The Basis of bio-Medicine and Challenges to the Biomedical model.

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Lecture 4

• The Basis of bio-Medicine and Challenges to the
  Biomedical model.

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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

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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.

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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.

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Modern biomedicine rests on two major
developments 1

• The Cartesian revolution (Rene Descartes).
• Dualistic approach
• mechanistic view
• body as machine

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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 Corbins The Foul and the
  Fragrant

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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.

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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

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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.

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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

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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

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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.

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CAM- continued

• BMA and Gp's more generally now accept some of
  more established practices namely
• Acupuncture
• Chiropractice
• Herbal medicine
• Homeopathy
• Osteopathy

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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

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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

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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

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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 bodys ability to recuperate
• disease as natural / part of life

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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
• Doesnt require expert knowledge

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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)

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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 'NRMs' 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

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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

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