The costs of ignoring a long-overdue chronomedicine: The chronome initiative emerging from the catacombs

Objectives. This position paper, revolving around the psychology of most health care providers, accompanies a case report in a companion paper in this issue. The topic is "the million-dollar baby", so named since the cost of his on-and-off hospital care for the first 13 months of his life was accounted to be U.S. $615,000, and his hospitalizations continued for another 13 months, presumably at a similar cost. Such an ordeal may be avoided if chronobiologic evidence would gain entry into the mainstream, e.g., by routine 7-day or, if need be, longer blood pressure monitoring with chronobiologic analyses. These activities belong in practice, rather than being relegated to research. Design. Historical parallel between the difficulties of introducing antiseptic and chronobiological principles, the latter focusing, in the face of an acceptable mean, on an altered variability, as illustrated in a case report and in follow-up validations on 297 and 424 patients. Results. Just as we now recognize the merits of scrubbing before surgery, the information contained in the dynamic characteristics of physiological variables such as blood pressure should be considered in medical practice, whether the variability occurs within or outside the usual value range. The systematic monitoring of vital signs in health serves to derive time-specified reference values for the interpretation of single measurements and of rhythm characteristics, thus refining the definition of health, rendering it positive and quantitative, thereby replacing the negative current definition of health as the abstence of disease. Conclusion. Chronobiology should no longer be regarded as the study of confounding epiphenomena, but enter the mainstream of medicine by detecting and treating high vascular disease risk.