“We are living through a period of dizzying transformation”

Medical advances are cause for optimism, says doctor Jean-Pierre Thierry. But this excitement must be accompanied by public health reform, at the risk of creating more social tensions. And give its full place to prevention.

This article comes from the magazine Les Dossiers de Sciences et Avenir n°220 dated January/March 2025.

A doctor specializing in public health and health IT, Jean-Pierre Thierry is an expert in the evaluation of medical technologies and the organization of healthcare systems. He served on the Transparency Commission of the High Authority for Health (HAS), a body responsible for evaluating new drugs. He is currently medical advisor to France Assos Santé, an organization representing and defending patients and users of the health system.

Les Dossiers de Sciences et Avenir: Where is the border between good health and illness today?

Jean-Pierre Thierry: The question is interesting, because in fifty years we have experienced an almost Copernican revolution, and which is far from over! Scientific medicine now makes it possible to effectively treat many formerly fatal diseases, transforming them into chronic pathologies. Even more surprising, today we consider certain risk factors as diseases in themselves.

Let's take an example: if you are a man over 60 with mild hypertension, you have only been considered a patient since 1992. Before that date, your condition was simply… normal. Another illustration: at the age of 70, a slightly elevated level of creatinine (a substance naturally present in the blood, which provides information on the functioning of the kidneys) now classifies you in the “chronic kidney disease” category, without necessarily signifying potential kidney failure. severe.

When we test parameters such as blood sugar, blood pressure, cholesterol, etc. in people who are well, we change the perception of who is sick and who is not. From an epidemiological point of view, these are only risk factors. But we talk about them as if they were bodily illnesses. This could be justified from a public health point of view.[…]

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