King's College London, Department of Primary Care and Public Health Sciences, Addison House, Guy's Campus, London, SE1 1UL, United Kingdom.
Soc Sci Med. 2019 Sep;237:112444. doi: 10.1016/j.socscimed.2019.112444. Epub 2019 Jul 25.
Over the last two decades diagnostic labels have increasingly been sub-divided based on molecular and genetic 'signatures'. But this emphasis on disease sub-types defined in molecular terms, elides the central role of population-based predictive technologies in determining these new diagnoses. While molecular diagnostic sub-types might flow from the laboratory, the clinical validity of every putative diagnostic category must ultimately be tested against its predictive powers. In effect, the former logic of prognosis following diagnosis is reversed. This paper explores the emergence of this new method of diagnostic practice over the last half century.
在过去的二十年中，诊断标签越来越多地根据分子和遗传“特征”进行细分。但这种对分子术语定义的疾病亚型的强调，忽略了基于人群的预测技术在确定这些新诊断中的核心作用。虽然分子诊断亚型可能源自实验室，但每个假定诊断类别的临床有效性最终都必须与其预测能力进行检验。实际上，以前的诊断后预后逻辑被颠倒了。本文探讨了过去半个世纪这种新的诊断实践方法的出现。
