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"Priority to the prevention and removal of environmental exposures". From BMJ the call for a new view of medicine



Italian Society of Environmental Medicine: "Observations tell us that a true epidemiological transition is taking place that must be considered as a whole, paying particular attention to the increases recorded over the decades from congenital malformations and disorders of neurodevelopment. autism, even pediatric cancers. "

NOV 12 – Pediatricians, epidemiologists and renowned scientists are the authors of the international appeal published last November 7 in the pages of the "British Medical Journal" directed at doctors and scientists from around the world to reverse the course towards primary prevention: stop "counting" patients "and providing decision-makers in real time with useful evidence and pointers to take action without delay to protect public health, even before disease develops.

"From the epidemiological observations, it is necessary to initiate a change of pace to a new view of medicine," explains the first author of the article, Piscitelli Prisco, medical epidemiologist at the Euro-Mediterranean Biomedical Scientific Institute (ISBEM) and vice-president of the Italian Society of Environmental Medicine (SIMA). Observations tell us that a true epidemiological transition is underway that must be considered as a whole, paying particular attention to increases seen over decades, from congenital malformations and neurodevelopmental disorders such as autism to pediatric cancers or of young adults, metabolic diseases – including juvenile diabetes -, thyroid and neurodegenerative, once very rare, such as Alzheimer's, ALS and Parkinson's disease. "

"If we look at the number of all these pathologies as a whole and the increases recorded for each of them over the past fifty years, it is not possible to minimize the problem for a matter of difference or congruence between observed and expected cases," continued Prisco Piscitelli . "In particular, it is unacceptable to any society that pediatric cancer, with about 320 deaths a year, according to ISTAT / EUROSTAT data (around 6,000 from 2000 to date), has become the leading cause of death from disease. among children in Italy and many other European countries, with estimated hospitalization and treatment costs of between € 30 and 50 million per year for our own country alone (and incalculable human costs). 0-19 years of age were not observed 50 years ago, although we have a much larger pediatric population. We need a medicine to help us change course, to change our view, a medicine that can change the world, like we wrote in the appeal of the BMJ ". As doctors and men or women of science, we should not and cannot be afraid to question established models if the observations do not correspond to the proposed explanations. Science does not proceed by dogma, just as epidemiology cannot be reduced to a useless accounting exercise without feeling the urgency of indicating here and now all possible solutions for decision makers. "

Teacher has no doubt Alessandro Miani, President of SIMA and co-author of the article: "Environmental exposures through epigenetic mechanisms are the lowest common denominator of all health problems that, since the postwar period, have reached real pandemic proportions. continuous and generic lifestyle and smoking patterns, as well as theories of progressive accumulation of mutations and DNA damage throughout life, cannot explain, for example, why tumors in the first year of life are at risk. It is evident that focusing solely on individual risk factors distances us from finding the right collective health solutions that can be found in the specific health determinants that can affect each local community, starting with so we breathe, eat, drink or drink.

12 November 2019
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