Chapter

Emergence and development of scientific medicine

Fabrizio Benedetti

in The Patient's Brain

Published on behalf of Oxford University Press

Published in print October 2010 | ISBN: 9780199579518
Published online February 2013 | e-ISBN: 9780191754661 | DOI: http://dx.doi.org/10.1093/med/9780199579518.003.0002
Emergence and development of scientific medicine

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1) This chapter describes how scientific medicine has developed over the centuries, with particular emphasis on the scientific acquisitions in the fields of anatomy, physiology, as well as of specific medical branches. Besides these anatomical and physiological advances, scientific medicine also includes a biopsychosocial approach, whereby biological factors merge with psychological and social factors in both the pathophysiology and the management of diseases. 2) The transition from the shaman to the modern physician, and from shamanism (i.e. a spiritual-based notion of disease) to scientific medicine (i.e. an anatomophysiological-based concept of disease), was a slow process that took many centuries to develop. Today there are plenty of medical sub-disciplines that have increased their own knowledge and skills over time. The over-specialized physician has often great difficulty to understand and to practice medical specialties other than his own. Therefore, medical care has evolved from the shaman who takes care of the whole body and soul to the modern doctor who takes care of single organs and apparatuses. 3) Animal experimentation has been, and is today, a major ethical problem, both for the lay person and for the scientist/clinician. In particular, the clinician must understand, although he may refuse morally, that what he uses in his routine medical practice comes from experiments and observations that have been made in different animal species. It is also important to recognize that the opponents to animal research are motivated by particularly cruel experiments that have been performed in the past, such as the use of curare without anaesthesia. 4) Many therapies that are used in routine clinical practice are not the consequence of anatomical and physiological advances. For example, treatments such as deep brain stimulation are highly effective, yet their mechanisms are completely or partially unknown. This does not detract from the significance and rigour of modern medicine, for it uses sophisticated methods to validate therapeutic efficacy. For example, pragmatic clinical trials are aimed at assessing efficacy, regardless of the understanding of the underlying mechanisms. 5) With the advent of psychoimmunology and the discovery that immune responses can be conditioned, modern medicine recognizes that the brain may play an important role in the pathophysiology of diseases. In addition, with the recent explosion of placebo research, particularly its biological underpinnings, modern medicine recognizes that the brain may also have an active role in the therapeutic outcome. 6) It is important to underscore that although medical approaches vary across different cultures, the interaction between the doctor and his patient does not change very much. For example, Western medicine explains the mechanisms of acupuncture differently from traditional Chinese medicine, nonetheless in both the psychosocial component, whereby the patient expects a therapeutic benefit, is crucial. 7) From these many aspects of modern scientific medicine, this chapter argues that the doctor–patient relationship can be made even more scientific by examining the patient's brain from a neuroscientific perspective. In so doing, four behavioural and biological steps can be identified that take place in the patient's brain. First, the subject starts feeling sick through both bottom-up and top-down processes. Second, he starts seeking relief from his discomfort by activating motivational and reward neural mechanisms. Third, trust and hope mechanisms are at work while the patient interacts with a doctor. At the same time, it is interesting to consider empathy and compassion mechanisms in the doctor's brain. Fourth, the very therapeutic act triggers expectation and placebo mechanisms in the patient's brain that only today begin to be understood. These four steps in the doctor–patient relationship will be treated throughout this volume, i.e. feeling sick in Chapter 3, seeking relief in Chapter 4, meeting the therapist in Chapter 5, and receiving a therapy in Chapter 6.

Chapter.  11724 words.  Illustrated.

Subjects: Psychiatry

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