title: [Theory and practice of medicine: levels of knowledge and clinical medicine as a cultural institution].
abstract: The author discusses the contents of his book "The inside of medicine" which appeared at the end of 1990 (it is written in dutch). The book aims to acquire a view how the metamorphosis of theory and practice of medicine as to size and diversity in the past fifty years came about. Also health care developed into a social right, and became a cultural institution. The book is not meant as a history of medicine of that period, but rather as a history of ideas illustrated with examples. The author feels qualified to do so, because he was actively involved with research during those years. Before World War II his activities were during ten years limited to laboratory research (biomedical) in the Netherlands, U.S.A. and finally at the Pasteur Institute in Paris. Residencies in internal medicine followed and qualification for this specialty. From 1948-1983 he held a chair at Leiden University in Internal medicine and concentrated his research on endocrinology and metabolic diseases (patient centered research). He was Founding Dean of the Rotterdam Medical Faculty for 5 years. Since the beginning of the 20th century it is accepted that illness in general is multifactorially determined. However research about illness is still dominated by the Newtonian unidirectional paradigm of cause to effect, which leads to mechanistic thinking. Obtained data are followed further by the same method, through different levels of knowledge from symptom to morphology and to pathophysiology, and finally to the molecular level. Undoubtedly much has been achieved. The integrated approach, reflecting reality, often characterized by the term of the bio-psycho-social view, was hardly used. It is frequently suspected that advances are disappointing in diseases like atherosclerosis, or the deviating course of disease and recovery in advanced age etc. because of that reason. Molecular biology is at a too early stage of development that reasoning upwards to the "lived human body" is possible. The author feels that there are signs of changing the approach and paradigm at present. Some examples will be discussed.
authors.affiliation: Rijksuniversiteit Leiden.
authors.forename: A
authors.initials: A
authors.lastname: Querido
mesh_terms: D003469:Culture; D006694:Holistic Health; D006801:Humans; D010686:Philosophy, Medical; D013672:Technology
vernacular_title: Theorie en praktijk der geneeskunde: niveaus van kennis en praktische geneeskunde als culturele institutie.