ABSTRACT
Although history-taking is the key to diagnosis in clinical medicine, and symptom relief is the goal of medical treatment, symptoms are often unreliable and invalid measures of the extent and severity of medical disease. Disease may unfold without causing symptoms, as is seen for example in silent myocardial infarctions and asymptomatic lumbar disk disease. Conversely, it is common to encounter patients with symptoms but no demonstrable disease, as for instance in chronic pain, somatization, and conversion symptoms. Medical treatment may cure disease without relieving symptoms (as has been demonstrated in peptic ulcers; Bodemar & Walan, 1978; Peterson et al., 1977, and rheumatoid arthritis; Dwosh, Giles, Ford, Pater, & Anastassiades, 1983), and ineffective treatment can bring about a symptomatic cure, as is attested to by the powerful and ubiquitous placebo effect (Harrington, 1997).
