On The Place Of Disease And HealthOn The Place Of Disease And HealthIn Human ExistenceIn Human Existence

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

please visit:

https://sites.google.com/site/sjlewis55/presentations/nettuno2003

On The Place OfOn The Place OfDisease And HealthDisease And HealthIn Human ExistenceIn Human Existence

Stephen LewisStephen Lewis

Health is a state of complete Health is a state of complete physical, mental and social well-physical, mental and social well-being and not merely the being and not merely the absence of disease or infirmity.absence of disease or infirmity.

W.H.O.W.H.O.

‘‘In the last quarter of the 20In the last quarter of the 20thth Century we have been witnessing an Century we have been witnessing an intense discussion on the nature of intense discussion on the nature of health … and disease and on the health … and disease and on the meaning of these … basic notions of meaning of these … basic notions of medicine.’medicine.’

Sadegh-Zadeh, K. (2000)

‘‘In the last quarter of the 20In the last quarter of the 20thth Century we have been witnessing an Century we have been witnessing an intense discussion on the nature of intense discussion on the nature of health … and disease and on the health … and disease and on the meaning of these … basic notions of meaning of these … basic notions of medicine. The discussion seems to medicine. The discussion seems to have ended up a blind alley, have ended up a blind alley, however.’however.’ Sadegh-Zadeh, K.

(2000)

Approaches to the definition of Health Approaches to the definition of Health and Diseaseand Disease

• Naturalism Naturalism (Descriptivi(Descriptivism)sm)

• NormativisNormativismm

Associated with:Associated with:

‘‘Humanism’Humanism’Associated with:Associated with:

‘‘Science’Science’

Health ScienceHealth Science Health StudiesHealth Studies

Non-disease:Non-disease:

“ “a human process or problem that a human process or problem that some have defined as a medical some have defined as a medical condition but where people may condition but where people may have better outcomes if the problem have better outcomes if the problem or process was not defined in that or process was not defined in that way.” way.”

“ “Some critics thought it was an Some critics thought it was an absurd exercise, but our primary aim absurd exercise, but our primary aim was to illustrate the slipperiness of was to illustrate the slipperiness of the notion of disease. We wanted to the notion of disease. We wanted to prompt a debate on what is and what prompt a debate on what is and what is not a disease and draw attention to is not a disease and draw attention to the increasing tendency to classify the increasing tendency to classify people’s problems as diseases.”people’s problems as diseases.”

(BMJ 13th April 2002) (BMJ 13th April 2002)

NormalNormal

Disease And Health As A Continuum

Peak of Peak of HealthHealthPathologicaPathologica

ll

AverageAverage

‘The Curve of Biological State’

OptimumOptimum

AverageAverage

‘Bio

log

ical

Sta

te’

Characterization of ‘Biological State’

Chemical/Molecular

Cellular

Tissue

Organ

System

Organism

FunctionUnits

Organisational Levels of the Organism

Organisational Levels of the Organism• OrganismOrganism• Organ SystemsOrgan Systems• OrgansOrgans• TissuesTissues• CellsCells• OrganellesOrganelles• MoleculesMolecules• AtomsAtoms• Sub-atomic ParticlesSub-atomic Particles• ??????

(After Koestler, 1978)

Chemical/Molecular

Cellular

Tissue

Organ

System

Organism

FunctionUnits

Organisational Levels of the Organism

Introduction to the Study ofIntroduction to the Study ofExperimental MedicineExperimental Medicine

(Introduction (Introduction à l’étude de la médicine à l’étude de la médicine expérimentale)expérimentale)

((Claude Bernard Claude Bernard – – 1865)1865)

““the words, life, death, the words, life, death, health, disease, have no health, disease, have no

objective reality.”objective reality.”

NormalNormal

Disease And Health As A Continuum

Peak of Peak of HealthHealthPathologicaPathologica

ll

AverageAverage

‘The Curve of Biological State’

OptimumOptimum

AverageAverage

‘Bio

log

ical

Sta

te’

Characterization of ‘Biological State’

Zero Biological StateZero Biological State

Dead

‘‘Physiological tests reveal that modern Physiological tests reveal that modern man has retained many … physiological man has retained many … physiological and mental attributes ill suited to and mental attributes ill suited to civilized life, just as he has retained civilized life, just as he has retained useless anatomical vestiges from his useless anatomical vestiges from his evolutionary past. As a result, he must evolutionary past. As a result, he must meet the challenges of today with meet the challenges of today with biological equipment largely biological equipment largely anachronistic. Many forms of organic anachronistic. Many forms of organic and mental disease originate from the and mental disease originate from the responses that man's Paleolithic nature responses that man's Paleolithic nature makes to the conditions of modern life.’makes to the conditions of modern life.’

Dubos, R. (1968)

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

Nesse, R.

Evolutionary medicine isEvolutionary medicine is

‘‘[the pursuit of] how evolutionary [the pursuit of] how evolutionary theory can sharpen the efficacy of theory can sharpen the efficacy of medical practice’.medical practice’.

Fabrega, H. (1997)

Natural Selection operates if and when the Natural Selection operates if and when the following conditions are met:following conditions are met:

• Reproduction - entities must have a means Reproduction - entities must have a means of reproducing to form a new generation.of reproducing to form a new generation.

• Heredity - offspring must be like their Heredity - offspring must be like their parents, but there must also be ...parents, but there must also be ...

• Variation - offspring must be able to differ Variation - offspring must be able to differ from their parents in specific characters.from their parents in specific characters.

• Differential ‘fitness’ - the products of the Differential ‘fitness’ - the products of the above differ in their ability to reproduce.above differ in their ability to reproduce.

On The Place Of Disease And HealthOn The Place Of Disease And HealthIn Human ExistenceIn Human Existence

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

please visit:

https://sites.google.com/site/sjlewis55/presentations/nettuno2003