The focus of medical practice is the lesion. It’s the lesion, the abnormal cells, tissue, organ or body system which IS the disease. This is the pathological approach to health. It gives pre-eminence to physical, “organic” abnormalities, names them (diagnosis) and then seeks to directly address those abnormalities with treatments. The treatments are primarily surgery to physically remove the lesions, and chemicals (drugs) to act against the lesions (or, in the case of infections, to act against the infecting organisms).
This approach works well for most acute disease and for clearly identifiable lesional problems. In fact, the more localised the problem, the greater the success of this way of working. However, there are at least two major difficulties. Firstly, the more complex a disorder, the harder it is to identify a “lesion” which is the sole cause of the patient’s illness. Secondly, there’s the difference between objective findings and subjective experience. Studies of symptoms have shown clearly that there is no direct linear relationship between lesions and symptoms. Not everyone with the “same” lesion (same diagnosis at same stage of disease) has the same symptoms or the same symptom severity. And, a person can have debilitating or incapacitating symptoms without lesions.
Here’s a study which highlights the other side of this coin – people can have lesions without symptoms. In this study, people with abnormalities in their MRI scans typical of Multiple Sclerosis but without any symptoms of MS – in other words where the findings were by chance while investigating some other problem – were followed up. 30% of them had developed symptoms of MS within about 5 years, but another 30% showed more lesions on the scan within 5 years but still no symptoms of MS. The researchers ask the question – does someone have MS if they have MRI-revealed lesions but no symptoms whatsoever? They argue a definite NO.
“Diagnosing a patient with MS has serious psychosocial and treatment implications, and physicians have an obligation to follow appropriate criteria in making the diagnosis,” Bourdette said. “Patients must have symptoms to receive a diagnosis. This study sets the stage for establishing a process for evaluating these patients and following them to help determine the risk of developing MS. Until then, we should not tell them that they have MS or treat them with disease-modifying therapies. For now, it’s best to remember the wise advice that we ‘treat the patient, not the MRI scan.'”
Read that conclusion carefully. They are arguing that we should address people not lesions. If we fully take that on board, there are significant consequences for the way we provide health care.
Heroes Not Zombies 
This brings up the old nut related in part to your essay on what is health or a healthy person.
Is health primary and sickness secondary?
If it is primary then a sick person has moved from a state of health to a state of sickness and usually at some point will manifest lesions. Of course it may be easy to remove lesions, but what most people worry about is, could or is this going to occur again…..and why shouldn’t it?
The reason for this anxiety should be because the reason for the person’s state of health moving to a state of sickness has not been addressed. Until this reason is addressed it will remain and at some point in time manifest itself again as a lesion, either in the same location or in some other location, classically called metastasis/es.
Is there any way of addressing this circumstance or do we have to just remove the manifestation and hope that we suffer a re-manifestation in many years time, not immediately, but with this time bomb hanging over us, and prodded any time we discover a new symptom?
Gosh… this is a really tough idea. Considering however that many of the drugs make you feel far sicker than the original “lesion” and do substantial damage over time, one has to wonder how to weigh treatment choices.