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Dis-ease or Disease? Ontological Rarefaction in the Medical-Industrial Complex

Abstract

Recent scholarship in medical humanities has expressed strong concern over the ability of pharmaceuticals companies to medicalize discomfort and subsequently invent diseases. In this article, I explore the clinical debates over the ontology of the sinus headache as a possible counter-case. Extending Foucault’s concept of principles or rarefaction, this paper documents the efforts of clinicians to resist the pharmaceutically-provided understanding of the sinus headache. In so doing, it offers institutions of rarefaction and rarefactive assemblages as useful heuristics for the exploration of disease legitimization discourse.

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Fig. 1

Notes

  1. 1.

    Atwood, Oryx and Crake, (New York: Anchor Books, 2003), 188.

  2. 2.

    Ibid., 210–211.

  3. 3.

    See, for example, P. Gardner, “Distorted Packaging: Marketing Depression as Illness, Drugs as Cure,” Journal of Medical Humanities, 24 (nos. 1–2): 105–130; K. Aho, “Medicalizing Mental Health: A Phenomenological Alternative,” Journal of Medical Humanities, 29 (no. 4): 243–259; C. Elliott, Better than Well, (New York: W. W. Norton. 2003).

  4. 4.

    In answering these questions I differentiate myself from the bulk of the disease resignification literature in focusing on an illness (sinus headache) that is considered entirely of physiological etiology. The underlying principle behind this case selection is my presupposition of the medical-industrial complex—an integrated entity that includes Western biomedicine writ large, physiological, pharmacological, psychiatric, etc.

  5. 5.

    Ibid., 248.

  6. 6.

    See Elliott, 124.

  7. 7.

    Ibid.,157–158.

  8. 8.

    See Aho, 244.

  9. 9.

    Elliott, 124–125.

  10. 10.

    See Gardner, 124.

  11. 11.

    B. Lewis, “Prozac and the Post-Human Politics of Cyborgs,” Journal of Medical Humanities, 24 (nos. 1–2): 49–63.

  12. 12.

    J. Derrida, “Structure, Sign, and Play in the Discourses of the Human Sciences,” Writing and Differene, trans. A. Bass, (London: Routledge, 1978). Derrida argued that language functions without a central structure and as such is merely the freeplay of signifiers.

  13. 13.

    J. Beaudrillard, Simulacra and Simulation, trans. S.F. Glaser, (USA: University of Michigan Press, 1994). Beaudrillard argued that all reality has been replaced by signs and symbols.

  14. 14.

    Elliott, 124. Italics added.

  15. 15.

    M. Foucault, The Archaeology of Knowledge and the Discourse on Language, trans. A.M. Sheridan Smith, (New York: Pantheon Books, 1972), 216.

  16. 16.

    Ibid., 224–225.

  17. 17.

    Ibid., 224.

  18. 18.

    Ibid., 223–224. I take Foucault’s “within the true” as an effective description of postmodern ontology (hence my title). As the Discourse explained the combined effects of the will to truth and the will to knowledge, “sketched out a schema of possible, observable, measurable and classifiable objects . . . ”—i.e., a collection of objects that can be recognized (through discourse) as being, as existing.

  19. 19.

    Ibid., 219.

  20. 20.

    The MPG is a multidisciplinary pain management educational organization that I have studied as a participant-observer. The data collected for this article is culled both from these observations and from my explorations of the sinus headache medical literature. (IRB approval was obtained for the observational part of this project.)

  21. 21.

    MPG, February 2007.

  22. 22.

    MidAmerica Neuroscience Institute, “So You Think You Have a Sinus Headache?” MidAmerican Neuroscience Institute. http://www.neurokc.com/mani2.aspx?pgID=990.

  23. 23.

    Eross, Dodick, and Eross, “The Sinus, Allergy, and Migraine Study,” Headache, 47 (no. 2): 214.

  24. 24.

    DeNoon, “Sinus Headache Symptoms = Migraine?” WebMD Health News, 2003, http://www.webmd.com/migraines-headaches/news/20030318/sinus-headaches

  25. 25.

    E. Eross, D. Dodick, and M. Eross, “The Sinus, Allergy, and Migraine Study,” Headache 47 (no. 2), 214.

  26. 26.

    See Foucault, 224.

  27. 27.

    Ibid., 223.

  28. 28.

    V. Kumar, A. Abbas, N. Fausto, Robbins and Cotran Pathologic Basis of Disease, 7th ed., (Philadelphia: Elsevier, 2005), 4.

  29. 29.

    I surveyed approximately a dozen pathology textbooks located at two Iowa medical schools (one osteopathic, one allopathic) and two medical archives. The publication dates on these textbooks ranged from the 1880s to 2008. At each of the medical schools, I located the textbooks currently being used in the basic pathology courses for medical students.

  30. 30.

    I. Damjanov, Pathology Secrets, (Philadelphia: Hanley and Belfus, 2005), xiii.

  31. 31.

    See Elliott, Better than Well; C. Whitbeck, “What Is Diagnosis? Some Critical Reflections,” Theoretical Medicine and Bioethics, 2 (no. 3): 319–329; H.T. Engelhardt, “Ideology and Etiology,” Journal of Medicine and Philosophy, 1 (no. 3): 235–268.

  32. 32.

    See Kumar, Abbas, Fausto, 4.

  33. 33.

    Ibid., 4.

  34. 34.

    Aho, 249.

  35. 35.

    R.K. Cady and C.P. Schreiber, “Sinus Headache: A Clinical Conundrum,” Otolaryngologic Clinics of North America, 37 (no. 2): 268.

  36. 36.

    M.E. Mehle and C.P. Schreiber, “Sinus Headache, Migraine, and the Otolaryngologist,” Otolaryngology—Head and Neck Surgery, 133 (no. 4): 490.

  37. 37.

    MPG, February 2007.

  38. 38.

    M.H. Swartz, Textbook of Physical Diagnosis, (Philadelphia: Saunders, 2005), 3.

  39. 39.

    W.W. Barclay, A Manual of Medical Diagnosis: Being An analysis of the Signs and Symptoms of Disease, (Philadelphia: Blanchard and Lea, 1862), 29.

  40. 40.

    S. McGee, Evidence-Based Physical Diagnosis, (St. Louis, Missouri: Saunders/Elsevier, 2007), 4.

  41. 41.

    S.B. Hulley, S.R. Cummings, W.S. Browner, D.G. Grady, and T.S. Newman, Designing Clinical Research: An Epidemiologic Approach, (Philadelphia: Lippincott Williams & Wilkins, 2007), 183.

  42. 42.

    S.M. Hauser and H.L. Levine, “Chronic Daily Headache: When to Suspect Sinus Disease,” Current Pain and Headache Report, 12 (no. 1): 45.

  43. 43.

    Ibid., 45.

  44. 44.

    R.K. Cady et al., “Sinus Headache: A Neurology, Otolaryngology, Allergy, and Primary Care Consensus on Diagnosis and Treatment,” Mayo Clinic Proceedings, 80 (no. 7): 909.

  45. 45.

    Ibid., 909.

  46. 46.

    National Headache Foundation, “The Complete Guide to Headache,” National Headache Foundation, http://www.headaches.org/educational_modules/completeguide/completeguide.html

  47. 47.

    See Mehle and Schreiber, 490.

  48. 48.

    MPG, February 2007.

  49. 49.

    Food and Drug Administration, “Drug Development and Review Definitions,” Food and Drug Administration, http://www.fda.gov/Drugs/DevelopmentApprovalProcess/HowDrugsareDevelopedandApproved/ApprovalApplications/InvestigationalNewDrugINDApplication/ucm176522.htm

  50. 50.

    However, it’s not only pharmaceuticals corporations that benefit materially from disease legitimization. Any disease, if recognized and validated by both the medical community and third-party players, ensures physicians an enormous number of billable hours. And while the legitimization of the disease ensures the billable hours, the mechanism of legitimization determines who gets those hours. Sinus headache, as it currently exists, is treated by otolaryngologists. However, if as many as 90% of sinus headache patients are actually migraineurs, then, by medical standards, they belong to neurologists.

  51. 51.

    Atwood, 188.

  52. 52.

    Ibid., 248–249.

  53. 53.

    S.S. Graham, “Agency and the Rhetoric of Medicine: Biomedical Brain Scans and the Ontology of Fibromyalgia,” Technical Communication Quarterly, 18 (no. 4): 376–404.

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Correspondence to S. Scott Graham.

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Graham, S.S. Dis-ease or Disease? Ontological Rarefaction in the Medical-Industrial Complex. J Med Humanit 32, 167–186 (2011). https://doi.org/10.1007/s10912-011-9137-5

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Keywords

  • Sinus headache
  • Migraine
  • Pathology
  • Diagnostics
  • Ontology
  • Discourse