Preventive model of health care needed, says King's Fund
BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7441.664-e (Published 18 March 2004) Cite this as: BMJ 2004;328:664
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First of all, many thanks to Dr. Andrew Yip for his “critical”,
positive speaking, response and questions, although expressed in an
irritating way, I disregard. After 46 years of biophysical-semeiotic
researches, finally I read some critics. Many thanks again. Unfortunately
I can’t speak and write fluent English. However, I think you can
understand what I mean, due to your intelligence.
The fact that my
statements “are hard to interpret in any recognised medical framework” is
perfectly right, and I agree with it. In fact, one must change his (her)
old paradigms, in order to see the thousand suns above the clouds. If one
knows steadily the “biophysical-semeiotic method” (See HONCode web site
233736, www.semeioticabiofisica.it), he can, then, easily understand that
between physiology, health condition, white zone (“What does “Health”
mean”: I modestly invite BMJ to initiate such as discussion on this
fundamental question…). In my opinion, “healthy” biological systems are
characterized, from the deterministic chaotic viewpoint, by the “strange
attractor” (Please, Dr. Andrew Yip do not put more questions…) and before
pathology, disorders, black zone, there is certainly a large space, I
named grey zone, wherein there is not the health, but there is not yet
overt disease. Until now, all around the world, machine-dependent doctors
(I am sure you all can understand what I mean!) have been unable, and
are nowadays not yet able, to “see” the wonderful events that happen
under such conditions in microcirculatory bed, as English authors say
“inaccurately” (I prefer to speak of “tissue-microvascular-unit”).
In
fact, one can recognize these biological-molecular events (i.e.,
vasomotility and vasomotion, technically speaking, according to my Master
S.B. Curri), if we are able to assess “clinically” and precisely the
behaviour of tissue-microvascular-units of all biological systems, under
diverse conditons, physiological as well as pathological, evaluating them
at rest and during a large number of stress tests.
As regards Dr. Andrew
Yip’s “provocative” statement: Let's go back to the beginning, your first
full paragraph. If you genuinely believe [?, My dear Andrew Yip…what are
you saying…] what you write, please answer the following questions for a
start. What proof do you have that cancers (in general) are increasing in
prevalence - after the data are adjusted for reduced deaths these decades
from myocardial infarctions and infections?
My “poor”, not fluent English
response is the following: two uncles of mine, mother, father, my dear
only brother, “all” died of CANCER, in spite of the “paramount” advances
of modern, traditional, academic oncology. In addition, I am, of course,
positive for oncological terrain: hopefully, I fight my personal war
against it, neglecting today’s medical frameworks, with the aid of a
proper diet, ethymologically speaking, including physical exercise,
a.s.o., and drugs, such as capsaicine (= chilly pepper powder), free-
radical scavengers, and particularly Melatonine-Adenosine, according to
famous Italian Prof Di Bella. If you have the possibility to translate in
English my papers, written in my one language, of course, I’d be
sincerely and very delighted to communicate with everybody, and
particularly with Dr. Andrew Yip, an intelligent “anestesyst”, as well as
a positively “critical” colleague, whom I invite to visit my above-cited
HONCode web site, because he ignores completely the new, original, physical
semeiotic, and consequently Clincal Microangiology (See my site
www.semeioticabiofisica.it/microangiologia).
Finally, who is a "medical
semiologist"? Generally admitted, he has a strange, out-moded-view of the
world. Perhaps he is a unique physician in the world, as I am, who continues
reasonably to visit “healthy” or diseased individuals with the aid of an
obsolete tool, the stethoscope, due to the fact that after 46 years lived
at the bed-side, I persist to rely on the science of “Semeions”, according
to which, there is no regal way to Biophysical Semeiotics.
Competing interests:
None declared
Competing interests: No competing interests
May I suggest that sentences such as:
"In fact, from the healthy stage, white zone, slowly, very slowly one
can reach the disease onset, black zone – DM, ATS, AI, dyslipidaemia,
gout, malignancies, a.s.o., going through the pre-morbid, pre-metabolic
stage, or grey zone, that can last years or decades, without any clinical
symptomatology, which is the topic of my present comment, as far as
arteriosclerosis (arterioscleropathy, according to american P. Hayden) and
type 2 DM are concerned (See HONCode web site 233736,
www.semeioticabiofisica.it)."
are hard to interpret in any recognised medical framework. Are you
really an endocrinologist, gastroenterologist AND haematologist as WELL as
being a "medical semiologist"? In fact, what is a medical semiologist?
How about:
"both grey zone, or pre-metabolic syndrome, and metabolic syndrome,
classic or “variant”, are based on Congenital Acidosic Enzyme- Metabolic
Histangiopathy-a (CAEMH-a) (,3,4,5,6) (See above-cited site), observable
since birth-day obviously in individual CAEMH-a positive"
What does that mean?
Let's go back to the beginning, your first full paragraph. If you
genuinely believe what you write, please answer the following questions
for a start.
What proof do you have that cancers (in general) are increasing in
prevalence - after the data are adjusted for reduced deaths these decades
from myocardial infarctions and infections?
How can dyslipidaemia be recognised at the bedside other than in extreme
cases?
What proof do you have that sexually transmitted diseases are "inherited"?
How does recognising "cancer" at the bedside allow "primary prevention" of
malignancy????
Competing interests:
None declared
Competing interests: No competing interests
My sincere and complete agreement with D. Singh’s intriguing article.
First, according to London UK government health policy will have little
impact unless it includes practical measures to build a health system that
promotes health rather than just caring for people when they become ill.
Second, all around the world, NHS, government authorithies, physicians and
people must take into consideration the urgent necessity of highlightening
rises in the prevalence of obesity, IIR, dyslipidemias, T2DM,
hypertension, cancer, as well as a large number of diseases, such as
sexually transmitted diseases, alcohol misuse, considered today’s serious
epidemics. Third, however, we need a “clinical” tool, based on
revolutionary medical knoweledges, wich allows doctors to recognize on
very large scale with low costs for NHS individuals at “real risk” of such
diseases, in order to perform an efficacious primary prevention. In fact,
we must consider the importance of bed side recognizing all above-mentioned, inherited conditions, which play a paramount role in primary
prevention of metabolic syndrome, Pre-Diabetes, and T2DM, among other
common human diseases, including particularly malignancy.
In fact, from the healthy stage, white zone, slowly, very slowly one can
reach the disease onset, black zone – DM, ATS, AI, dyslipidaemia, gout,
malignancies, a.s.o., going through the pre-morbid, pre-metabolic stage,
or grey zone, that can last years or decades, without any clinical
symptomatology, which is the topic of my present comment, as far as
arteriosclerosis (arterioscleropathy, according to american P. Hayden) and
type 2 DM are concerned (See HONCode web site 233736,
www.semeioticabiofisica.it).
Metabolic syndrome, X syndrome, or Reaven’s syndrome, classic or
“variant”, I described years ago (6), represent the possible end of grey
zone. Due to this reason, I termed the grew zone as pre-morbid or pre-
metabolic syndrome (Oncological Terrain, in above-cited site).
Interestingly, both grey zone, or pre-metabolic syndrome, and metabolic
syndrome, classic or “variant”, are based on Congenital Acidosic Enzyme-
Metabolic Histangiopathy-a (CAEMH-a) (,3,4,5,6) (See above-cited site),
observable since birth-day obviously in individual CAEMH-a positive. It is
a functional mitochondrial cytopathology, inheredited, as a general rule,
from the mother, mainly asymptomatic in initial stages, as well as for
long time, before ending in poly-metabolic syndrome.
The main problem, we have to face and hopefully resolve, is, therefore, to
recognize and define “clinically” underlying molecular-biological events,
characteristic of grey zone by means of efficacious method, rapid to
perform at the bed-side, as Biophysical Semeiotics, meaning it as
conceptual and operative tool.
In the method are implicit all future knowledges, and, thus, we ask this
method – but not only to logic-deductive method, according to our
philosophy (5) to allow us to recognize “clinically” pre-morbid syndrome,
which represents the locus of primary prevention of most severe human
diseases (2-6). Therefore, as starting point of my reasoning, it is to be
found a biophysical semeiotic reading key, really different from that,
based on “classic” signs and symptoms, which are, on the other hand,
completely absent in pre-morbid stage or grey zone, which permits us to
correctly diagnose in a “quantitative” manner the pre-metabolic syndrome,
in easy and rapid way, during common physical examination, even performed
for whatever other reason.
References
1) Singh D. Preventive model of health care needed, says King's Fund. BMJ
2004;328:664 (20 March), doi:10.1136/bmj.328.7441.664-e
2) Stagnaro S., Istangiopatia Congenita Acidosica Enzimo-Metabolica
condizione necessaria non sufficiente della oncogenesi. XI Congr. Naz.
Soc. It. di Microangiologia e Microcircolaz. Abstracts, pg 38, 28
Settembre-1 Ottobre, Bellagio 1983
3) Stagnaro S., Istangiopatia Congenita Acidosica Enzimo-Metabolica. X
Congr. Naz. Soc. It. di Microangiologia e Microcircolazione. Atti, 61. 6-7
Novembre, Siena 1981
4) Stagnaro S., Istangiopatia Congenita Acidosica Enzimo-Metabolica. Una
Patologia Mitocondriale Ignorata. Gazz Med. It. – Arch. Sci. Med. 144, 423
(Infotrieve) 1985
5) Stagnaro-Neri M., Stagnaro S. Introduzione alla Semeitica Biofisica. Il
Terreno Oncologico. Travel Factory Ed., Roma, (in press).
6) Stagnaro-Neri M., Stagnaro S., Sindrome di Reaven, classica e variante,
in evoluzione diabetica. Il ruolo della Carnitina nella prevenzione del
diabete mellito. Il Cuore. 6, 617 (Pub-Med indexed for Medline) 1993
Competing interests:
None declared
Competing interests: No competing interests
Re: First of all, many thanks to Dr. Andrew Yip
Dr Stagnaro might well feel pleased to discover that his views find
considerable corroboration in ancient and medieval medicine. For example,
while www.dictionary.com defines semeiotics as a branch of semiotics or
semiology—that is, “the theory and study of signs and symbols”—Boerhaave
[1668-1738], the influential professor of physic at Leiden, defined it as
“that which shows signs distinguishing between sickness and health,
diseases and their causes in the human body.” [Boerhaave, 78-79, quoted by
Coulter, II, 133]
As “the pre-eminent early Enlightenment physician,” [Porter, 246]
Boerhaave probably was the most important European physician standing
between the times of William Harvey [1578-1657] and Thomas Sydenham [1624-
1689] and that of William Cullen [1710-1790] and John Brown [1735-88].
Therefore, Dr Stagnaro might be said to be in pretty good company.
Semeiology has been defined as the study of “signs, symptoms and
indications,” [McLean, 279] or as “the nature of signs,” [McLean, 279] or
the “logic of signs.” [McLean, 279] Medieval medicine gave a very sound
definition of semeiotics as “the knowledge of all indications of a
therapeutic method, discovered by rational doctors through their own
resources…for the sake of effecting a cure.” [McLean, 281] Furthermore, it
was agreed by all medieval physicians that, “signs always precede an
illness, and are always accompanied by a cause,” [McLean, 282] and that
such causes of sickness “are intelligible…[to the physician] through
necessary signs.” [McLean, 282] Dr Stagnaro implies much the same notion.
In ancient medicine, for example, “two prominent sources of symptoms
are pulse and urine…together with faeces, sweat, spit, vomit, and so on.”
[McLean, 283] The business of physicians in the ancient, medieval and
Renaissance medical systems very largely concerned the collection and
interpretation of signs of sickness, garnered by “the patient, his or her
attendants…and the doctor himself.” [McLean, 284] Certainly, therefore,
the views Dr Stagnaro suggests are exactly in accordance with the approved
procedures of normal European medical practice from the time of
Hippocrates right down until at least the 18th century.
Even though the nature and interpretation of medical signs changed
considerably as medicine made its transition into the scientific era, the
basic diagnostic and observational skills of the physician still concerned
the interpretation of signs and symptoms “for the sake of effecting a
cure.” [McLean, 281] And as Dr Stagnaro repeatedly states, that is
semeiotics. In this sense at least, Andrew Yip is wrong to suggest that Dr
Stagnaro’s views do not conform “to any recognised medical framework.”
This exchange also provides a good example of the way medical history
can be used to shed some useful light upon modern medical problems.
Sources
Hermann Boerhaave, Academic Lectures on the Theory of Physic, 1742-46
Harris L Coulter, Divided Legacy a History of the Schism in Medical
Thought, Volume II Progress and Regress: J P van Helmont to Claude
Bernard, Washington, Wehawken Books, 1975
Ian McLean, Logic Signs and Nature in the Renaissance: the Case of
Learned Medicine, Cambridge: Cambridge University Press, 2002
Roy Porter, The Greatest Benefit to all Mankind a Medical History of
Humanity, New York: Norton, 1998
Competing interests:
None declared
Competing interests: No competing interests