Towards a biological perspective on disease

Towards A Biological PerspectiveTowards A Biological PerspectiveOn DiseaseOn Disease

For a full transcript of the presentation,for which these slides were an accompaniment,

please visit:

https://sites.google.com/site/sjlewis55/presentations/brownbag2005

Which is, and which is not, a ‘disease’?And why?

‘My research is concerned with exploring the biological and philosophical aspects of the concepts of disease and health and considering the uses and applications of these findings.’

Towards a BiologicalPerspective on Disease

Stephen Lewis

‘The point of philosophy is to start with something so simple as not to seem worth stating, and to end with something so paradoxical that no one will believe it.’

Bertrand Russell

‘[P]hilosophy is often a matter of finding a suitable context in which to say the obvious.’

Iris Murdoch (1970)

‘[I]f we want to learn anything really deep, we have to study it not in its 'normal', regular form, but in its critical state, in fever, in passion. If you want to know the normal healthy body, study it when it is abnormal, when it is ill.’

Imre Lakatos (Proofs and Refutations, 1976)

'Central to the enterprises of both philosophy and medicine are the images and ideas held about what man is and what his existence signifies for himself and the world …

… medicine and biology are two powerful instruments of scrutiny of the image of man. Together with philosophy, they can help contemporary man to understand a little more about what he is …’

(Editorial. (Edward Pellegrino) J. Med. Phil. 1976)

Which is, and which is not, a ‘disease’?And why?

Gall stones (Acute-on-Chronic Cholecystitis)

(Lobar) Pneumonia

‘Sickness ... is the external and public mode of unhealth. Sickness is a social role, a status, a negotiated position in the world, a bargain struck between the person henceforward called 'sick', and a society which is prepared to recognise and sustain him.’

Marshall Marinker, 1975

‘Illness ... is a feeling, an experience of unhealth which is entirely personal, interior to the person of the patient.

Often [illness] accompanies disease, but the disease may be undeclared, as in the early stages of cancer or tuberculosis or diabetes. Sometimes illness exists where no disease can be found.'

Marshall Marinker, 1975

‘Disease ... is a pathological process, most often physical as in throat infection, or cancer of the bronchus, sometimes undetermined in origin, as in schizophrenia … There is an objectivity about disease which doctors are able to see, touch, measure, smell.’

Marshall Marinker, 1975

Giovanni Battista Morgagni(1682-1771)

De Sedibus et Causis Morborum per Anatomen Indagatis – 1761[On the Seats and Causes of Disease Investigated by Anatomy]

NOT sites

- Effects of the presence of the ‘seat’

- ‘Seat’ of disease

Self-Awareness

Anatomy &Physiology

OverallBiologicalState

Orange

R – 240

G – 40

B – 10

OverallBiologicalState

Anatomy &Physiology

Self-Awareness

Disturbance

Disease

Illness

Pathological

No illness

NoPathology

Health

R - 245B - 45G - 5

R - 240B - 35G - 5

R - 235B - 35G - 5

R - 245B - 45G - 10

R - 240B - 40G - 10

R - 235B - 35G - 10

R - 245B - 45G - 15

R - 240B - 45G - 15

R - 235B - 35G - 15

Which is, and which is not, a ‘disease’?And why?

• Why these particular responses?• Why the differences?• Why the similarities?• What are the consequences for the organism?

Response to stimulus ‘X’

Response to stimulus ‘Y’

‘Darwinian medicine is the enterprise of trying to find evolutionary explanations for vulnerabilities to disease …

Disease, [is] not … a product of [natural] selection.’

Randolph Nesse

‘The meaning of a word is its use.’

Ludwig Wittgenstein

Towards A Biological PerspectiveTowards A Biological PerspectiveOn DiseaseOn Disease

For a full transcript of the presentation,for which these slides were an accompaniment,

please visit:

https://sites.google.com/site/sjlewis55/presentations/brownbag2005