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ORIGINS OF THE MULTIPLE FACTORS ETIOLOGY THESIS IN ECLAMPSIA. |
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Just as it has been happening with the syndrome concept in the last ten years, the concept of a multifactorial etiology in the case of pre-eclampsia-eclampsia also has been appearing more and more often in the texts of authors concerned with its pathogenesis. But here again no references are given, as if the concept would have resulted from some sort of spontaneous creation, while it has very clear and precise origins. |
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The first time, to our knowledge, that the possibility of multiple factors involved in the etiology of the toxemic syndrome was presented took place at Basel (Switzerland) in April 25/26, 1969, during an International Symposium on Die Spatgestose. The full title of the presentation was "General and Regional Hemodynamic Factors in the Etiology of the Toxemic Syndrome" by L�pez-Llera M.M. The short article was later published in the proceedings of the Symposium by a serious publisher (Schwabe &; Co - Verlag - Basel/Stuttgart 1970 p 132-136). |
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Approximately one year later, this multiple factors thesis was briefly but clearly explained in the paragraph titled "Etiology and Pathogenesis" in the article "Some aspects of the toxemic syndrome in a sector of the Mexican population" (J.Reprod.Med. 1970:4:19-28, by L�pez-Llera M.M. and Rubio L.G.). Here, two facts must be emphasized; (1) the various factors mentioned in these two articles were not necessarily the only ones nor the correct ones, what mattered at the time was the concept of multiple causality in itself, and (2) by 1969-70 the computing sciences and technology were in their infancy and the chaos theory and the sciences of complexity were very rarely mentioned if at all, being really re-discovered around 1980. The great French mathematician, Henri Poincar�, had a brief encounter with the problems posed by these sciences at the end of the XIX and beginning of the XX Centuries but decided to leave things in peace because he was concerned for his mental sanity. Going deep into chaos and complexity at that time would have turned many things upside-down and add to the concise and predictable science of mathematics a horribly unreliable chapter. |
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After several local publications in Spanish, the concept of multiple factors involved in the etiology of pre-eclampsia-eclampsia received full treatment in the book titled "Toxemia del Embarazo. Lecciones B�sicas" in the chapter "Consideraciones Sobre la Etiopatogenia" by Lopez-Llera M.M. (Editorial LIMUSA SA de CV M�xico. 1st Ed 1981, 2nd Ed 1985 ). Between the two editions and several repeated printings something like 12,000 books were sold, naturally among Spanish speaking persons. But, the issue was again discussed and analyzed, now in the English language, so everybody could read the refreshed thesis, in the article titled "Complexity and Complicity in Eclampsia. Barriers or Bridges ?" that appeared in Med Hypoth 1995; 45: 591-601 by L�pez-Llera M.M. By 1994-95 the computing and complexity sciences were fairly well advanced and could provide firm grounds for the exploration of the multifactorial pathogenesis of complex diseases, among many other crucial matters. But, surprise, apparently nobody read this article nor its Spanish cousins !! Of course, we tried to publish it first in such important medical journals like the New Eng J Med or the Acta Obstet Gynecol Scand and others with negative responses, but at least the respective refereeing committees had to read, if not all at least parts of it, and sort of spread the news of an unusual (?) hypothesis. Also, a couple of years before this latter crucial article the subject of multiple etiological factors was clearly mentioned and defended while reporting 24 cases of recurrent eclampsia ("Recurrent eclampsia. Clinical data morbidity and pathogenic considerations". Europ J Obstet Gynecol Reprod Biol 1993; 50: 39-45, by L�pez-Llera M.M.). |
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At the beginning of the story, while participating in various medical meetings and talking during coffee breaks about this multiple factors thesis, many colleagues would express themselves in a rather derogatory tone commenting that to say that the etiology was multifactorial was the same thing as saying that it was unknown, that there was no real progress in such proposition. Such posture misses the main point entirely. To accept the possibility of multiple factors needs a radical conceptual change from the typical reductionist approach, that so far has met with repeated failure, to the new and not fully developed methods, techniques and resources of the sciences of complexity. It is to abandon an old and overused trail for a new and not yet fully known road with multiple connections, divisions and of course many surprises., pleasant and unpleasant. |
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These are the facts, printed and published, some in English, some in Spanish, as I know them. One may agree or disagree with their contents and implications, but their chronological existence in the medical literature cannot be ignored I acknowledge the fact two or more deeply concerned authors working independently of each other for the necessary length of time with similar resources and clinical material will eventually reach similar conclusions about a given problem without having to copy one another, but the timings of the events must be respected above all and credit placed where it belongs. |
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Dr. Mario Lopez-Llera M. |
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Eclampsia Data Center |
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May 2002. Mexico D.F. |
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Note.- After waiting for quite some time, finally a serious journal approaches the issue of complexity in health and disease in a rather short section (see; Science. 2002;296:685-703. The puzzle of complex diseases), but no mention of pre-eclampsia-eclampsia can be detected. (go to News Alert). |
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