Semantics of disease

[Guest guest]

Semantics of disease

A team of University of Toronto surgeons is proposing a new

definition of disease that shifts its meaning to make allowances for

cultural relativity

 

 

Joseph Brean

National Post

 

Taking medicine for wrinkly skin may not be that far-fetched a notion

for North American society. Meanwhile, other cultures simply view

lines on a face as a natural part of ageing.

 

To anyone suffering from pneumonia, the definition of the

word " disease " is of minor importance at best. Semantics will ease a

fever far less than a good dose of antibiotics.

 

To a doctor, though, the definition of disease is a professional

touchstone. A doctor's concept of disease determines which patients

will be treated and how, and it is reflected in social policies from

health insurance to hospital funding.

 

A team of surgeons at the University of Toronto, worried that the

recent mapping of the human genome has skewed how doctors label

people as diseased, has proposed an entirely new definition.

 

Their definition presents disease as a fluid concept that is

scientific, but neither universal nor constant.

 

" [Our definition] accommodates a social constructionist viewpoint,

and begins to explain what we already know to be the truth; that

people think of disease differently with time and between cultures, "

says Dr. James Wright, a senior author of the essay that presents the

new definition in today's issue of the journal Science.

 

" As more and more genetic variations among individuals are

discovered, there will be a rush to label many of these variations as

disease-associated, " Wright says.

 

But genetic variations are a normal and necessary part of evolution,

he says, and if every genetic abnormality that shows itself in

physical symptoms is a disease, then every bald man or curly haired,

red-headed girl is diseased.

 

Carlos Prado, a philosopher at Queen's University who studies the

medical establishment, says advances in medical diagnostic

techniques, such as CAT scans, reveal so much variation in people's

genetic makeup and physiologies, that they force the perplexing

question, " Is anyone healthy? "

 

Previous definitions of disease, by doctors and lexicographers alike,

have been weak, circular and useless, Wright says.

 

Some doctors have even rejected all definitions of disease, the

authors write, claiming that treatment, the ultimate goal of

medicine, is still possible without one.

 

The earliest definitions, which go back about 200 years, focused on

symptoms, but some distinct diseases have similar symptoms, like

schizophrenia and syphilitic insanity, the authors write.

 

The Canadian Oxford Dictionary defines the term as " an unhealthy

condition of the body or mind. " This standard definition is circular,

and amounts to nothing more than saying that disease is the absence

of health, which is in turn the absence of disease. Definitions such

as these are all but useless, Wright says.

 

The authors propose that a disease be defined as " a [genetic or

physiological] state which places an individual at an increased risk

of adverse consequences, " rather than as a state of abnormality or

unhealthiness. Identifying adverse consequences allows doctors to

separate real diseases like cancer from other genetic conditions that

give rise to physical symptoms, such as the wrinkling of skin and

weakening of bones that come with age.

 

Certain diseases, such as manic depression, illustrate the cultural

relativity that comes with this definition.

 

In some cultures, Wright says, a person with manic depression is seen

as suffering from the adverse effects of a diseased mind, such as

emotional pain and diminished social opportunities.

 

But manic depression is highly correlated with artistic genius. So in

another culture such a person might be labelled an artist rather than

a patient.

 

In others cultures still, the manic depressive would be worthy of

both medical pity and artistic praise, Wright says.

 

Another example is menopause, which in our culture " is being viewed

as a medical condition, " Wright says. " It's clear that there's a

whole industry directed toward minimizing the symptoms of menopause,

and yet in other cultures this is seen as a very natural part of

ageing and people wouldn't consider taking medications for it. It

would be nonsense. "

 

It would be like taking medicine for wrinkly skin, he says, which in

our culture may not be so far-fetched.

 

In any one culture, the understanding of disease changes over time,

Wright says. He notes that in our own culture, many elderly people

are reluctant to seek treatment for osteoarthritis, the degeneration

of bones and joints with age, because it is a natural process of the

body.

 

" We suspect that will change very much as the Baby Boomers, who are

used to a very active lifestyle, get older. Osteoarthritis will be

viewed very differently in about 20 years compared to how many

elderly people view it now. "

 

The authors' nominalist view, in which the name of a disease denotes

a complex of causes and not an underlying essence, allows them to

accommodate both environmental and genetic factors in describing

diseases, Wright says.

 

At the same time, though, he admits their work is open to the

accusation that, by calling disease a cultural concept, he is

explaining it away.

 

Wright says his goal is simply to foster reticence among clinicians

who would otherwise jump at the latest discovery of a genetic

abnormality and label it a disease.

 

 

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