Abstract:We argue that 'multimorbidity' is the manifestation of interconnected physiological network processes within an individual in his or her socio-cultural environment. Networks include genomic, metabolomic, proteomic, neuroendocrine, immune and mitochondrial bioenergetic elements, as well as social, environmental and health care networks. Stress systems and other physiological mechanisms create feedback loops that integrate and regulate internal networks within the individual. Minor (e.g. daily hassles) and major… Show more
“…The strong underlying biological network connections between certain sets of pathologiesparticularly those relating to systemic inflammatory status that underpin multiple chronic disease conditions -may mean we move away from attempts to find correspondence between individual exposures and outcomes, and towards using biological networks to link and explain complex exposure patterns with (multi)morbidities defined by detailed molecular phenotyping (86,148).…”
Section: Exposome and Adverse Outcome Pathways: Inflammation And Ros mentioning
Running title: Biomarkers of oxidative stress and inflammation Note: All authors contributed equally. Contributors to each section: first section on biomarkers and the conclusions, PG and LF; nanomaterials, DB; NRF2, AC and GM; noise, SL; brain-body interactions, FDA, AH and PG; exposome, TA and LS. PG edited and coordinated the text.
“…The strong underlying biological network connections between certain sets of pathologiesparticularly those relating to systemic inflammatory status that underpin multiple chronic disease conditions -may mean we move away from attempts to find correspondence between individual exposures and outcomes, and towards using biological networks to link and explain complex exposure patterns with (multi)morbidities defined by detailed molecular phenotyping (86,148).…”
Section: Exposome and Adverse Outcome Pathways: Inflammation And Ros mentioning
Running title: Biomarkers of oxidative stress and inflammation Note: All authors contributed equally. Contributors to each section: first section on biomarkers and the conclusions, PG and LF; nanomaterials, DB; NRF2, AC and GM; noise, SL; brain-body interactions, FDA, AH and PG; exposome, TA and LS. PG edited and coordinated the text.
“…Sturmberg et al describe the patient in the clinical case as a ‘fairly typical person with multimorbidity’ [, p. 2]. From their biomedical P4 model, the patient is typical in that common pathophysiological mechanisms underlay the patient's multimorbidity.…”
Section: Resultsmentioning
confidence: 99%
“…In a manner similar to Hood et al , Sturmberg et al also define P4 medicine in biomedical terms as “the capacity to predict disease development and influence decisions about lifestyle choices or to tailor medical practice to an individual”. It is a highly biomedical concept aimed at (a) diagnosing a disease (and possibly the subtype) in an individual; (b) assessing an individual's risk of disease; (c) identifying whether an individual will benefit from particular interventions; and/or (d) tailoring dosing regimens to individual variations in metabolic response [, p. 13].…”
Section: P4 Medicinementioning
confidence: 99%
“…He had cataract surgery at age 63 years and hip‐replacement surgery at age 73 years. According to Sturmberg et al , many of these morbidities are connected through common pathophysiological mechanisms. For example, the patient's elevated levels of glucose – often associated with diabetes – can accelerate mitochondrial damage and result in homeokinetic instability within the various systems of the body.…”
Rationale, aims and objectives Multimorbidity is a serious challenge to providing patients with quality health care. Sturmberg et al. propose a P4 or whole-person medical model based on a holistic approach to deliver such care. The aim of this commentary is to examine critically their P4 model and holistic approach. Methods The P4 model and holistic approach of Sturmberg et al. are analysed conceptually in terms of an effective strategy or sequence for framing P4 medicine and with respect to different philosophical notions of holism for grounding it. Results Instead of a P4 medicine strategy or sequence that emphasizes the predictive and preventive aspects of health care from a biomedical perspective, as Sturmberg et al. do, a more effective strategy or sequence for framing P4 medicine to deliver quality health care is to accentuate the personalized and participatory aspects from a humanistic perspective. The basis of this proposed strategy for P4 medicine is not a technoscientific holism that emphasizes mechanisms to define the whole utilizing bottom-up causation, as Sturmberg et al. ground their biomedical P4 model, but rather a phenomenological holism that also incorporates the person's illness experience and top-down causation. Conclusions The proposal of Sturmberg et al. to treat patient multimorbidity through P4 medicine and a holistic approach is certainly a move in the right direction. However, to achieve their goal requires an alternative strategy for P4 medicine and a more robust notion of holism.
“…But health systems are failing. We need a different mindset or paradigm—a shift from alleviation and management of disease to health and wellbeing; an acceptance of the biological inevitability of disease emergence over a lifetime; and an appreciation that experiencing good health is unrelated to morbidity 6. Good health is the strongest predictor of service use and future mortality 78…”
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