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I have nothing against Prof. Burioni, no aversion. He, like me, loves science but simply has an idea of science and medicine different from mine. Although I do not know him in person, he is an average type of doctor, very familiar to me. He is the orthogonal projection of a certain type medicine that has the sole defect of having sat still over time, accumulating increasing degrees of regressivity, and that because of this, today requires a profound rethinking.
The pacts on medicine have to look to the future, not to the past, that is, they can not be conservative as if medicine were a monument to be restored, but must be innovative. Medicine particularly must resolve its own credibility crisis, for which restoration is not enough.
The pact of Prof. Burioni makes me think of a doctor, to stay on topic, who continues to prescribe to his patient leeches instead of hypotensive drugs. Today the leeches are scientifically impractical as well as socially unacceptable so I can not be criticized if I, confronted with this, leave.
Conclusion: the medicine of choice
In closing, I would like to recall, for the benefit not only of Prof. Burioni, two developments that those who discuss medicine and pacts should not ignore. In my opinion the authentic “breakthroughs” are:
• The reform of ethics proposed by the Order of Trento, • The 100 theses published by Fnomceo to invigorate discussion of the general states of the medical
profession.
They propose to start a new discourse on medicine. For this reason, both have been forced, for their own purposes, to take stock of scientific medicine, its problems, its contradictions, its crises, and finally to propose theses for a redefinition – obviously, for discussion.
In Trento’s work, medicine is defined as:
• A system of scientific and humanistic knowledge of a
complex nature, which takes advantage of the
rationality of common sense and reasonableness,
• Which admits exceptions, derogations, interpretations, integrations, in cases where available scientific knowledge does not work or is in contradiction with
clinical facts,
• Against which it is the duty of the physician to ensure
appropriate modalities.
The 100 theses propose a turn in the traditional definition of medicine toward: the “medicine of choice “. It is built step by step through 35 theses (93.0 / 93.35) and I invite everyone to read and discuss them. (http://www.quotidianosanita.it/allegati/create_pdf.php ?all=9734757.pdf).
I limit myself to citing the synopsis, which opens the theses: “To connote a different idea of medicine compared to the classical one of the positivist paradigm, it is proposed to use the expression “medicine of choice”. If the patient is a world with many worlds, a complexity, a set of potentialities, a singularity, the metaphysical assumption of positivism falls, which is that of the one-way clinical choice made mandatory by a single universe with a single decision- maker. Today the choice is not only for the doctor but also for the patient and, what is more, as a shared choice with respect to complexity, one must choose more, not less, and therefore imposes new autonomies and new responsibilities. For these reasons the concept of choice is taken as emblematic of a new idea of illness and therefore of medicine. The choice is therefore a radical concept that in itself sums up the sense of change. “
On the “Medicine of Choice”, as a pact with Prof. Burioni, I would sign without hesitation. Ivan Cavicchi 21 January 2019 © Reproduction reserved
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