Lecture 4

The Basis of bio-Medicine and Challenges to the

Biomedical model.

Overview

Last weeks -conditions of modernity and their effects on peoples experiences of health and healthcareissues of power and professional dominance how the medical profession secured a monopoly on the diagnosis and treatment of disease. This week -the biomedical modelthe influence of germ theory the aetiology or causes of disease the stress illness model. challenges to the biomedical model complexity theory and health

The basis of biomedicine-Re-cap

until well into the 19th century medicine in Europe comprised a huge diversity of beliefs, practices and theories of disease. religious ideasancient Greek and Roman medicine 'humours' equilibrium theories. Folk medicine Theories of "spontaneous generation" profoundly ‘un-scientific’ naïveté of medical knowledgemiasma/ exhalations and odours.

A Shift in Ideas

As the 19th century progressed diversity of belief contained and homogenised growing acceptance of a developing scientific model.Research, observation, technology new ways of thinking about disease and the body.Emergence of bio-medical model.

Modern biomedicine rests on two major developments 1

The Cartesian revolution (Rene Descartes).

Dualistic approach

mechanistic view

body as machine

Modern biomedicine rests on two major developments 2

Pasteur (1850) development of 'Germ Theory'.diseases were transmitted by microscopic micro-organisms'germs that float in the air' as Pasteur himself said. 1870's Pasteur demonstrates that germs are the cause rather than the product of disease.1880's Robert Koch - 'Doctrine of Specific Aetiology'. each disease is always caused by a particular micro organism Constrast this with accounts of origins of disease in Alain Corbin’s ‘The Foul and the Fragrant’

Stress and the Aetiology of Disease. 1

Move forward to 20th century emphasis on role that stress has to play in the Aetiology of disease.disease as the tail end of a process of becoming ill. Illness entails diachronic analysis.'prior causes' of disease present in our everyday livespersonal crises and stress.

Stress and the Aetiology of Disease. 2

Hans Selye (1936). Stress is a physiological response to a stressor that is a threatening stimulus from outside the body. Faced with a stressor the body prepares itself for action by initiating a range of physical changes. IncludingIncreased blood pressureIncreased secretion of adrenalinRelease of potentially dangerous corticosteriodsTemporary drop in immunity.Stress can better prepare the body for adaptation or defence but at high levels it exhausts the organism and it can kill more basic organisms

Hart (1985).

For Hart (1985). The contraction of disease follows a sequence of stages.Potential stressor(s).Perception of Stressor(s) as threateningStress-the bodily responseIncreased susceptibility, partly through damage to the lymphatic systemExposure to virus, bacterium or noxious agentLow resistance-weakened immunityPhysical symptoms.Common stressors- bereavment, migration, divorce or marital conflict, persecution/ bullying or harassment, unemployment, excessive exposure to heat, damp, noise.

Problems with the Stress Illness model.

Even with good knowledge of endogenous stressors- difficult to predict likelihood of stress or disease.Different perceptions of stress, threat, hazard or danger- Notion of Stress highly subjective.Culturally and historically specific.Differential coping abilities, strategies and behaviours.Same stressors provoke different and unpredictable disease responses.Frank Furedi- notion of vulnerable self- unlimited stressors

Alternative or Complementary Medicine

Mainstreaming of ‘alternative’ medicinechanging terminology: 1990s shifted from ‘alternative’ to ‘complimentary’ to ‘complimentary and alternative’ (CAM) Trend towards ‘integrative’ medicine(Hardy) - by 1981 the number of GP's had been outnumbered by alternative therapists in UK BBC report in August 1999 using research commissioned by ICM showed 21% of population had tried it in previous year – double the number from similar survey 6 years earlierDept of Health research 1999 – at least 40% of general practices provide some CAM services50,000 CAM practioners in UK

CAM- continued

Most dramatic change is in attitude of medical professionBMA 1986 ‘Alternative Therapy’ – high scepticism and defence of gains of orthodox 1993 BMA Complimentary Medicine: New Approaches to Good Practice?They said that the effectiveness of these therapies was impossible to prove to prove scientifically, however so many people had reported positive benefits that these therapies should have a place in conventional medicine.

CAM- continued

BMA and Gp's more generally now accept some of more established practices namely

Acupuncture

Chiropractice

Herbal medicine

Homeopathy

Osteopathy

House of Lords Complimentary and Alternative Medicine (2000)

House of Lords Complimentary and Alternative Medicine (2000) by select committee endorsed acceptance of CAM

Urge that all medical graduates be exposed to understand

Alternative medicine is not really ‘alternative’ any longer!

This type of medicine split into Three Groups by (House of Lords) select comitee.

1 Established groups endorsed by BMA

2 Complimentary Therapies

3 Alternative Therapies

Features of Alternative Medicine

Key feature is reaction against excess of rationality in orthodox medicine (critique of enlightenment scientificism)Against seeing man as machine – back to Enlightenment model based on separation between mind and body – Descartes More holistic, link between man and natural worldStrong claim to a tradition despite recent revival – most medicine before 19th century was really just guesswork

Orthodox medicine

emphasis on man as machine

almost wholly mechanistic

genetics and modern biology

pathology – only understand once you can give detailed account of it at cellular and even molecular level

Characterising Alternative Medicine: 1

The Concept of the NaturalBody has natural tendency towards health and CAM to facilitate thisOrthodox medicine somehow interferes – disruptive and unnaturalCAM gently removes blocks on natural healthRecognition of body’s ability to recuperatedisease as natural / part of life

Characterising Alternative Medicine: 2

Holism

‘treats the patient as a whole person’

‘treats the person, not the disease’

Highly personal consultation (therapeutic benefits?)

lifestyle, diet and emotional questions

notion of psychic stress

Doesn’t require ‘expert’ knowledge

Characterising Alternative Medicine: 3

Vitalism and Subtle Energy

‘energy’ , ‘life force’, élan vital

Belief in vital force persisted until 18th century

Link to theiries of vital air in Corbin

link body to natural elements and forces

energy balancing (link to equilibrium theories)

Understanding its popularity

Expression of limits of conventional medicine?more patient control and autonomy.more participation – equal partners in exchangepsychotherapeutic benefits?‘a powerful healing force' Pietroni (1991).Decline of other sources of support like 'NRM’s’' A secular theodicyQuest for meaning.Belief and belongingThomas Dalyrymple – not doing any harm at leastFitzpartick – believe what you like, problem is official endorsement

‘The Surrender of Scientific Medicine’

Empiricist/orthodox medicine open to critical evaluationProblems with mechanistic view of body, Body as a ‘dissipative structure’ or open system Role of sociology in undermining ‘expert’ discourseRole of mediaMoral PanicsFrankenstein doctorsPatient as guinea pigTrust, risk and uncertainty