The basic importance of the physiological approach in clinical medicine: the experience in the area of hypertension.

Abstract

Since Claude Bernard the physiological approach has dramatically contributed to the unprecedented progress that clinical medicine has seen during the second half of the 19th and throughout the 20th century. If I go back to about fifty years ago, when I started as a medical student and investigator under the guidance of Giuseppe Moruzzi and Cesare Bartorelli our understanding of arterial hypertension was very small and our therapeutic abilities close to nothing, but progressive knowledge of the physiology of the sympathetic nervous system, of the kidney, of the renin-angiotensin system, etc, led to a progressive understanding of the mechanisms of elevated blood pressure and to the development of an array of effective blood pressure lowering drugs, thanks to which hypertension is now a controllable disease. The supremacy of the physiological approach to clinical medicine has been recently endangered by the rising of two new approaches, whose worshippers consider the ultimate ones promising solid conclusions and unforeseen progress. These are the large randomized therapeutics trials, that are often arrogantly defined as evidence-based medicine (as if they were to provide the only real "evidence") and molecular and genetic medicine. Needless to say, both are important new tools in medicine, but neither can make the physiological method obsolete. The risk of the pretended superiority of the new approaches (and the new fashions) is that these claims are unbalancing research activity and its financial support, thus weakening the very basis upon which these new methodologies are founded and have developed.