系统医学大事记索引
系统医学/系统生物学大事记
美国医师协会杂志于2009年9月发表系统医学文章,引起关注
作者: Bill Cayley
发布: 2009.11.13

Concerning Systems Medicine


October 29, 2009


A recent commentary in the Journal of the American Medical Association (JAMA vol 302, p994,
http://jama.ama-assn.org/cgi/content/extract/302/9/994) proposes "systems medicine" as a new paradigm for moving medicine "from reductionism to holism." However, commentary itself takes an unfortunately narrow view and primarily biologic view, focusing mainly on the integration of genomics with disease prevention.

It seems to me a true systems approach must address issues at multiple levels that affect patients individually or as communities: biology, personality, communication, culture, lifestyle, socio-economics, and environment. For example, while diabetes risk may be partially related to genetic vulnerability, an individual's risk of diabetes is also significantly mediated by lifestyle factors and socioeconomic factors, while cultural and communication factors may play a major role in his or her understanding of the disease.

This broader view of systems medicine is nothing new to those in primary care. Focusing on first-contact care, long-term person-focused care, comprehensiveness, and care coordination we are already well-positioned to practice "systems medicine". Family physicians, in particular, are trained to address the multiple systems levels that bear on patients' lives and well-being.

Shifting to a truly systems based approach really would represent major advance forward for medicine. But in order to make the first step towards this advance, we must ensure adequate funding, institutional and academic support, and clinical structures to support a strong primary care enterprise.