In the traditional period (1750-1880), medicine focused on illness: people who felt sick sought help from doctors who relied exclusively on the history and physical exam to make diagnoses. The birth of modern pathology - with the invention of the microscope and bacteriology - allowed doctors to actually visualise abnormalities and pathology. This visualisation created a new paradigm for understanding disease: the abnormalities and pathology (disease) detected account for the symptoms (illness). The focus of medicine became detecting disease.
The shift from illness to disease has had a profound impact on modern medicine – particularly in the realm of cancer screening. In screening, it is not patients with illness who seek help from the healthcare system; it is asymptomatic healthy individuals who are invited into the healthcare system to be examined for pathology. The underlying assumption of screening is that abnormalities and pathology always progress to the point of serious troubling symptoms, disability, or death. If this were true it would always make sense to look for disease even when people feel well.
The present workshop will explore if the fundamental assumption that disease invariably leads to illness is valid and if not, what happens to screening test accuracy.