical selection (in France: breast and colon), the fuzzy terminology present two new types of problems. For public health, resulting in increased morbidity experienced oncology. For biomedical and basic research, the maintenance of this confusion may be, ultimately, a source of discredit and obstruction.
With the spread of the mass screening, more and more patients are thus declared cured of a tumor that would have emerged fifteen years later. They would therefore be medically “cured” fifteen years before being “clinically” patients and their clinical disease would have appeared twenty years after the biomedical diagnosis. In the case of a latent tumor or spontaneous regression, they would be declared “cured” of a disease they never had!
Healing and is defined, it can be said that 90% of cancers detected early heal. This formulation is, by convention, or incorrect or false, can be repeated without re-evaluation by the experts and the media. Yet, for a science that wants strict, this definition and formulation are no longer acceptable.
The terminology of oncology must evolve to access this discipline to a science. It is a categorical that cancers are a scourge of humanity as imperative.
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