Moving from a reductive anatomico-pathological medicine to an authentically anthropocentric model of healthcare: current transitions in epidemiology and epistemology and the ongoing development of person-centered clinical practice

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Andrew Miles


Two major processes of transition are currently occurring within international healthcare which present us with serious challenges but also, to be sure, with considerable opportunities. The first is the epidemiological transition from acute to chronic disease, where 63% of the 57 million global deaths in 2008 were due to chronic illness (principally cardiovascular and chronic respiratory diseases,  diabetes and the cancers), a percentage which, as we enter 2013, is probabilistically now significantly higher, since the trends in incidence and prevalence have remained upward.  The second process of transition is the epistemological transition from medicine’s reductive reliance on purely objective sources of evidence for clinical decision-making to its willingness, even enthusiasm, to embrace the largely subjective sources of evidence represented by so-called ‘patient factors’. The former type of knowledge has been consistently emphasised by the evidence-based medicine (EBM) movement as constituting the basis of medicine and the latter form of knowledge by the patient-centered care (PCC) movement as remaining central to the provision of effective and acceptable care.

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Author Biography

Andrew Miles, WHO Centre for Public Health Education and Training, Imperial College, London

Editor-in-Chief, International Journal of Person Centered Medicine & Professor of Clinical Epidemiology and Social Medicine, Medical School, University of Buckingham, UK Professor Miles, MSc, MPhil, PhD is a senior public health scientist. He previously held professorships and senior fellowships at King’s College University of London, Queen Mary College University of London, the University of East London, the University of Westminster, the University of Surrey and the University of Wales.He is Editor-in-Chief and Chairman of the International Advisory Board of the Journal of Evaluation in Clinical Practice, a leading and highly ranked international periodical for public health policy and health services research published by Wiley Blackwell Ltd with high impact factor and citation rate and extensive world circulation.Professor Miles is National Director and Editor-in-Chief of the UK Key Advances in Clinical Practice Series, a major collaboration between medical Royal Colleges and UK specialist clinical societies in a multi-disciplinary contribution to the evaluation and development of clinical practice in the UK, resulting in the organisation of some 22 annually recurring national conferences and some 22 annually updated, extensively referenced clinical texts which serve to document current scientific evidence and expert clinical opinion for the investigation and management of common diseases, the results of which are widely disseminated across the medical community of the UK. The Series entered its 13th successful annual cycle in January 2010.He is Director and Editor-in-Chief of the UK Masterclasses in Effective Clinical Practice Series in collaboration with the medical Royal Colleges and specialist clinical societies which examines how ‘general research evidence’ derived from the clinical literature is successfully applied to the care of difficult individual patients as part of the development of UK knowledge-based clinical practice.Professor Miles is an accomplished teacher at both undergraduate and postgraduate levels in public health and social medicine, and experienced in Master’s level course development and validation, and in university committee work and higher degree supervision at Master’s degree and PhD levels.He has published extensively in his field: over 50 edited textbooks in public health sciences and health services research, together with substantial numbers of original articles in leading peer-reviewed international clinical journals. He has contributed extensively to the international evidence-based medicine debate and to the development of thinking on the nature of knowledge for clinical practice. He has provided the intellectual leadership and organisational skills for 89 national clinical conferences and 26 national clinical masterclasses from 1998 to date. He regularly lectures at national and international conferences, and has made a substantial contribution to British medical education and clinical scholarship.


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