Symptoms Research: A Fertile Field

• Pathological conditions, signs and symptoms
• Health services research
• Physician-patient relations

“I'm very brave generally … Only to-day I happen to have a headache.”

Lewis Carroll, Through the Looking Glass

What Lewis Carroll wrote of headache is true of any consuming symptom. Pain, vertigo, pervasive fatigue—each can be enervating and disheartening. Any of us even temporarily inconvenienced by a head cold or motion sickness or sports injury realizes the detrimental impact on work, recreation, and even rest. Symptom comes from the Greek symptoma, which means “anything that has befallen one”; the Greek verb is piptein, “to fall” (1). Symptoms are literally a fall from our usual state of functioning. Symptom-free, we can focus our full attention and energies on the world around us. Symptomatic, we focus inward, distracted from what we know can and should be done. Generally, we are brave. But not when we have a headache.

Symptoms are the principal reason for clinic visits in about half of all outpatient encounters. Yet biomedical research has typically focused on the end state—a specific disease—rather than the generic symptom. This is not surprising given that the traditional scientific method, particularly laboratory science, has favored a narrow question, a homogenous sample, and fastidious replicability. This paradigm is immensely successful at the level of the genome, the cell, and even the organ. Symptoms, however, involve the whole human and are more undifferentiated. Collaboration of clinical epidemiologists, social and behavioral scientists, and health services researchers is needed to complement the more basic sciences. The first step is to enhance our awareness of the possibilities and challenges in studying symptoms.

The …