Lecture 4

1. Lecture 4 The Basis of bio-Medicine and Challenges to the Biomedical model.

2. 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

3. 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.

4. 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.

5. Modern biomedicine rests on two major developments 1 • The Cartesian revolution(Rene Descartes). • Dualistic approach • mechanistic view • body as machine

6. 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 Corbin’s ‘The Foul and the Fragrant’

7. 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.

8. 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

9. 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.

10. 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

11. 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

12. 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.

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

14. 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

15. 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

16. 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

17. 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 body’s ability to recuperate • disease as natural / part of life

18. 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 • Doesn’t require ‘expert’ knowledge

19. 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)

20. 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 'NRM’s’' 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

21. ‘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