The illness-disease dichotomy and the biological-clinical splitting of medicine, Tesio and Buzzoni, 2021

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The illness-disease dichotomy and the biological-clinical splitting of medicine
Tesio and Buzzoni 2021

Abstract

In a recent paper, Sharpe and Greco (2019) argue that some clinical conditions, such as chronic fatigue syndrome (sometimes called myalgic encephalomyelitis), should be treated by altering the patient's experience and response to symptoms without necessarily searching for an underlying cause. As a result, we should allow for the existence of ‘illnesses without (underlying) diseases’.

Wilshire and Ward (2019) reply that this possibility requires unwarranted causal assumptions about the psychosocial origins of conditions not predicted by a disease model. In so doing, it is argued that Sharpe and Greco introduce epistemological and methodological problems with serious medical consequences, for example, patients feel guilt for seeking treatment for illnesses that only exist ‘all in the mind’, and medical researchers are discouraged from looking for more effective treatments of such conditions.

We propose a view that integrates the insights of both papers. We abandon both the strict distinction between disease and illness and the naïve unidirectional account of causality that accompanies it. This, we claim, is a step towards overcoming the current harmful tendencies to conceptually separate (1) Symptom management and disease-modifying treatments. (2) Rehabilitative-palliative care and ‘causal’ curing. (3) Most importantly, biomedicine and clinical medicine, where the latter is currently at risk of losing its status as scientific.

https://mh.bmj.com/content/47/4/507
 
What puzzles me most about this subject is how anybody can hope to discuss it seriously without mention of:

The Disease-Illness distiction: a model for effective and practical integration of behavioural and medical sciences
Arthur Cott, McMaster University
in Illness behaviour - a multidisciplinary model (1986) (EDIT eds McHugh and Vallis) - a report on the proceedings of the second international conference on Illness Behaviour held in Toronto in August 1985.

The thinking at the heart of the book is significant in creation of the BPS model for ME and is referred to by Arthur Kleinman the chair of the 1992 CIBA Symposium.

I tmay be that the authors of these new papers see themselves as having created a different dichotomy, although the Sharpe paper cites Eisenberg's 1977 paper, and he was central to the illness behaviour conference. Sharpe , at least, must have been well aware of this historical line. Even if they wish to reject it they should mention it.

All very perplexing.
 
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This whole debate is absurd. There are things modern medical technology can see and understand, signs, and things it can't yet, which we call symptoms. That's it, that's the whole of it. The problem is that medical professionals have been speculating on what they can't see for, well, ever, essentially inserting themselves, their thoughts and beliefs, into the process and essentially studying their own thought process. Had this never happened we wouldn't be in this mess. Had medical science accepted what all other sciences can accept, that what we can't see can't serve as speculation for what can be there other than as a theoretical model, people would simply do the necessary work and we would spare massive suffering.

Medicine should have minimal awareness and respect for object permanence. Just do the damn work and eventually it gets understood, this isn't even especially hard. Whining until then and having "debates" is purely for entertainment, and the patients whose life drift away while people are having fun debating one another are having none of that fun.

This is especially absurd when you consider that on this topic we have both fully speculative philosophical musings being mixed with "pragmatic" of the "let's just throw stuff at the wall and see what sticks" type. What this debate never considers is that underneath this are real human beings. Health is not a discipline where we can wildly speculate because it's generally harmless. It's very harmful to do that, and this whole ridiculous debate is hiding it.

This is exactly like the natural philosophy debates over phlogiston and the aether and other speculative ideas people had before science paved the way for modern physics. It's completely pointless. Except the consequences are real and time is the greatest contributor of harm. Just do the damn work, damnit. It's literally easier and cheaper in the end.
 
"...without necessarily searching for an underlying cause", is IMO very risky. Consider the level of misdiagnoses discussed elsewhere on this Forum: about 40 to 50% in some cases.

The practice/theory of not necessarily searching for an underlying cause has of course evolved into don't bother searching for an underlying cause, to these patients don't deserve biomedical help, to these people can be discounted, dismissed and maligned. Ultimately this theory became official policy.
 
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If they had not searched for an underlying cause for type 1 diabetes everyone with the disease would have died. Not only that, it lead to an understanding of all hormone diseases so people with thyroid diseases, Addison's disease and so on would still have a shortened life span as well.

Who knows what biological insights they will get when they uncovered the biology of ME?
 
Mithriel said:
If they had not searched for an underlying cause for type 1 diabetes everyone with the disease would have died. Not only that, it lead to an understanding of all hormone diseases so people with thyroid diseases, Addison's disease and so on would still have a shortened life span as well.

Who knows what biological insights they will get when they uncovered the biology of ME?
Click to expand...

:thumbup:
 
DokaGirl said:
"...without necessarily searching for an underlying cause", is IMO very risky. Consider the level of misdiagnoses discussed elsewhere on this Forum: about 40 to 50% in some cases.

The practice/theory of not necessarily searching for an underlying cause has of course evolved into don't bother searching for an underlying cause, to these patients don't deserve biomedical help, to these people can be discounted, dismissed and maligned. Ultimately this theory became official policy.
Click to expand...
I think a survey survey by the MEA many years ago (of Leicestershire..Liverpool..?) found 40% of referrals ended up having other explanations for their fatigue and not qualifying for a diagnosis (of ME/CFS), so I assume if they hadn't have investigated the those 40% would not have got the treatment they needed.

Edit to add "ME/CFS"
 
:emoji_hot_pepper::emoji_hot_pepper::emoji_hot_pepper:
rvallee said:
This whole debate is absurd. There are things modern medical technology can see and understand, signs, and things it can't yet, which we call symptoms. That's it, that's the whole of it. The problem is that medical professionals have been speculating on what they can't see for, well, ever, essentially inserting themselves, their thoughts and beliefs, into the process and essentially studying their own thought process. Had this never happened we wouldn't be in this mess. Had medical science accepted what all other sciences can accept, that what we can't see can't serve as speculation for what can be there other than as a theoretical model, people would simply do the necessary work and we would spare massive suffering.

Medicine should have minimal awareness and respect for object permanence. Just do the damn work and eventually it gets understood, this isn't even especially hard. Whining until then and having "debates" is purely for entertainment, and the patients whose life drift away while people are having fun debating one another are having none of that fun.

This is especially absurd when you consider that on this topic we have both fully speculative philosophical musings being mixed with "pragmatic" of the "let's just throw stuff at the wall and see what sticks" type. What this debate never considers is that underneath this are real human beings. Health is not a discipline where we can wildly speculate because it's generally harmless. It's very harmful to do that, and this whole ridiculous debate is hiding it.

This is exactly like the natural philosophy debates over phlogiston and the aether and other speculative ideas people had before science paved the way for modern physics. It's completely pointless. Except the consequences are real and time is the greatest contributor of harm. Just do the damn work, damnit. It's literally easier and cheaper in the end.
Click to expand...
 
Always wary of anything coming from McMasters University now, an educational base for evidenced-based medicine for the commonwealth. One of their residents within their department of Addiction Psychiatry have made a lot of comments in major publications of the world press that Long Covid is not a real disorder and just a cultural phenomena made up by a LC support group with lots of homophobic and misogynist references. A narrative was started. He has not been publicly sanctioned.

Illness behaviour is BPS, I have seen this in action throughout all spheres of medicine.
 
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