Transcript Lecture 4 - University of Bath

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
healthcare
issues of power and professional dominance
how the medical profession secured a monopoly
on the diagnosis and treatment of disease.
This week -the biomedical model
the 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 ideas
ancient Greek and Roman medicine 'humours'
equilibrium theories.
Folk medicine
Theories of "spontaneous generation"
profoundly ‘un-scientific’
naïveté of medical knowledge
miasma/ 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 microorganisms
'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 lives
personal 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. Including
Increased blood pressure
Increased secretion of adrenalin
Release of potentially dangerous corticosteriods
Temporary 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 threatening
Stress-the bodily response
Increased susceptibility, partly through damage to the
lymphatic system
Exposure to virus, bacterium or noxious agent
Low resistance-weakened immunity
Physical 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’ medicine
changing 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 earlier
Dept of Health research 1999 – at least 40% of general
practices provide some CAM services
50,000 CAM practioners in UK
CAM- continued
Most dramatic change is in attitude of medical
profession
BMA 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
world
Strong 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 Natural
Body has natural tendency towards
health and CAM to facilitate this
Orthodox medicine somehow interferes –
disruptive and unnatural
CAM gently removes blocks on natural
health
Recognition of body’s ability to
recuperate
disease 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 exchange
psychotherapeutic benefits?
‘a powerful healing force' Pietroni (1991).
Decline of other sources of support
like 'NRM’s’' A secular theodicy
Quest for meaning.
Belief and belonging
Thomas Dalyrymple – not doing any harm at least
Fitzpartick – believe what you like, problem is
official endorsement
‘The Surrender of Scientific
Medicine’
Empiricist/orthodox medicine open to critical
evaluation
Problems with mechanistic view of body,
Body as a ‘dissipative structure’ or open system
Role of sociology in undermining ‘expert’ discourse
Role of media
Moral Panics
Frankenstein doctors
Patient as guinea pig
Trust, risk and uncertainty