Mittal Madhukar, Jethwani Parth, Naik Dukhabandhu, Garg M K
Department of Endocrinology and Metabolism, All India Institute of Medical Sciences Jodhpur, Jodhpur 342005, India.
Department of Endocrinology and Metabolism, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India.
World J Methodol. 2022 Sep 20;12(5):402-413. doi: 10.5662/wjm.v12.i5.402.
As we delve into the intricacies of human disease, millions of people continue to be diagnosed as having what are labelled as pre-conditions or sub-clinical entities and may receive treatments designed to prevent further progression to clinical disease, but with debatable impact and consequences. Endocrinology is no different, with almost every organ system and associated diseases having subclinical entities. Although the expansion of these "grey" pre-conditions and their treatments come with a better understanding of pathophysiologic processes, they also entail financial costs and drug adverse-effects, and lack true prevention, thus refuting the very foundation of Medicine laid by Hippocrates "Primum non nocere" (Latin), do no harm. Subclinical hypothyroidism, prediabetes, osteopenia, and minimal autonomous cortisol excess are some of the endocrine pre-clinical conditions which do not require active pharmacological management in the vast majority. In fact, progression to clinical disease is seen in only a small minority with reversal to normality in most. Giving drugs also does not lead to true prevention by changing the course of future disease. The goal of the medical fraternity thus as a whole should be to bring this large chunk of humanity out of the hospitals towards leading a healthy lifestyle and away from the label of a medical disease condition.
当我们深入研究人类疾病的复杂性时,数百万人仍被诊断为患有被标记为前期病症或亚临床实体的疾病,可能会接受旨在预防疾病进一步发展为临床疾病的治疗,但其影响和后果存在争议。内分泌学也不例外,几乎每个器官系统及其相关疾病都有亚临床实体。尽管对这些“灰色”前期病症及其治疗方法的了解有所增加,这伴随着对病理生理过程的更好理解,但它们也带来了经济成本和药物不良反应,并且缺乏真正的预防效果,从而违背了希波克拉底提出的医学基本原则“Primum non nocere”(拉丁语,意为“勿伤”)。亚临床甲状腺功能减退、糖尿病前期、骨质减少和轻度自主性皮质醇增多症是一些内分泌亚临床病症,绝大多数情况下不需要积极的药物治疗。事实上,只有一小部分人会发展为临床疾病,大多数人会恢复正常。用药也不会通过改变未来疾病的进程来实现真正的预防。因此,整个医学界的目标应该是让这一大部分人走出医院,过上健康的生活方式,摆脱疾病的标签。