The physician in the face of scientific determinism

Alvaro Daschner

The physician has a role as an actor when dealing with the patient. He can actively influence the course of the disease or observe cautiously. The flow of medical concepts typically goes from diagnosis to prognosis and treatment. The doctor learns and has at his disposal tools that help the decision-making process in each of these phases. Biomedicine is based on scientific studies and the application of the results predisposes to a rather deterministic thinking. However, the studies are based on specific study populations and show statistical trends. The growing reductionism of biomedical research has advanced to clarify patho-physiological mechanisms and causes of many diseases. Thus a continuous phenotyping of patients and diseases is emerging with the intention of seeking personalized treatments. But this trend further increases the deterministic predisposition, which attempts to associate linearly phenotypes and sub-phenotypes with defined prognoses and treatments. This makes it difficult to take into account the plasticity over time of the disease carriers. It is the theory of evolution, which is based on the variability of traits and teaches us how the environment affects phenotypes to a large extent and the disease is one of them. The doctor's dilemma in the face of scientific determinism is the difficulty to decide extrapolation of clinical studies results to the individual patient.