Disease is indeed a "slippery" concept which has never been
adequately defined, despite being medicine's most fundamental term. What
is more, doctors are generally unwilling to think seriously what they mean
by disease, either because they are convinced its meaning is self-
evident, or because they want to be free to be inconsistent. For this
reason it may be more profitable to examine the circumstances in which
attributions of disease status are bestowed (eg hypertension and
alcoholism in the 1950s; attention deficit hyperactivity disorder in the
1980s), or occasionally withdrawn (homosexuality in the 1970s), rather
than searching fruitlessly for an agreed formal definition. This approach
has convinced me that what our profession, and the general public, really
means when it accepts a condition as a disease is a) that it is an
undesirable state of affairs, and that attempts should therefore be made
to prevent it developing or ameliorate its consequences; and b) that the
medical profession and its technologies seem more likely to achieve these
desirable goals than other available professions and institutions - such
as the criminal justice system (treating the condition as crime), the
Church (treating it as sin), social work (treating it as a social problem)
or beauticians (treating it as an aesthetic blemish).
This implies that the availability of an apparently effective
treatment often precedes, and is more fundamental than, the detection of
pathology. And it explains why we have acquired so many new diseases in
the last 20 years - because of the great expansion in the scope of medical
technologies, particularly a much wider range of potent drugs. It also
leads to the prediction that, as effective pharmacological treatments
become available over the next decade, obesity will, like hypertension
before it, come to be generally accepted as a disease in its own right
rather than simply as a human waakness that predisposes to other diseases.
Rapid Response:
THE MEANING OF "DISEASE"
Disease is indeed a "slippery" concept which has never been
adequately defined, despite being medicine's most fundamental term. What
is more, doctors are generally unwilling to think seriously what they mean
by disease, either because they are convinced its meaning is self-
evident, or because they want to be free to be inconsistent. For this
reason it may be more profitable to examine the circumstances in which
attributions of disease status are bestowed (eg hypertension and
alcoholism in the 1950s; attention deficit hyperactivity disorder in the
1980s), or occasionally withdrawn (homosexuality in the 1970s), rather
than searching fruitlessly for an agreed formal definition. This approach
has convinced me that what our profession, and the general public, really
means when it accepts a condition as a disease is a) that it is an
undesirable state of affairs, and that attempts should therefore be made
to prevent it developing or ameliorate its consequences; and b) that the
medical profession and its technologies seem more likely to achieve these
desirable goals than other available professions and institutions - such
as the criminal justice system (treating the condition as crime), the
Church (treating it as sin), social work (treating it as a social problem)
or beauticians (treating it as an aesthetic blemish).
This implies that the availability of an apparently effective
treatment often precedes, and is more fundamental than, the detection of
pathology. And it explains why we have acquired so many new diseases in
the last 20 years - because of the great expansion in the scope of medical
technologies, particularly a much wider range of potent drugs. It also
leads to the prediction that, as effective pharmacological treatments
become available over the next decade, obesity will, like hypertension
before it, come to be generally accepted as a disease in its own right
rather than simply as a human waakness that predisposes to other diseases.
[I have no competing interests to declare.]
Competing interests: No competing interests