Medical Interferences.

Epidemiology, hygiene and sanitary organization

THE ROLE OF ANTICIPATIVE MEDICINE AND OF EDUCATIVE EXIGENCY

FOR A PARTICIPATIVE APPROACHING OF THE MEDICAL ACT

Letiţia-Doina DUCEAC1, Liviu Stafie2, Cristina-Maria JITĂREANU3, Maricica

PĂVĂLEANU4, Mădălina DUCEAC5, Bogdan Constantin NECULAU6
1
Assoc. Prof. PhD, ”Apollonia” University of Iaşi, ”Sf. Maria” Clinical Emergency Child Hospital of Iaşi, Romania
2
Assist. Prof. PhD, ”Apollonia” University of Iaşi, Direction of Public Health of Iaşi, Romania
3
Assist. Prof. PhD, ”Apollonia” University of Iaşi, ”Sf. Maria” Clinical Emergency Child Hospital of Iaşi, Romania
4
Assoc. Prof. PhD, ”Apollonia” University of Iaşi, ”Elena Doamna” Hospital of Obstetrics and Ginecology of Iaşi, Romania
5
Student, ”Apollonia” University of Iaşi, Romania
6
Lecturer, PhD, Alexandru Ioan Cuza” University of Iaşi, Romania
Corresponding author: Liviu Stafie;e-mail: dr_liviustafie@yahoo.com

Abstract of various heterogeneous data, such as patient’s

The concept of preventive medicine and its methodology
witnessed a gradual evolution, alongwith the development
of the human society. The term anticipation, namely the
successful actions perfomed by the organism for
maintaining its life, which add to the attainment of the
expected results, appear as empirical proofs about the
existence of this concept at living beings level. Data on
anticipative processes was accumulated in varied domains
of life. In the actual context of technological development,
besides the concept of anticipative medicine, other terms
appeared, such as precision medicine, personalized
medicine, participative medicine, multi-layer medicine.
Modern medicine is now increasingly oriented towards
prevention, focusing its efforts on attaining a long-term
equilibrium between humans and their life and work
environment. The major objective of health services is
protection of the natural and social surrounding
environment, thus promoting communitary health.
Anticipative medicine, alongwith the requirements of
education, contributes to a participative approaching of the
medical act and to its full success.
Keywords: prevention, anticipative medicine, concept,
education.
With the technological and informational
evolution specific to the contemporary society,
health-care is facing significant modifications as
to its approaches. The informatic assault,
materialized, as well, in the development of the
system of electronic medical recordings,
contributes to the development of personalized
medical assistance, as well as to a pre-symptomatic
treatment, thus offering the possibility of more
applied analyses of different categories of
patients. The medical decision, based on the
exploitation of information, requires the analysis
files, medical imagistics, results of biological
data, etc [1].
The concept of anticipative medicine was
promoted and explained by researcher Mihai
Nadin, considered the creator of this domain, his
book, Anticipation and Medicine, recently
published (2017) at Springer International
Publishing, Switzerland, evidencing this concept.
The author advances the idea that the term
anticipation, namely the successful actions
performed by the organism, in general, for
maintaining life and for attaining good results,
provides empirical proofs supporting the
existence of this concept at the level of the living
organism. Data about anticipative processes
were gathered from most varied domains of
science (medicine, psychopaedagogy, technology,
life sciences, etc.). Prevision is an essential
starting point in the establishment of short-,
medium- and long-term objectives and strategies.
Accordingly, necessary now in any domain is the
need of an initial evaluation (for knowing exactly
wherefrom one starts, what one has at hand for
the succes of one’s approach), one or more
evaluations along the various steps, for taking
the necessary corrections/reconsiderations of
the initial planl, as well as a final evaluation that
will establish whether the objectives have been
attained and will offer conclusions and
perspectives for future projects.
Recent studies promoted the principle of
personalized medicine and that of anticipative

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Nicolae-Tiberiu POPÂRLAN, Ioana PĂVĂLEANU
medicine. Dr. Jean-Marcel Ferret, former
physician of the French national football team,
was a promoter of these two principles. The
scope of his investigations was to extend the
empirically obtained results and acquisitions for
high-class sportmen, whichever the sport they
represent, to other social groups, with the aim of
transforming each individual into his/her own
health manager, by offerring recommendations
on the style of life, nutrition, physical exercises,
etc. All these involve to support a type of
personalized anticipative medicine. To establish
a personalized scheme of health-care and of
presymptomatic therapy, a decisional health
system should permit a transversal analysis on
a certain group of patients, as well as storing of
global medical data, such as the biometric ones,
the biological and cardiovascular parameters or
clinical and psychological data. Such databases
might offer predictions on a future group of
patients, with similar characteristics and,
consequently, such a complex medical system
would provide data permitting various types of
analyses, thus favoring personalized and
anticipative medicine (opposed to curative
medicine), on well-identified patients, as well as
statistical data for epidemiological studies on
populational groups or on groups of patients
with various risks [2].
Prevention may be defined as the totality of
actions performed in the absence of disease, for
maintaining this condition over an as long as
possible period, included here being the assembly
of medical, social, economic, technical and
political measures developed as local, regional,
national or international actions, that may reduce
the risks of installation and extension of a disease
at populational and global level. Prevention
assumes knowledge of health risks, of the
modalities of neutralizing their action, of tracing
the populational groups at risk, namely the pre-
disease and disease conditions in their as early
and as presymptomatic possible stages [3].
Both the concept of preventive medicine and
the methodology of its application evolved
gradually, alongwith the development of the
society. However, the modern society also
assumes, besides the technology which assures
medical progress, the occurrence of new causes
generating aggressive factors upon the human
158
organism. After a period dominated by the
medicine of diagnostic and treatment of the sick
people, mankind rediscovered preventive
medicine and its importance at both individual
and health system level, if considering the
medical costs and the socio-economic
peculiarities. The models the individual receives
in his/her first years of life have impact at both
microscopic level (included here being the
schemes of immunization, of preventive
administration of vitamins D and A through
various national health programs, especially in
the developing countries), and at macroscopic
level, with reference to the level of future
(predictive, anticipative) health of an individual,
as part of a community. Modern medicine is
more and more oriented towards prevention,
taking steps for attaining a sustainable balance
between the human being and his/her living and
work environment. Therefore, the main objective
of the health services is to protect the environment,
both naturally and socially, thus promoting
communitary health [4].
In the present context of technological
development, the authors consider useful to
discuss other concepts, associated to that of
anticipative medicine, on which they are actually
based. For example, precision medicine is a
medical pattern which proposes personalization
of medical assistance, in which the medical
decisions, the therapy schemes should be adapted
to each patient in part. According to such a
pattern, testing of the diagnostic is usually
employed for selecting adequate and optimum
therapies, based on genetic data of the patient or
on other molecular or cellular analyses. The
instruments used in precision medicine may
include molecular diagnostic, computer
imagistics and analysis. Personalized medicine
is a medical concept which distinguishes among
patients of different groups, while the medical
decisions, the practices or interventions are
specifically adapted to the individual patient, on
the basis of his/her anticipated response or of
his/her own risk of getting ill. The terms
personalized medicine, precision medicine or
stratified medicine are interchangable for
describing this concept, even if some authors and
schools of medicine use such expressions
separately, for outlining certain nuances. Even if
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adaptation of the treatment to the peculiarities
of each patient is being performed as early as
Hippocrates time, the term has been more
frequently used only in recent years, in the
context of the new diagnostic and informatic
approaches, which assure understanding of the
molecular bases of diseases, mainly genomic
medicine, a situation offerring a distinct databasis
for patients’ classification.
Predictive medicine is a domain involving
prognosis of the probability of one’s falling ill
and of the measures to be taken for completely
preventing the disease or for considerably
diminishing its impact upon the patient (such as
death prevention or reducing of morbidity).
Different prevention modalities do exist -
genomics, proteomics and cytomics, however an
efficient strategy for anticipating future maladies
should be based on genetics. Even if proteomics
and cytomics permit an early detection of the
disease, they refer mainly to biological markers,
whose presence is due to the fact that the
physiopathological process of the malady had
already started.
Large-scale genetic testing (e.g., by the
utilization of ADN matrices or by sequencing of
the complete genome) permits to estimate the
years of risk malady occurrence decades prior to
the manifestation of any disease, or even
identification of the situation in which a healthy
foetus evidences a higher risk for a disease to be
manifested during adolescence or at maturity.
The persons more susceptible to future maladies
may receive advice on their life style and drugs
capable of preventing the diseases announced by
such techniques [5].
All these open the way to anticipative
medicine and also to the development of some
other aspects referring to psychological
counselling, genetic advices or bioethical
considerations.
The actual orientations on genetic tests,
supported by the specialists of health domains,
discourage the purely predictive genetic testing
of minors, untill they come to understand the
relevance of genetic examination, which would
permit to establish the extent of adequation of a
decision about their own person. Genetic
examination of the newly-born ones and of
children in relation with predictive/anticipative
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HPV INFECTION AND ITS ROLE IN CARCINOGENESIS
medicine is viewed as motivated only by the
manifestation of a clinically convincing reason,
such as prevention or treatment of subsequent
maladies [6].
Participation of patients, alongwith the
physician, to the medical decisional process is
especially important. From this point of view, a
special education is necessary, for both patient
and health supplier, who is expected to
adequately explain to the patients the possible
treatments and alternatives, for an optimum
choice of a treatment scheme best suited to their
personal, family, cultural convictions.
Participative medicine, as well as patient-
centered care appear as synonyms expressing
patients participation to the medical decisional
act. A few requirements should be here observed.
Such a type of coparticipation should be
anticipated, the patient should have full trust in
the physician, so that his advice, followed by a
common decision, will be associated to the idea
of competence and empathy. The medical staff
should fully understand the situation of the
patient, offerring him/her all the time he/she
needs and giving him/her realistic hopes, with
optimism and warm human understanding. In
view of his participation to decision-making –
which renders participative medicine operational
– the patient should fully understand the issue
under analysis, as well as the consequences of a
possible decision. The explanations offered by
the medical representative should observe two
paedagogically essential principles, namely:
The principle of accessibility of knowledge, in
full agreement with patient’s peculiarities, both
in issues of terminology and in those related to
specific details and elements;
The principle of an active and conscious
participation to the decision-making act, namely,
of both physician and patient.
Trust in the success of the treatment, in one’s
own power of surviving critical moments
(according to the words of the famous stoic
Roman philosopher Lucius Annaeus Seneca,
who used to say that wanting to be cured is the
beginning of healing), as well in the positive
effects of the decision taken are essential.
On the other side, anticipative medicine
induced a general modification of the paradigm,
in which the previously passive patients are
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Nicolae-Tiberiu POPÂRLAN, Ioana PĂVĂLEANU
more involved in decision-taking processes. For
example, a recent meta-analysis performed on
115 studies stated that in only 50% of them
(performed prior to the year 2000) most of the
respondents preferred to participate to medical
decision-taking, while 71% of the investigations
done after 2000 evidenced that most of the
respondents perferred to actively participate to
such processes. Numerous international
organizations, such as the American Cancer
Society and the American College of Physicians,
recommend an active participation of the patients
to medical practices. In this way, participative
medicine gets combined with and adds to
anticipative medicine [7].
Nowadays, when the risks of health have
been diversified and integrated within the very
lifestyle of the contemporary people, the efforts
made for health protection are also advancing.
Medicine is more and more oriented upon
prevention, and new concepts, such as primordial
prevention and quaternary prevention – apart
from the classical structuring into primary,
secondary and tertiary prevention – provide new
evidence favoring the application of such
methods at communitary level.
As part of the universitary medical training,
these modern concepts are useful for the students
of medical faculties, who come to know that
contemporary medicine is also facing implications
of economic nature, reflected in a rapid increase
of the costs for health, especially caused by the
160
unbalanced development of therapeutical
medicine (of the ”sick one”), which became much
too expensive and hardly accessible, if considering
the main objective of the World Health
Organization, to be attained in the following
dacades – ”health for all”, viewed not only as the
absence of malady and pain, but also as a general
state of physical, mental, social, emotional and
spiritual well-being, which requires an equally
sequential and complementary approaching.
References
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New York: Cornel University Press; 2008.
2. Wickramasinghe N, Geisler E. Encyclopedia of
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3. Ivan A. Epidemiology treaty of transmissible
diseases [in Romanian]. Iaşi:Polirom Publishing
House; 2002.
4. Duceac L. Ecosocial epidemiology: modern trends
in preventive medicine. Rev Med Chir Soc Nat Iasi.
2015;119(3):809-12.
5. National Institute of Health. What is the difference
between precision medicine and personalized
medicine? What about pharmacogenomics?
Washington:U.S. National Library of Medicine
USA;2019.
6. Baranov VS. Genome paths: a way to personalized and
predictive medicine. Acta Naturae. 2009;1(3):70-80.
7. Golubnitschaja O, Kinkorova J, Costigliola V.
Predictive, Preventive and Personalised Medicine
as the hardcore of ‘Horizon 2020’: EPMA position
paper. EPMA J. 2014;5(1):6.
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