Principles Behind Definitions of Diseases – a Criticism of the Principle of Disease Mechanism and the Development of a Pragmatic Alternative
- Morten Severinsen
- … show all 1 hide
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Many philosophers and medical scientists assume thatdisease categories or entities used to classify concrete cases ofdisease, are often defined by disease mechanisms or causalprocesses. Others suggest that diseases should always be definedin this manner. This paper discusses these standpoints criticallyand concludes that they are untenable, not only when `diseasemechanism' refers to an objective mechanism, but also when`mechanism' refers to a pragmatically demarcated part of thetotal ``objective'' causal structure of diseases. As an alternativeto principles that use the concept of disease mechanism oranalogous concepts, a pragmatic approach is suggested anddescribed. This approach has been suggested before, but inproblematic or inadequate versions. This paper proposes a versioncompiled of two ``pragmatic principles'' and shows that they aremuch more adequate than the principle of disease mechanism. Withreference to a case study of a still ongoing internationaldiscussion of various candidates for a classification system formalignant lymphomas, including REAL (Revised European–AmericanClassification of Lymphoid Neoplasms) in which the concept ofdisease mechanism or analogous concepts plays a very small part,it is shown just how pivotal these two pragmatic principles canbe in actual discussions of definitions of diseases. Finally, itis pointed out that with regard to modern philosophy of languageit may, at least in some cases, be problematic to distinguishbetween the two pragmatic principles as they stand.
- Vineis P. Definition and classification of cancer: Monothetic or polythetic? Theor Med 1993; 14: 249–256.
- Flier FJ, Robbé PFDV. Nosology and causal necessity; The relation between defining a disease and discovering its necessary cause. Theor Med Bioethics 1999; 20(6): 577–588.
- Hempel CG. Fundamentals of concept Formation in Empirical Science. Chicago: University of Chicago Press, 1952.
- Wulff HR, Pedersen SA, Rosenberg R. Medicinsk filosofi. Copenhagen: Munksgaard, 1990. (Revised edition of: Philosophy of Medicine. Oxford: Blackwell Scientific Publications Limited, 1986.)
- Wulff HR, Gøtzsche PC. Rationel Klinik – Evidensbaserede diagnostiske og terapeutiske beslutninger, 4th edn. Copenhagen: Munksgaard, 1997. (Revised edition of: Wulff HR. Rational Diagnosis and Treatment. Oxford: Blackwell, 1976.)
- Harris HW, Shaffner KF. Molecular genetics, reductionism, and disease concepts in psychiatry. J Med Phil 1992; 17: 127–153.
- Nordenfelt L. On the Nature of Health: An Action-Theoretic Approach (2. revised and enlarged edition). Dordrecht: Kluwer Academic Publishers, 1995.
- D'Amico R. Is disease a natural kind? J Med Phil 1995; 20(5): 551–569.
- Rizzi DA. Klassifikation af sygdomme – kan systematik kun opnås på bekostning af anvendelighed? Nord Med 1991; 106: 246–248.
- Reznek L. The Nature of Disease. London and New York: Routledge and Kegan Paul, 1987.
- Reznek L. Disease about kinds: Reply to D'Amico.J Med Phil 1995; 20(5): 571–584.
- Murphy EA. The Logic of Medicine. Baltimore and London: The Johns Hopkins University Press, 1976.
- Stempsey WESJ. Disease and Diagnosis. Dordrecht: Kluwer Academic Publishers, 1999.
- Mackie JL. Causes and conditions. Am Phil Quart 1965; 2(4): 245–264.
- Whitbeck C. Causation in medicine: The disease entity model. Phil Sci 1977; 44: 619–637.
- Whitbeck C. What is diagnosis? Some critical reflections. Metamedicine 1981; 2: 319–329.
- Engelhardt Jr HT. Typologies of disease: Nosologies revisited. In Schaffner KF, ed. Logic of Discovery and Diagnosis in Medicine. Berkeley, Los Angeles and New York: University of California Press, 1985.
- Jaffe ES et al. World Health Organization classification of neoplastic diseases of the hematopoietic and lymphoid tissues. Am J Clin Pathol 1999; 111(Suppl. 1): S8–S12.
- Jaffe ES et al. Extranodal peripheral T-cell and NK-cell neoplasms. Am J Clin Pathol 1999; 111(Suppl. 1): S46–S55.
- Meusers P, Brittinger G. R.E.A.L. – Klassifikation der Non-Hodgkin-Lymphome aus klinisch-onkologischer Sicht. Schweiz Rundsch Med Prax; 87(23): 793–800.
- Jaffe ES. Hematopathology: Integration of morphologic features and biologic markers for diagnosis. Mod Pathol 1999; 12(2): 109–115.
- Jaffe ES et al. World Health Organization classification of lymphomas: A work in progress. Ann Oncol 1998; 9(Suppl. 5): S25–S30.
- Kripke S. Wittgenstein on Rules and Private Language. Oxford: Oxford University Press, 1982.
- Miller A. Philosophy of Language. London: UCL Press Limited, 1998.
- Engelhardt Jr HT. Ideology and etiology. J Med Phil 1976; 1: 256–268.
- Weng E et al. Accuracy and clinical impact of mediastinal lymph node staging with FDG-PET imaging in potentially resectable lung cancer. Am J Clin Oncol 2000; 23: 47–52.
- Burchill SA, Selby PJ. Molecular detection of low-level disease in patients with cancer. J Pathol 2000; 190(1): 6–14.
- Herman WH, Wareham, NJ. The diagnosis and classification of diabetes mellitus in nonpregnant adults. Prim Care 1999; 26(4): 755–770.
- Principles Behind Definitions of Diseases – a Criticism of the Principle of Disease Mechanism and the Development of a Pragmatic Alternative
Theoretical Medicine and Bioethics
Volume 22, Issue 4 , pp 319-336
- Cover Date
- Print ISSN
- Online ISSN
- Kluwer Academic Publishers
- Additional Links
- disease category
- disease entity
- disease kind
- disease mechanism
- pragmatic principles
- Author Affiliations
- 1. Department of Medical Philosophy and Clinical Theory, University of Copenhagen, Panum Institute, Blegdamsvej 3, DK-2200, Copenhagen N, Denmark E-mail