Too much doing and too little thinking in medical science!

[The jibarization of logos: how medical reductionism can kill]

In recent decades, a disciplinary and subdisciplinary proliferation has triggered both in the medical fields and science in general. This trend may be partially explained by two diachronic, dialectically interconnected facts: the deepening of technical, social and international division of labor in the globalized capitalist world, and the triumph of the reductionist program, mainly developed by the logical empiricism of the Vienna Circle. This paper aims to deepen the debate on the intricate links between medicine, biology, philosophy, reductionism and complex thought, by using two examples: a case report of current medicine and the situation experienced by a famous American scientist, Stephen Jay Gould, about his first cancer, an abdominal mesothelioma. We have witnessed how the two above-mentioned historical facts have been operating as a super-structure like a pair of "tweezers", dismembering and compressing at the same moment the object of knowledge, the theories that allow their study, and the subject that receives the knowledge. This jibarization of logos is a real problem for public health, from the moment that it impacts, omnipresent, in the actual hegemonic medical model, leading to potentially dangerous attitudes to the various components of health systems.

Performance of the Framingham and SCORE cardiovascular risk prediction functions in a non-diabetic population of a Spanish health care centre: a validation study

OBJECTIVE

To analyse the 10-year performance of the original Framingham coronary risk function and of the SCORE cardiovascular death risk function in a non-diabetic population of 40-65 years of age served by a Spanish healthcare centre. Also, to estimate the percentage of patients who are candidates for antihypertensive and lipid-lowering therapy.

DESIGN

Longitudinal, observational study of a retrospective cohort followed up for 10 years.

SETTING

Primary care health centre.

PATIENTS

A total of 608 non-diabetic patients of 40-65 years of age (mean 52.8 years, 56.7% women), without evidence of cardiovascular disease were studied.

MAIN OUTCOME MEASURES

Coronary risk at 10 years from the time of their recruitment, using the tables based on the original Framingham function, and of their 10-year risk of fatal cardiovascular disease using the SCORE tables.

RESULTS

The actual incidence rates of coronary and fatal cardiovascular events were 7.9% and 1.5%, respectively. The original Framingham equation over-predicted risk by 64%, while SCORE function over-predicted risk by 40%, but the SCORE model performed better than the Framingham one for discrimination and calibration statistics. The original Framingham function classified 18.3% of the population as high risk and SCORE 9.2%. The proportions of patients who would be candidates for lipid-lowering therapy were 31.0% and 23.8% according to the original Framingham and SCORE functions, respectively, and 36.8% and 31.2% for antihypertensive therapy.

CONCLUSION

The SCORE function showed better values than the original Framingham function for each of the discrimination and calibration statistics. The original Framingham function selected a greater percentage of candidates for antihypertensive and lipid-lowering therapy.

Attachment in the doctor-patient relationship in general practice: a qualitative study

OBJECTIVE

To explore why interpersonal continuity with a regular doctor is valuable to patients.

DESIGN, SETTING, AND SUBJECTS

A qualitative study based on 22 interviews with patients, 12 who saw their regular general practitioner (GP) and 10 who saw an unfamiliar GP. The patients were selected after an observed consultation and sampled purposively according to reason for encounter, age, and sex. The research question was answered by means of psychological theory.

RESULTS

A need for attachment was a central issue for the understanding of the value of interpersonal continuity for patients. The patients explained that they preferred to create a personal relationship with their GP and the majority expressed a degree of vulnerability in the doctor-patient relationship. The more sick or worried they were the more vulnerable and the more in need of a regular GP. Furthermore, patients stated that it was difficult for them to change GP even if they had a poor relationship.

CONCLUSION

Attachment theory may provide an explanation for patients' need to see a regular GP. The vulnerability of being a patient creates a need for attachment to a caregiver. This need is fundamental and is activated in adults when they are sick or scared.