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September 2017

Skin and Vascular Disease—Inside-Out/Outside-In

Author Affiliations
  • 1Cardiovascular Medicine Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
JAMA Cardiol. 2017;2(9):944-945. doi:10.1001/jamacardio.2017.1420

Partitioning clinical syndromes into their discrete constituent entities is the essence of making a diagnosis. As medicine has evolved, incentives have created more specialized physicians who are consequently less capable of crossing the artificial boundaries that define their experience. Disease pathophysiology knows no such bounds. Biological pathways are used in multiple ways at multiple stages of life or in response to multiple perturbations. Nevertheless, in clinical medicine we often insist on using narrow conceptual frameworks for biology—usually on the basis of earlier phenomenology. For example, in cardiovascular practice the transformation of troponin from a simple biomarker to a virtual diagnosis is partially a consequence of the widely held belief that “cardiac” troponins can only be expressed in cardiomyocytes.1 Similarly, many molecules required for recruiting leukocytes in response to tissue debris or external insults are also critically important in physiologic cellular migration in numerous other processes, yet their involvement is often subsumed in the generic term inflammatory. Modern molecular medicine brings a need to move beyond these artificial silos.

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