The road to Rome
W GRANT THOMPSON Emeritus Professor of Medicine
University of Ottawa, Ottawa, Canada
Correspondence to: W Grant Thompson, MD, 7 Nesbitt Street, Nepean, Ontario K2H 8C4, Canada.
| The first 150 words of the full text of this article appear below. |
Medical diagnosis generally requires observed anatomical or
physiological abnormalities. Description of the illness and criteria for its diagnosis follow naturally. Recognized symptoms can then be
attributed to the observation, and a diagnosis predictably follows. In
the case of the functional disorders, such a process is impossible. As
there are no observed defects, we only know of the existence of these
disorders through the words of our patients. Hence there can be no
animal model. Parrots may talk, but are not likely to discuss their
bowels. The need to define these disorders of unknown pathology
represents a major paradigm shift, a substantial change in thinking for
doctors whose training concentrates on basic science and palpable
evidence. As more than half of the gut disorders encountered by
gastroenterologists and primary care doctors are functional, we must
face the reality that scientific evidence to explain these disorders
does not exist, and develop alternative
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