Staging and stratification are two diagnostic approaches that have introduced a more dynamic outlook on the development of diseases, thus participating in blurring the line between the normal and the pathological. First, diagnostic staging, aiming to capture how diseases evolve in time and/or space through identifiable and gradually more severe stages, may be said to lean on an underlying assumption of “temporal determinism”. Stratification, on the other hand, allows for the identification of various prognostic or predictive subgroups based on specific (...) markers, relying on a more “mechanistic” or “statistical” form of determinism. There are two medical fields in which these developments have played a significant role and have given rise to sometimes profound nosological transformations: oncology and psychiatry. Drawing on examples from these two fields, this paper aims to provide much needed conceptual clarifications on both staging and stratification in order to outline how several epistemological and ethical issues may, in turn, arise. We argue that diagnostic staging ought to be detached from the assumption of temporal determinism, though it should still play an essential role in adapting interventions to stage. In doing so, it would help counterbalance stratification’s own epistemological and ethical shortcomings. In this sense, the reflections and propositions developed in psychiatry can offer invaluable insights regarding how adopting a more transdiagnostic and cross-cutting perspective on temporality and disease dynamics may help combine both staging and stratification in clinical practice. (shrink)

Les 25 et 26 mars 2021, en pleine pandémie de Covid-19, ont eu lieu deux journées d’études organisées par Sorbonne Université sur la thématique des patients experts, des patients partenaires et de leur intégration dans divers dispositifs de participation en santé. Elles ont réuni des chercheurs canadiens et européens autour du développement de la démocratie en santé, dont les principaux modèles sont issus de ces deux régions. Cette nouvelle forme de gouvernance de la santé invite à la collaboration entre les (...) acteurs classiques politiques et médicaux du champ de la santé et des individus de la société civile organisés ou non en associations. Il s'agit là d'un sujet devenu central dans les domaines de la médecine et des humanités biomédicales, et que le contexte de la pandémie de Covid-19 n'a rendu que plus saillant. (shrink)