Adnkronos (Adnkronos) – The average age is over 70, with more than four chronic diseases each. This is the profile of more than three out of four patients admitted to Italy's internal medicine departments, according to a recent survey by FADOI, the Federation of Associations of Hospital Directors of Internal Medicine. These doctors, working every day in hospitals from north to south across the country, are the first to witness the new needs the National Health Service is called upon to address.
From the trenches of complexity, internists have long been calling for the classification of their departments to be adjusted to the intensity of care they provide. They want to "contribute to a qualitative leap in the functioning of the National Health Service" to redesign a system truly capable of caring for new patients. This summarizes the goal of the conference "The Future of Internal Medicine: Between Complexity, New Technologies, Artificial Intelligence, and Humanization," scheduled for October 8-10 in Capo d'Orlando, in the province of Messina.
Among the three-day event's promoters is Antonino Mazzone, former director of the Department of Medical Area and Continuity of Care and of the Internal Medicine Complex Unit at the Asst Ovest Milanese. Born in Messina, he spent the last 26 years of a long career as an internist at the Legnano hospital, deeply in love with his chosen profession.
"Internal medicine is not the cure of diseases, but of patients," is his mantra. "Internal medicine is the brain of the hospital," the director of diagnostic and treatment pathways, the first destination for patients arriving from emergency rooms. Mazzone retired on September 2nd, but he's not stopping there. He returns home and, with the Sicilian meeting, reaffirms the centrality of the discipline to which he has dedicated his life. He will be co-chairing the event with Salvatore Di Rosa, head of Internal Medicine for more than twenty years and former general director of the Villa Sofia Hospital in Palermo, and Carlo Nozzoli, director of Internal Medicine I at the Careggi University Hospital in Florence.
"The conference will seek to address the innovative and strategic issues that will transform healthcare delivery and organization in the coming years," say Di Rosa, Mazzone, and Nozzoli. These are issues that see internal medicine at the forefront. "Diseases related to internal medicine are, in fact, the leading cause of death globally," the specialists emphasize. "They include heart disease, stroke, cancer, diabetes, chronic respiratory diseases, mental illnesses, musculoskeletal disorders, gastrointestinal disorders, vision and hearing impairments, as well as genetic diseases," they list. "These diseases," the experts explain, "can begin at a young age and take decades to manifest clinically. Given their nature, they require long-term care, but they also present numerous opportunities for prevention," priorities for a more efficient and sustainable National Health Service. "The main risk factors" for diseases within the scope of internal medicine "are common and modifiable: unhealthy diet, tobacco use, alcohol abuse, and a sedentary lifestyle, behaviors that can lead to intermediate risks such as hypertension, high blood sugar, high cholesterol, and obesity. However, there are also non-modifiable risk factors, such as age and genetic predisposition." Furthermore, "chronic diseases are influenced by implicit determinants, often referred to as 'causes of causes,' which reflect social, economic, and cultural forces. These include globalization, urbanization, population aging, and environmental policies." Hence the role of internal medicine advocated by the summit's promoters: a leading specialty and a 'laboratory' for prevention and innovation, with a keen eye on advancing AI.
The presidents present some of the most anticipated papers at the Capo d'Orlando conference, organized by Coop Servizi Sociali. Gene therapy for rare anemias will be discussed by Domenica Cappellini, former president of the European Federation of Internal Medicine (EFIM), longtime director of the Rare Diseases Center at the Fondazione IRCCS Policlinico in Milan, and recently awarded the Ferrata Prize as the best hematologist. It transforms the treatment of anemia (especially sickle cell and thalassemia) thanks to the ability to modify a patient's stem cells by harvesting them, correcting the genetic defect in the laboratory with tools such as the CRISPR-Cas9 "molecular scissors" to reactivate fetal hemoglobin, or by inserting a healthy gene, and reinfusing them after preparatory chemotherapy to eliminate the diseased cells. This offers a potentially long-lasting cure. Another rare disease, hypoparathyroidism, will also be discussed, along with a new therapy that promises to be a turning point in patients' clinical history. The spotlight will then be on immunotherapy: training a patient's "immune soldiers" to recognize, track down, and attack tumor cells that often manage to hide or inhibit the body's natural defenses. Specific drugs such as immune checkpoint inhibitors block the signals that cancer uses to "switch off" T lymphocytes, keeping them "awake" to fight the disease. This approach differs from chemotherapy because it doesn't directly attack the tumor, but stimulates the internal defenses to destroy it. Speakers at the meeting included Carmelo Carlo-Stella, professor of Hematology and director of the School of Specialization in Hematology at Humanitas University, and director of the Hematology Division at the IRCCS Humanitas Research Hospital in Rozzano (Milan).
The conference will detail the results obtained from translational research in various fields of medicine: diabetes, lung disease, cardiovascular disease, rare diseases including amyloidosis, rheumatologic and oncological diseases. It will also focus on the challenges of AI, with their bright and dark sides. Chiara Sgarbossa, director of the Life Science Innovation Observatory at the Polytechnic University of Milan, will discuss the use of artificial intelligence in medicine. AI allows us to reframe the questions that science asks to maximize scientific and clinical benefits; it also offers the possibility of continuous discussion and exchange among researchers, and data science methods can be used to extract and highlight additional information from existing observations and clinical data. On the other hand, however, artificial intelligence is transforming medicine not only technologically, but also culturally, cognitively, and ethically.
Salvatore Corrao, full professor of Internal Medicine at the University of Palermo and director of the Department of Clinical Medicine and the Internal Medicine Unit at the Arnas Civico-Di Cristina-Benfratelli Hospitals, and a speaker at the conference, explains this well. In his book "Curare con intelligenza – L'intelligenza artificiali tra sapere medico e deciso umana," Corrao points out that AI does not replace doctors: it supports them, expanding their ability to read complex data, recognize diagnostic patterns, predict clinical risks, and manage uncertainty. But human intelligence remains crucial, because AI is only as "smart" as the person who uses it. Alberto Scanni, one of the most well-known figures in Italian oncology, will address the emergence of artificial intelligence in the doctor-patient relationship. He is the former director general of the National Cancer Institute in Milan, founder and president of the Italian Society of Psycho-Oncology and the Italian College of Chief Hospital Oncologists (Cipomo), and honorary president of the association "Progetto Oncologia Uman.A," which he founded. In the age of algorithms, the experts at the conference stated, it is once again imperative to talk about the humanization of medicine and a holistic approach. This approach is the same one that internal medicine has always cultivated: a 360-degree view of the patient, who must be listened to, understood, and treated in all of their complexity.
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