Why symptom-labelled disease categories prevent causal medicine
Modern medicine is not failing because of insufficient data, lack of dedication, or inadequate funding. It is failing because of architecture. The fundamental structural problem of medicine lies in how we divide the human body — organ by organ — and then define diseases accordingly. As described in the chapter Organ-Based Medicine , clinical departments, specialisations, and even reimbursement systems are built around organ chapters of the ICD classification.
Diseases are named:
• after organs (heart failure, kidney failure, dermatitis)
• after symptoms (shortness of breath, hearing loss)
• or after the physicians who first described them (Alzheimer’s, Crohn’s, Parkinson’s)
This was historically practical. It is now scientifically obsolete.
The Symptom Becomes the Diagnosis
When we do not understand the cause of a disease, we wait until symptoms appear. We then name the disease after that symptom. The symptom becomes the diagnosis. As you describe clearly in the early chapters, this leads to a circular logic: because the cause remains unknown, we treat only the symptom. The symptom improves — temporarily — but the underlying mechanism continues to operate silently.
This produces:
• chronic disease
• recurrence
• escalating treatment
• polypharmacy
• increasing healthcare costs
The garden-hose analogy in the text illustrates this vividly: lowering blood pressure without addressing the systemic cause is like widening the hose while ignoring a defective pump in the house. The symptom improves. The system remains broken.
Autoimmune Diseases: A Case Against Organ Labels
The autoimmune examples provide one of the strongest arguments. Over 80 autoimmune diseases are still classified by the organ in which symptoms manifest.
Yet therapeutic responses reveal mechanistic subtypes that cut across organs:
• Anti-TNF therapy benefits only certain subgroups.
• IL-23 inhibition works across Crohn’s disease, psoriasis, and ankylosing spondylitis .
• Some patients present with combinations of rheumatoid arthritis, Crohn’s disease, and psoriasis — suggesting shared pathways.
The organ label fragments what is mechanistically unified. Treatment response becomes the first real classifier. This is not precision medicine. It is post hoc correction.
Asthma ≠ Asthma
The deconstruction of asthma illustrates the same structural flaw. “Asthma” literally means shortness of breath. It is a symptom, not a cause . Editorials in The Lancet have called for abandoning asthma as a disease concept. Subdivisions such as “allergic asthma” or “exercise-induced asthma” remain descriptive. Only when measurable endotypes are introduced does mechanistic differentiation begin. The mills grind slowly in medicine, as you note .
The Real Structural Cost
Organ-based classification produces:
• siloed departments
• fragmented research funding
• misaligned clinical trials
• poor translational success
Even if all research were reproducible and statistically sound, the architectural problem would remain We are optimizing within a flawed taxonomy.
The Necessary Shift
The alternative is not incremental improvement. It is architectural redesign:
• Disease defined by mechanism, not organ.
• Subtypes identified by pathway, not symptom.
• Treatment selected by causal architecture, not clinical tradition.
The shift is conceptual before it is technological. Precision medicine does not begin with more data. It begins with redefining disease.