Diseases and medical knowledge Flashcards
Normative need
A professional assessment of a person’s need for health care based on objective measures.
Defining a disease
You could define ‘disease’ as the absence of health and health as the absence of disease. But this is circular. Defining ‘disease’ involves two approaches, selfassessment and professional assessment. Self-assessment inevitably involves a subjective assessment of how one feels about one’s own health. Therefore, it is often referred to as ‘felt need’ and is an indication of a person’s ‘need for health’. Given that such an assessment is subjective, we will vary in our perceptions. At one extreme there are stoics who will put up with more than others. In contrast, there are people who are hypochondriacal and will complain about the slightest problem. Also, lay people may not distinguish between symptoms of disease and symptoms that are normal or physiological such as those associated with pregnancy or teething.
To understand health or disease we must have some objective measurements in addition to the introspective account. If we can weigh or measure something, then we have a little more confidence, and we feel more firmly grounded in objective reality.
Other examples of how the boundary between being healthy and being diseased vary between places and over time are:
- malaria – in Europe any person with a parasitaemia (presence of malaria parasites in the blood) would be treated, whereas in tropical endemic areas where 60% of the population may have a parasitaemia but no symptoms, only persons with manifest disease would be treated;
- dyslexia, chronic fatigue syndrome and repetitive strain injury – have all been recognized as diseased states in recent years whereas previously they were not;
- homosexuality – used to be categorized by the World Health Organization as a diseased state.
Medical knowledge and diseases
Medical knowledge is based on categorizing states of ill health into discrete diseases. Diseases are patterns of factors (symptoms, signs) that occur in many people in more or less the same way.
One way of understanding a complicated system such as disease categorization is to study it when changes occur.
Changes occur for five reasons:
1 Real changes in occurrence – for example, newly emergent diseases such as HIV/ AIDS and new variant Creutzfeldt–Jacob disease. Diseases may also disappear for example, sweating sickness
2 Changes in name – many different names were used for the same disease before the name coronary heart disease had been created, as mentioned above (Stehbens 1987). Glue ear (otitis media with effusion) is another example: the name for the same condition has changed more than 50 times since the nineteenth century
3 Changes from single to multiple categories – this is a common phenomenon with the progress of medical knowledge. For example, diabetes was first split into diabetes insipidus and diabetes mellitus on the basis of the appearance and taste of the patient’s urine. The latter was then divided into type I and type II on whether or not the problem was the failure of the person to create insulin or the failure of their body to respond to insulin. More recently, molecular biology has contributed to further subcategorization of diabetes.
4 Changes in recognition of abnormality – this includes a range of conditions where medicine has changed its view. night starvation in the 1930s (the belief that people suffered from low sugar levels as they slept and should, therefore, have a sugary drink before going to bed).
5 Uncovering of previously rare conditions – due to the reduction or elimination of other prevalent conditions.
Scientific knowledge represents our best explanation and understanding of the world (both natural and social) at present – at best, scientific ‘truth’ is only historically relative and is conditional, that is, it will change in the future.
Medicine and culture
when comparing traditional Indian (Ayurvedic) medicine to western medicine, you may analyse the material culture and compare the medical tools and products used by both systems. You can also analyse the non-material culture and examine the ideas underlying Ajurvedic and western medicine. These ideas are the different beliefs, values and norms, which are reflected in medical theory and practice of both systems.
International differences in treatment
a) Fibroids require hysterectomy in the USA but myomectomy in France.
b) Cerebral vasodilators used in France but not in the UK and USA.
c) BCG vaccination used universally in France but not in the USA.
d) Higher use of heart drugs in Germany than in the USA, France and UK.
e) Fewer antibiotics used in Germany than in France, the USA and UK.
International differences in diagnosis
a) Schizophrenia (USA); manic depression or neurosis (UK); delusional psychosis (France). b) Neurosis (UK); spasmophilia (France); vasovegetative dystonia (Germany); panic disorder (USA).
Felt need
A person’s subjective assessment of their need for better health.
