Throughout the twentieth century diseases were defined by their clinical expression, "Hypertension, Alzheimer's Dementia, Parkinson's Disease." However, entering the twenty-first century began earlier diagnosis of these entities, in preclinical stage. So is necessary to redefine the concept of disease?
In my opinion, for both infectious and non-infectious diseases, if you're not showing clinical signs, then you do not yet have the disease. For infectious diseases, you may still be infected however. Asymptomatic yet infected individuals are different than uninfected individuals, and still different from symptomatic and infected individuals. Changing the definition of "disease" to include those not showing signs would only muddy the waters more than they are already.
Infectious disease: condition of reduced host fitness caused by a pathogen or parasite
Non-infectious disease: condition of reduced fitness that is not caused by a pathogen or parasite, or caused by some other organism (like a predator, or [secondary compounds produced by] a plant.)
The key to these concepts is the "reduced fitness". Currently, however, some diseases can be diagnosed and treated very early, before the decline of the individual functions.
Such is the case of some infectious, metabolic or hereditary diseases. In these cases we are not talking about diseases in the classical sense, but insults or damage that can eventually cause dysfunction.
Furthermore, some noxas can have a synergistic effect beyond their independent impact. For example, the presence of ApoE4 in patients with Parkinson's disease which increases the risk of dementia. These people dont have two diseases (Alzheimer + Parkinson) but undergo two simultaneous insults.
Finally, aging produces a remarkable "reduced fitness". So it should be considered a disease?
For these reasons I consider that the concept of disease should be redefined and that the goal of medicine should start to move from the classical concept of disease to the detection and treatment of insults or susceptibilities in healthy populations.
AD, PD, Hypertension, Inflamation... ect, are not diseases, only symptoms or syndromas. Disease must have the cuse, the ETIOLOGY! The mean of word Diagnosis is not only phenomenology, Than ETIOPATOGENESIS, too.
I completely agree with you. Could you help us redefine the concept of "disease"?
Diseases are alterations in body structure and body function with known etiology (etiopatogenesis).
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