Presentation on theme: "Lecture 4 The Basis of bio-Medicine and Challenges to the Biomedical model."— Presentation transcript:
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 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
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 bodys 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 Doesnt 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 '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
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