Yes.
Webster defines a disease as “a
particular destructive process
in an organism” and a medical
dictionary defines a disease
as “any deviation from, or interruption
of, the normal structure or
function of any body part, organ,
or system that is manifested
by a characteristic set of symptoms
and signs and whose etiology,
pathology, and prognosis may
be known or unknown.” With
this definition of the word,
peripheral neuropathy is a disease.
Conversely, it is understood that in the medical field of research and the clinical approach to the patient, neuropathy is NOT seen as a single disease, but a clinical entity.
Dr. Bruce Carruthers, MD, CM, FRCP (C) notes the clinical approach important to research in his article - “The Importance of Clinical Definitions for Defining and Studying Syndromes”. “A syndrome involves determining the symptoms and how they interact, and how a cluster of symptoms interacts as a group. This establishment of this interaction is essential in clinical practice (and in research).”
Yet in the real world of the neuropathy patient where the public understands a disease, but not a clinical entity, funding for neuropathy research is difficult, as the view persists that neuropathy is JUST a symptom of another disease so funding is too often dedicated to these diseases. Consequently if the patient does not have one of “those” diseases, too often in the clinic the conclusion is that the patient could not possibility have neuropathy!
If medicine fails to identify or recognize the disease or causes of neuropathy which have only advanced recently beyond the well known causes such as diabetes, aids, alcoholism or possibility a virus or a flu shot with a live virus, this approach leads to misdiagnosis, failure to diagnose and treatment of neuropathy patients before damage is done. This failure occurs when the definitions of a clinical entity are not updated as research improves or is not done at all, blocking clinical progress when retained too long, as noted by Dr. Carruthers. “Thus critical and definitive dynamic features of the actual clinical syndromes, as lived by patients, have been ignored in these research definitions and even if mentioned have been downplayed.”
As long as peripheral neuropathy is publically viewed as JUST a symptom of another disease process, given the value to research and the clinical approach of seeing Peripheral Neuropathy as a clinical entity, we will struggle in our attempt to fund neuropathy research, struggle in our attempt to eliminate the word “idiopathic” from the vocabulary of the neuropathy patient and struggle in attempts to discover better tools for diagnosis of the disease of Peripheral Neuropathy as in affecting a major component of the human body.
I wish I knew the answer to this dilemma between what research and the clinical approach must consider and the real world of diagnosis for the neuropathy patient. Too many in and out of the medical system have poor preconceived attitudes toward neuropathy. This may in part be due to the lack of clinical training and the refusal to call peripheral neuropathy a disease in the sense of the standard definition of that word. The idea that it is JUST a symptom of some other disease, feeds this poor attitude and the temptation to not take the disease seriously when the known causes are NOT present in the patient when they present to the clinic for help.
These unhelpful attitudes toward neuropathy often delay funding of needed research, prevent Medicare payments for neuropathy testing, limit clinical training in medical schools, preventing better thinking about this disease. Informed neurologists admit that they spend very little time on understanding the clinical approaches to patients with peripheral neuropathy. Outdated approaches to neuropathy may help in sorting out causes and treatments, yet it limits thinking. Consequently we are left with poor attitudes toward neuropathy and the failure to fully understand its impact as a major disease affecting millions of people of ALL ages.
Conversely, it is understood that in the medical field of research and the clinical approach to the patient, neuropathy is NOT seen as a single disease, but a clinical entity.
Dr. Bruce Carruthers, MD, CM, FRCP (C) notes the clinical approach important to research in his article - “The Importance of Clinical Definitions for Defining and Studying Syndromes”. “A syndrome involves determining the symptoms and how they interact, and how a cluster of symptoms interacts as a group. This establishment of this interaction is essential in clinical practice (and in research).”
Yet in the real world of the neuropathy patient where the public understands a disease, but not a clinical entity, funding for neuropathy research is difficult, as the view persists that neuropathy is JUST a symptom of another disease so funding is too often dedicated to these diseases. Consequently if the patient does not have one of “those” diseases, too often in the clinic the conclusion is that the patient could not possibility have neuropathy!
If medicine fails to identify or recognize the disease or causes of neuropathy which have only advanced recently beyond the well known causes such as diabetes, aids, alcoholism or possibility a virus or a flu shot with a live virus, this approach leads to misdiagnosis, failure to diagnose and treatment of neuropathy patients before damage is done. This failure occurs when the definitions of a clinical entity are not updated as research improves or is not done at all, blocking clinical progress when retained too long, as noted by Dr. Carruthers. “Thus critical and definitive dynamic features of the actual clinical syndromes, as lived by patients, have been ignored in these research definitions and even if mentioned have been downplayed.”
As long as peripheral neuropathy is publically viewed as JUST a symptom of another disease process, given the value to research and the clinical approach of seeing Peripheral Neuropathy as a clinical entity, we will struggle in our attempt to fund neuropathy research, struggle in our attempt to eliminate the word “idiopathic” from the vocabulary of the neuropathy patient and struggle in attempts to discover better tools for diagnosis of the disease of Peripheral Neuropathy as in affecting a major component of the human body.
I wish I knew the answer to this dilemma between what research and the clinical approach must consider and the real world of diagnosis for the neuropathy patient. Too many in and out of the medical system have poor preconceived attitudes toward neuropathy. This may in part be due to the lack of clinical training and the refusal to call peripheral neuropathy a disease in the sense of the standard definition of that word. The idea that it is JUST a symptom of some other disease, feeds this poor attitude and the temptation to not take the disease seriously when the known causes are NOT present in the patient when they present to the clinic for help.
These unhelpful attitudes toward neuropathy often delay funding of needed research, prevent Medicare payments for neuropathy testing, limit clinical training in medical schools, preventing better thinking about this disease. Informed neurologists admit that they spend very little time on understanding the clinical approaches to patients with peripheral neuropathy. Outdated approaches to neuropathy may help in sorting out causes and treatments, yet it limits thinking. Consequently we are left with poor attitudes toward neuropathy and the failure to fully understand its impact as a major disease affecting millions of people of ALL ages.
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