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Disease or adaptation, normal or abnormal?

Peter Soeters and Peter De Leeuw of Maastricht University Medical Center wrote an interesting perspective piece entitled Disease or adaptation, another look at the practice of medicine, that was published in January in the journal Postgraduate Medicine.

They write:

“thanks to the great advances in medical technology we are now able to detect many more abnormalities than before, however subtle. As a side effect, we tend to classify as abnormal also accidentally found deviations from the norm that are, in fact, not pathological at all. It requires knowledge of pathophysiological mechanisms to be able to appreciate whether to act or to refrain from interfering.”


One phenomenon that they focus on is stress hyperglycemia – the observation that in normal healthy adults, the stress of trauma increases blood glucose by 7–10 mmol/l. They write that this predictable response “may not be bad at all.”

From the abstract:

“The practice of medicine has changed considerably over the past few decades and is now focusing more and more on early intervention strategies. As a result, we tend to consider pre-symptomatic abnormalities, however small, already as a potential target for treatment. In this viewpoint, we argue that we should put more emphasis on pathophysiological thinking as many of the so-called early abnormalities may, in fact, reflect adaptive mechanisms rather than disease. This view should influence medical care and education, emphasizing the importance of knowledge of pathophysiology.”


The link to the paper is here.

Categories: Uncategorized

Joe Alcock

Emergency Physician, Educator, Researcher, interested in the microbiome, evolution, and medicine

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