McEwen Bruce S
Laboratory of Neuroendocrinology, The Rockefeller University, New York, NY 10065.
Metabolism. 2017 Apr;69S:S21-S29. doi: 10.1016/j.metabol.2017.01.018. Epub 2017 Jan 11.
The future of medicine is discussed in the context of epigenetic influences during the entire life course and the lived experiences of each person, avoiding as much as possible the "medicalization" of the individual and taking a more humanistic view. The reciprocal communication between brain and body via the neuroendocrine, autonomic, metabolic and immune systems and the plasticity of brain architecture provide the basis for devising better "top down" interventions that engage the whole person in working towards his or her welfare. The life course perspective emphasizes the importance of intervening early in life to prevent adverse early life experiences, including the effects of poverty, that can have lifelong consequences, referred to as "biological embedding". In the spirit of integrative, humanistic medicine, treatments that "open windows of plasticity" allow targeted behavioral interventions to redirect brain and body functions and behavior in healthier directions. Policies of government and the private sector, particularly at the local, community level, can create a supporting environment for such interventions. See "Common Ground for Health: Personalized, Precision and Social Medicine McEwen & Getz - https://www.youtube.com/watch?v=IRy_uUWyrEw.
医学的未来是在整个人生历程中的表观遗传影响以及每个人的生活经历的背景下进行讨论的，尽可能避免对个体的“医学化”，并采取更具人文主义的观点。大脑与身体之间通过神经内分泌、自主神经、代谢和免疫系统进行的相互交流以及大脑结构的可塑性，为设计更好的“自上而下”干预措施提供了基础，这些干预措施能让整个人参与到促进自身福祉的努力中。生命历程视角强调在生命早期进行干预以预防不良早期生活经历的重要性，这些经历包括贫困的影响，可能会产生终身后果，即所谓的“生物嵌入”。本着综合、人文主义医学的精神，“打开可塑性之窗”的治疗方法允许有针对性的行为干预，将大脑、身体功能和行为引导到更健康的方向。政府和私营部门的政策，特别是在地方、社区层面的政策，可以为这类干预创造一个支持性环境。见《健康的共同基础：个性化、精准和社会医学》 麦克尤恩与盖茨 - https://www.youtube.com/watch?v=IRy_uUWyrEw 。
