Why Do We Treat the Disease Instead of the Person? And Why Is Everything a Disease?
As the first chapter in the book To Fix or To Heal: Patient Care, Public Health and the Limits of Biomedicine, Davis’ article explores why medicine is ever more “characterized by reductionism, mechanism-based explanations for clinical syndromes, and heavy reliance on technical solutions, despite important reasons to change,” and why we welcome medicine’s extension into more and more areas of our lives.
Davis identifies two developments that put an end to holist thinking in mainstream medicine: disease specificity, and treatment specificity.
“The first was the idea of disease specificity. Rather than disruptions of the whole body, disease came to be understood as specific entities with separate and universally identifiable causes and characteristic physiological effects. This more ontological notion of disease…was medical convention by the end of the nineteenth century.”
He explains how “germ theory revolutionized the theory and practice of medicine and the very conception of disease. The essential idiosyncrasy of disease is gone; the afflicted individual is the ‘host’ for impersonal physiological processes.” As new diagnostic tools like X-rays and thermometers were developed, patients’ own descriptions of their symptoms became less and less necessary to diagnoses.
The concept of treatment specificity solidified the trend. “Newly identified bacteria suggested not only that each was associated with its own disease, but that each might require specific management.” Then, as antitoxins, immunizations and vaccines and curative medicines were developed, their use fit into the prevailing model.
This model persisted even as multiple cause explanations came to be employed for non-communicable diseases, taking into account risk factors that might be ameliorated by lifestyle modifications (like diet and exercise). What were once seen as contributors to disease (like hypertension to heart disease) came to be seen as diseases themselves, with specific drug and lifestyle treatments.
“In part because of past successes, the specific disease and treatment models, with their mechanism-oriented reductionism – the biomedical model – remain dominant.”
Davis goes on to consider how medical practices both shape and are shaped by cultural imperatives. He identifies two - personal freedom and health – that are dominant in Western societies, and closely bound to medical developments, contributing to increasing medicalization. “Through medicine and the technologies it controls, the ability to intervene and alter the body for emancipatory lifestyle purposes has been radically enlarged.” Medicine thus passes from the treatment of disease, to prevention of disease and now to enhancement of life.
“As autonomy has become more of a cultural ideal, so limitations on, say, autonomy of movement are felt to be a burden, and medicine is called upon to provide whatever technological means it controls to relieve this burden. It is similar with virtually any attribute that an individual might regard as inhibiting to them or their life plans: short stature, anxiousness, shyness, perfectionism, low task-specific energy or concentration, insufficient libido, and much more. So too with troublesome emotions, and with various role conflicts or inadequacies…Intervention in these matters is legitimate medicine in the Baconian sense because it addresses burdens for the patient, the modification or reduction of which is regarded as a good, one enabling her or his pattern of life.”
“We can see why we invite medicalization. On the individual level, a specific diagnosis provides a predetermined narrative that can decrease the burden of responsibility, account for problematical experience, legitimate exemptions from social expectations, and offer a positive prognosis and access to treatment, all within a seemingly value-neutral framework. Access to medical technologies for emancipatory and lifestyle issues is another incentive, one that in the liberal health society can become an obligation. The relentless yearning for control, coupled to the optimism industry, makes even the contemplation of therapeutic limits difficult to accept.”