Intended for healthcare professionals

Feature Essay

Towards regeneration: the evolution of medicine from fighting to building

BMJ 2018; 361 doi: (Published 17 April 2018) Cite this as: BMJ 2018;361:k1586
  1. Ian G Hargraves, assistant professor1,
  2. Atta Behfar, associate professor2,
  3. Jilian L Foxen, instructor2,
  4. Victor M Montori, professor1,
  5. Andre Terzic, professor2
  1. 1Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
  2. 2Department of Cardiovascular Medicine and Center for Regenerative Medicine, Mayo Clinic
  1. Correspondence to: V M Montori Montori.victor{at}

We should retreat from metaphors of war in medicine and look to regenerative medicine in its broadest sense, say Ian Hargraves and colleagues with a focus on rebuilding both bodies and lives

The practice of medicine and the art of caring for patients are evolving, driven in part by the new epidemiology of chronic disease and the technological advances made to tackle it. Medicine is increasingly shifting its focus from combating disease to helping to build or rebuild human life.

The shift is adaptation more than inspiration. When infection was the major threat to survival, medicine responded with better sanitation and nutrition, antibiotics, surgical debridement, and supportive care. Some patients succumbed “after a long battle”; others recovered, often with battle scars.

In an era of chronic non-communicable conditions, the long criticised fighting metaphor feels antiquated.12 Now we live, and eventually die, with diabetes, heart failure, rheumatoid arthritis, chronic obstructive pulmonary disease, or as a survivor from a battle against cancer or against sepsis in the intensive care unit. When no enemy remains, or when defeat of the enemy is not achievable, fighting and thinking of medicine as a fighting force is often cruel, counterproductive, and futile.

The specialty of regenerative medicine has contributed remarkable technological achievements at the fringes of medicine, but the term and practice have a broader significance. We propose recognising that regenerative approaches in medicine extend from the need to combat illness and injury to the rebuilding and regeneration of lives affected by chronic disease.

Patients’ needs

Medicine can complement fighting disease with building health. In the case study (box 1) the blockage in the patient’s coronary artery was an immediate threat, but resolution of the patient’s situation and the reintegration of his life and family cannot be achieved solely by eliminating that threat. In the first …

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