Intended for healthcare professionals

Rapid response to:

Feature Medicalisation

A new deal on disease definition

BMJ 2011; 342 doi: (Published 03 May 2011) Cite this as: BMJ 2011;342:d2548

Rapid Response:

"where normality ends and disease begins" ... Is there really a line?

Normality and diseases do not have sharp delineations. It's quite
arbitrary that a label, "disease," begins with a clinical diagnosis. One
may ask: does the disease of lung cancer, for example, begin with the
diagnosis or somewhere else along the 30 year trajectory of smoking?
Indeed, as diagnostic tools improve, the beginning of each disease is
being moved further back along the line of the disease true origin. Then,
however, we encounter another paradox, the disease that is diagnosed
"early" but later is proven that it has remained "under control" for
decades (e.g. some prostate cancers). Health and disease may be just
different sides of the same coin; the clinical diagnosis of a "disease"
depends heavily on when health care steps in and in a way "freezes" the
image of the health/disease ongoing balancing act within the human body.

The Dynamic Systems Model (reference is below) suggests that a system
remains in its Health Territory (where it continues to create value as a
reflection of its emergence) because of its complex adaptive nature that,
in a dynamic fashion, maintains a positive expression of the
health/disease oscillating probabilities. Human body can be conceptualized
as such a system. Within this Model, the Zone of Chaos expresses the loss
of system adaptability/organized complexity and thus heightened
probability of disease manifestations such cancer. The opposite zone is
marked in the Model as Zone of Entropy where system functionality
diminishes and the bodily system is significantly prone to express
degenerative diseases.

Increasing the arbitrary expansion of "disease" categorizations may
be just an expression of persistent conceptual linear approach to
health/disease fluctuations within, however, a non-linear system that is
the human body. There seems to be a fundamental mismatch.

Janecka IP: Cancer control through principles of systems science,
complexity, and chaos theory: A model. Int J Med Sci 2007; 4:164-173.

Competing interests: No competing interests

12 May 2011
Ivo P. Janecka, MD, MBA, PhD
Foundation for Systems Research and Education