新整体论:P4系统医学与健康及生命本身的医学化

The new holism: P4 systems medicine and the medicalization of health and life itself.

作者信息

Vogt Henrik, Hofmann Bjørn, Getz Linn

机构信息

General Practice Research Unit, Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway.

Section for Health, Technology, and Society, Norwegian University of Science end Technology, Gjøvik, Norway.

出版信息

Med Health Care Philos. 2016 Jun;19(2):307-23. doi: 10.1007/s11019-016-9683-8.

Abstract

The emerging concept of systems medicine (or 'P4 medicine'-predictive, preventive, personalized and participatory) is at the vanguard of the post-genomic movement towards 'precision medicine'. It is the medical application of systems biology, the biological study of wholes. Of particular interest, P4 systems medicine is currently promised as a revolutionary new biomedical approach that is holistic rather than reductionist. This article analyzes its concept of holism, both with regard to methods and conceptualization of health and disease. Rather than representing a medical holism associated with basic humanistic ideas, we find a technoscientific holism resulting from altered technological and theoretical circumstances in biology. We argue that this holism, which is aimed at disease prevention and health optimization, points towards an expanded form of medicalization, which we call 'holistic medicalization': Each person's whole life process is defined in biomedical, technoscientific terms as quantifiable and controllable and underlain a regime of medical control that is holistic in that it is all-encompassing. It is directed at all levels of functioning, from the molecular to the social, continual throughout life and aimed at managing the whole continuum from cure of disease to optimization of health. We argue that this medicalization is a very concrete materialization of a broader trend in medicine and society, which we call 'the medicalization of health and life itself'. We explicate this holistic medicalization, discuss potential harms and conclude by calling for preventive measures aimed at avoiding eventual harmful effects of overmedicalization in systems medicine (quaternary prevention).

摘要

系统医学(或“P4医学”——预测性、预防性、个性化和参与性)这一新兴概念处于后基因组时代迈向“精准医学”运动的前沿。它是系统生物学在医学上的应用,系统生物学是对整体的生物学研究。特别值得关注的是,P4系统医学目前被视为一种革命性的新生物医学方法,它是整体性的而非还原论的。本文分析了其整体论概念,涉及健康和疾病的方法及概念化。我们发现,它并非代表与基本人文理念相关的医学整体论,而是源于生物学中技术和理论环境变化所产生的技术科学整体论。我们认为,这种旨在疾病预防和健康优化的整体论指向了一种扩展形式的医学化,我们称之为“整体医学化”:每个人的整个生命过程都从生物医学、技术科学的角度被定义为可量化和可控的,并处于一种全面的医学控制体系之下,这种控制体系是整体性的,因为它涵盖了所有方面。它针对从分子到社会的所有功能层面,贯穿生命始终,旨在管理从疾病治疗到健康优化的整个连续过程。我们认为,这种医学化是医学和社会中一种更广泛趋势的具体体现,我们称之为“健康和生命本身的医学化”。我们阐述了这种整体医学化,讨论了潜在危害,并通过呼吁采取预防措施以避免系统医学中过度医学化的最终有害影响(四级预防)来得出结论。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2b59/4880637/02db78aea863/11019_2016_9683_Fig1_HTML.jpg

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