Querido A
Rijksuniversiteit Leiden.
Verh K Acad Geneeskd Belg. 1993;55(3):203-20; discussion 220-4.
The author discusses the contents of his book "The inside of medicine" which appeared at the end of 1990 (it is written in dutch). The book aims to acquire a view how the metamorphosis of theory and practice of medicine as to size and diversity in the past fifty years came about. Also health care developed into a social right, and became a cultural institution. The book is not meant as a history of medicine of that period, but rather as a history of ideas illustrated with examples. The author feels qualified to do so, because he was actively involved with research during those years. Before World War II his activities were during ten years limited to laboratory research (biomedical) in the Netherlands, U.S.A. and finally at the Pasteur Institute in Paris. Residencies in internal medicine followed and qualification for this specialty. From 1948-1983 he held a chair at Leiden University in Internal medicine and concentrated his research on endocrinology and metabolic diseases (patient centered research). He was Founding Dean of the Rotterdam Medical Faculty for 5 years. Since the beginning of the 20th century it is accepted that illness in general is multifactorially determined. However research about illness is still dominated by the Newtonian unidirectional paradigm of cause to effect, which leads to mechanistic thinking. Obtained data are followed further by the same method, through different levels of knowledge from symptom to morphology and to pathophysiology, and finally to the molecular level. Undoubtedly much has been achieved. The integrated approach, reflecting reality, often characterized by the term of the bio-psycho-social view, was hardly used. It is frequently suspected that advances are disappointing in diseases like atherosclerosis, or the deviating course of disease and recovery in advanced age etc. because of that reason. Molecular biology is at a too early stage of development that reasoning upwards to the "lived human body" is possible. The author feels that there are signs of changing the approach and paradigm at present. Some examples will be discussed.
作者讨论了他于1990年末出版的《医学的内在》（该书用荷兰语写成）的内容。这本书旨在探讨在过去五十年中，医学理论与实践在规模和多样性方面的转变是如何发生的。此外，医疗保健已发展成为一项社会权利，并成为一种文化机构。这本书并非那个时期的医学史，而是一部用实例说明的思想史。作者认为自己有资格这样做，因为那些年他积极参与了研究工作。第二次世界大战前，他的活动在十年间局限于荷兰、美国的实验室研究（生物医学），最后是在巴黎的巴斯德研究所。随后是内科住院实习，并获得了该专业的资格。1948年至1983年，他在莱顿大学担任内科教授，研究集中在内分泌学和代谢疾病（以患者为中心的研究）。他曾担任鹿特丹医学院院长五年。自20世纪初以来，人们普遍认为疾病一般是由多种因素决定的。然而，对疾病的研究仍然受牛顿式的从原因到结果的单向范式主导，这导致了机械思维。通过从症状到形态学、病理生理学，最终到分子水平的不同知识层面，用同样的方法进一步追踪所获得的数据。毫无疑问，已经取得了很多成果。反映现实的综合方法，通常以生物 - 心理 - 社会观点来表述，却很少被使用。正因如此，人们常常怀疑在动脉粥样硬化等疾病方面进展令人失望，或者在老年疾病的异常病程和康复等方面也是如此。分子生物学尚处于发展的早期阶段，以至于向上推理到“有血有肉的人体”是不可能的。作者认为目前有改变研究方法和范式的迹象。将讨论一些例子。
