Mittal M, Jethwani P, Naik D, Garg MK. Non-medicalization of medical science: Rationalization for future. World J Methodol 2022; 12(5): 402-413 [PMID: 36186743 DOI: 10.5662/wjm.v12.i5.402]
Corresponding Author of This Article
Madhukar Mittal, MBBS, MD, DM, FACE, Additional Professor, Department of Endocrinology and Metabolism, All India Institute of Medical Sciences Jodhpur, Basni hase 2, Jodhpur 342005, India. mittalspace@gmail.com
Research Domain of This Article
Endocrinology & Metabolism
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Madhukar Mittal, Parth Jethwani, MK Garg, Department of Endocrinology and Metabolism, All India Institute of Medical Sciences Jodhpur, Jodhpur 342005, India
Dukhabandhu Naik, Department of Endocrinology and Metabolism, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India
Author contributions: Mittal M was involved in conceptualization and design of the manuscript; Mittal M and Jethwani P performed the search and wrote the manuscript; Mittal M, Naik DB, and Garg MK edited and reviewed the manuscript; all authors have read and approved the final manuscript.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Madhukar Mittal, MBBS, MD, DM, FACE, Additional Professor, Department of Endocrinology and Metabolism, All India Institute of Medical Sciences Jodhpur, Basni hase 2, Jodhpur 342005, India. mittalspace@gmail.com
Received: March 20, 2022 Peer-review started: March 20, 2022 First decision: June 8, 2022 Revised: June 13, 2022 Accepted: July 20, 2022 Article in press: July 20, 2022 Published online: September 20, 2022
Abstract
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), i.e., 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.
Core Tip: In this article we discuss several pre-clinical conditions (subclinical hypothyroidism, pre-diabetes, osteopenia, and minimal autonomous cortisol excess), highlighting the futility of early treatment which may not alter the course of future disease. The medical community needs to exercise restraint with pharmacological measures where changes in lifestyle could play a more decisive role in leading a healthy life. 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), i.e., do no harm.
