In the last few days, an intense debate has been generated in the medical field due to the Health Reform Bill, specifically in its article 123, which established the obligation of physicians to guarantee the cure of patients.

This proposal aroused controversy because although the article was modified, it ratified a panorama of ignorance on the subject on the part of decision-makers and patients. This allows us to reflect on the fundamental question: Can medicine cure everything?

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To begin with, it is important to recognize that medicine has advanced significantly throughout history, achieving notable advances in the prevention, diagnosis, treatment, palliation and rehabilitation of various diseases.

However, it is essential to clarify that this and other health professions are focused on the means and not on guaranteed results, i.e., those who practice must do everything possible to achieve the best outcome in the treatment of their patients’ disease, but this does not mean that they can ensure the cure of all diseases, partly because most cannot be cured.

Despite scientific and technological advances, there are currently inherent limitations to disease and the human body that can be understood from the Natural History of Disease (NHD). The NHD establishes the process or course of all diseases, which can be days or years.

This process begins with a period called pre-pathogenic, in which people are at risk of acquiring the disease, but do not yet have it.

Once the disease is acquired, four pathogenic periods follow, ranging from small changes without any symptomatology (subclinical pathogenic), the presence of initial symptoms (prodromal), the clear and evident presentation of the disease (clinical) and the consequences of the disease as the last period (resolution).

In this sense, the final period of a disease can range from cure (complete disappearance of the disease without traces or consequences), to chronification, generation of sequelae, disability, incapacity or even death.

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In this regard, it should be clarified that there are very few diseases that current medicine can cure – with the exception of some infectious conditions and nutritional disorders – since in our country, most patients suffer from chronic diseases (those that, once diagnosed, remain for life and whose treatment is focused on the control and prevention of complications, as occurs with arterial hypertension or diabetes mellitus), and even conditions that apparently can be resolved in an operating room, but that can leave sequelae.

Given the lack of knowledge about HNE on the part of health professionals and the population in general, it is necessary to improve the elements of health education and health education at the following levels: primary prevention, focused on intervening in the risk factors that cause disease; secondary prevention, aimed at early diagnosis and timely treatment of diseases; and tertiary prevention, aimed at rehabilitating or returning patients to their environments with the best quality of life.

In this sense, and with regard to the unrealistic article that proposed to guarantee the cure of patients, although fortunately it was modified, it left aside the adequate socialization of the reasons that made it unfeasible, because only when society reevaluates the expectations towards medicine and health professionals, it becomes possible to recognize cure as a desired goal and to value preventive medicine, comprehensive care, quality of life, chronic disease management and palliative care with adequate expectations.

Column References:

• Congress of Colombia. Law 1164. 2007
• Hernández E. Atención primaria y determinantes sociales en salud en la formación de recursos humanos en Colombia para el mejoramiento de la salud de la población [Doctoral thesis]. Alicante: Miguel Hernández University, 2017.

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