Is Medicine Devolving Back to Its Primitive Beginnings?

By Wayne Persky

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Despite all the elaborate rituals, Latin terminology, and authoritative pronouncements, early medicine is probably best described as fundamentally primitive — operating without understanding of basic biological processes, disease mechanisms, or scientific method. The sophistication was all surface-level theatrical display masking profound ignorance about how the human body actually works. It's a sobering description because it forces us to confront how much of what seemed "advanced" to practitioners of the time was actually just dressed-up guesswork.

Fast forward to today, and consider that:

Labels are replacing understanding in modern medicine.

​Medicine has come a long way from the days when unexplained symptoms were attributed to “bad humors” or witchcraft. Yet, in some ways, today’s medical system continues to apply labels that offer more comfort to physicians, than clarity to patients. Conditions such as Irritable Bowel Syndrome (IBS), Chronic Fatigue Syndrome (CFS), and Functional Neurological Disorder (FND) illustrate a troubling trend — when tests fail to reveal a clear pathology, the medical profession often creates a “syndrome” to fill the gap. These syndromes, presented as diagnoses, provide a name, but not an explanation.

Syndromes are being defined as diseases.

A syndrome is meant to describe a cluster of symptoms that appear together, without implying a known cause. That’s reasonable as a temporary classification. The problem arises when these placeholders harden into quasi-diseases, presented to patients as final diagnoses. This can mislead both patient and doctor into thinking the mystery is solved. Consider how:​

• IBS is often diagnosed when inflammatory bowel disease and celiac disease are ruled out, yet many patients later discover they actually have microscopic colitis (MC), bile acid malabsorption, or mast cell activation disorder.
• Chronic Fatigue Syndrome has historically been a catch-all for unexplained exhaustion, though research now points toward immune dysregulation, viral triggers, and mitochondrial dysfunction.
  
• Functional Neurological Disorder frequently serves as a default when neurological testing is inconclusive, sometimes leaving patients feeling dismissed rather than helped.

​EHR systems promote labels rather than understanding.

Electronic health record (EHR) systems require clinicians to enter standardized diagnostic codes for billing, insurance, and regulatory reporting. This means that even when the cause of a patient’s symptoms is uncertain, the physician must still pick a code. Instead of documenting “undiagnosed abdominal pain pending further investigation,” the system often pressures the clinician into selecting “IBS, functional dyspepsia, or another convenient label. Once entered, that label becomes part of the official record, shaping how future providers perceive the patient’s case.

Once a diagnosis is coded into the record, it tends to persist — even if later evidence proves it wrong.

• Updating or correcting old entries is time-consuming and often discouraged by system design.
• Future clinicians frequently “copy forward” prior notes, perpetuating the same questionable diagnosis without re-examining the original evidence.
• Because billing is tied to codes, removing or downgrading a diagnosis can cause administrative and reimbursement problems, so it often remains in place.

This undermines accuracy.

• An incorrect diagnosis in the record biases the thinking of future clinicians, making them less likely to search for alternative explanations.
• Codes for vague syndromes like IBS, fibromyalgia, or chronic fatigue are often used as placeholders but end up looking like definitive diagnoses in the record.
• Instead of honestly recording “cause unknown,” physicians select a code to satisfy the EHR, giving the illusion of diagnostic certainty.

Patients may be permanently tagged with a condition they don’t truly have, which can:

• Affect insurance eligibility and premiums.
• Lead to inappropriate treatments.
• Cause stigma (e.g., being labeled as having a “functional” disorder).
• Even when patients later discover a more accurate diagnosis (e.g., microscopic colitis instead of IBS), the old label may remain embedded in the system.

Where will this lead?

• Over time, EHRs become cluttered with half-true or outright incorrect diagnoses, making the medical record less reliable.
• Data from these systems then feeds into research and public health databases, skewing statistics and perpetuating misleading conclusions.
• Clinicians may lose diagnostic curiosity, relying instead on code-driven categories that don’t reflect biological reality.

This trend doesn't bode well for the integrity of medicine.

On one level, these labels reflect medical humility — physicians acknowledge they don’t yet know the underlying cause. But in practice, they are often wielded as if they were genuine disease entities. This practice undermines trust in medicine because:

1. It creates false certainty. Patients believe they have a diagnosis when in fact they’ve been handed a descriptive placeholder.
2. It discourages further inquiry. Once a label is given, both doctors and patients may stop searching for root causes.
3. It can feel dismissive. Patients often hear “it’s just IBS” or “it’s just functional,” which invalidates their suffering and lumps them into vague categories.

This echoes the intellectual shortcuts of pre-scientific medicine, where unexplained conditions were attributed to supernatural causes. While today’s terms are more scientific-sounding, the underlying issue — explaining the unknown with arbitrary categories, remains.

The trend is ultimately counterproductive.

If medicine continues down this path, more patients will feel alienated, and public confidence will erode. Worse, real discoveries may be delayed because conditions are dismissed as “functional” rather than investigated. The challenge for modern medicine is to replace syndrome labeling with biological understanding. That requires:

• Investment in research to uncover hidden immune, microbial, or neurological drivers.
• More precise use of language: telling patients when a diagnosis is provisional rather than definitive.
• Openness to patient experience, which often points to patterns overlooked by normal testing.

Conclusion:

The reliance on arbitrary syndromes is a symptom of medicine’s discomfort with uncertainty. While such labels may ease clinical conversations, they risk repeating the mistakes of history—swapping “witchcraft” for “functional” and leaving patients with no true answers. The future of integrity in medicine depends on humility, honesty, and a commitment to dig deeper until symptoms are explained not by labels, but by knowledge. Looking at this situation realistically, though, does anyone believe that medicine will "heal itself"?

Here's my opinion of why this is happening.

The basic problem here appears to be that precious few certified medical specialists have ever learned a basic fact that most PhD holders, for example, clearly understand — despite their certification as an "expert", experts can never learn everything there is to know about their field of expertise, making them perpetual students. That implies that they never stop learning (at least that's how it's supposed to work, in theory). It works for PhD holders — why doesn't it work for MD holders?

​As most MC patients can attest, many (possibly most) gastroenterologists have never significantly advanced past their initial relatively basic understanding of MC, and its treatment. They are clearly not continuing to learn (or else they are doing a good job of hiding their newly acquired knowledge from their patients). Apparently this concept is not being properly taught during their medical training.

And the confusing part of that attitude is that patients don't expect specialists to know everything there is to know about their specialty — they only expect specialists to provide the best care of which they are capable, and for which they are charging relatively high fees. So why do specialists choose to compromise the integrity of their profession by defining "diseases" that don't actually exist? Although it surely isn't intentional, by doing so, they are effectively devolving medical care as they choose to use some of the techniques that we find so appalling from the early days of medicine.