A Picture Of HealthA Picture Of Health

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

please visit:

https://sites.google.com/site/sjlewis55/presentations/seminar2006

A Picture of HealthOn the search for conceptual biological

models of disease and health, and beyond

Stephen Lewis

‘[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)

‘Philosophical reflection never reaches a final goal, and for that reason it must never cease. Fresh angles of approach always await us, and improvement is always possible when we attempt to answer all the large and difficult questions' ...

'[t]he fact that we never reach an absolute final point ... does not mean that we do not make progress.’

Lennart Nordenfelt (Talking about Health, 1997)

Which is a disease and why?

‘Popper points out that essentialist definitions, depending upon intuitive acceptance for their validity, have no place in science.’

(Scadding, 1988)

Which is a disease and why?

Rudolf Virchow(1821-1902)

‘Virchow … towards the latter part of his life, was most outspoken in … declaring that a disease was a living physical entity, an ens morbi:

“In my view the disease entity is an altered part of the body; in principle, an altered cell or cell aggregate … In this sense I am a thoroughgoing ontologist and have always regarded it as a merit to have brought into line with genuine scientific knowledge the old and essentially justified assertion that disease is a living entity … [which has] a parasitic relationship with the otherwise healthy body to which it belongs and at the expense of which it lives.”’

(Taylor, 1980)

From: Wade, D, & Halligan, P (2004)Do biomedical models of illness make for good healthcare systems?BMJ, 329, 1398-1401.

Molecules

OrganismSystems

Organs

Tissues

Cells

‘Reversed reductionism’

Reversing the arrows doesnot an organism make …

‘Constructionism’

… neither does simply putting the bits together.

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

(Marinker, 1975)

The Biopsychosocial model

Theoretical basis(Engel, 1981)

The Biopsychosocial model(Applied)

(Engel, 1981)

Organisms have …

• Physical states that are variable

• Ways of monitoring their physical state so as to ensure survival

Illne

ss

‘Physical State’

Illne

ss

‘Physical State’

Illne

ss

‘Physical State’

Robust constitution

Frail constitution

‘Physical State’ (Degradation)

Illne

ss‘R

efle

xive

Sta

te’

‘Ref

lexi

ve S

tate

’

‘Physical State’ (Degradation)

‘Physical State’

‘Re

flexi

ve S

tate

’

‘Physical State’

‘Re

flexi

ve S

tate

’

Different Individuals

Which is a disease and why?

‘Ref

lexi

ve S

tate

’

‘Physical State’ (Degradation)

The major task of pathologists …

‘to find morphological correlates and biological explanations of phenomena that clinicians and patients call disease.’

William Stempsey (2000)

This …

‘has the implausible consequence of holding that disease is best understood by people who are not physicians.’

William Stempsey (2000)

Acknowledgements:

Konrad Lorenz Institute, Altenberg.

Gerd Müller – ChairmanWerner Callebaut – Scientific ManagerAstrid Jutte – Executive ManagerEva Karner – SecretaryTarquin Mittermayr – Archivist

Daniela Meisel (Austria)Elias Khalil (Palestine) Sabine Brauckmann (Germany)Javier Capdevila (Spain)József Garay (Hungary)Ulrich Krohs (Germany)Sharon Minsuk (US)Igor Popov (Russia)Zoltán Varga (Hungary)Maurizio Tirassa (Italy)George McGhee (US)Lennart Olsson (Sweden)Julien Delord (France)Steve Stearns (US)Mihaela Pavlićev (Slovenia)

Riccardo Draghi-Lorenz (Italy-Austria)

A Picture Of HealthA Picture Of Health

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

please visit:

https://sites.google.com/site/sjlewis55/presentations/seminar2006