The Development of Disease: The Case of Aids

  • Mary Ann G. Cutter
Part of the Philosophy and Medicine book series (PHME, volume 81)


Acquired Immunodeficiency Syndrome (AIDS) provides the basis for our initial reflections on the character of disease. It is a relatively familiar clinical phenomenon, much has been written about it, and our understanding of AIDS has changed dramatically in the span of almost two decades (1980–2000), from viewing AIDS as a syndrome to viewing it as a disease in its own right. This chapter takes advantage of this “discovery” and makes three points. First, the more one advances in the process of accounting for disease, the more one deals with entities that are human constructions of thought expressing certain recognizable observables in nature. As an illustration, the first part of this chapter discusses ways in which contemporary medicine has successfully explained AIDS in terms of a syndrome, an etiological agent, and a model (Cutter, 1988). Second, disease explanations seek knowledge for the sake of action. On this, the second section explores how the epistemic (i.e., knowledge-gathering) and non-epistemic (i.e., action-oriented) concerns of disease interact in how we explain AIDS. As one way to link the first two points, the third section discusses the role negotiation plays in fashioning clinical explanation by examining the ways in which socio-cultural forces shape our understanding of AIDS. In short, the movement through the explanatory levels of disease reflects medicine’s effort to understand and to be able to control disease in ways that will facilitate their resolution within particular socio-cultural settings. The following is offered as a way to set the stage for a detailed analysis of disease that takes place in subsequent chapters.


Infectious Disease Specialist Combination Drug Therapy Vulvovaginal Candidiasis Moral Appropriateness Subsequent Chapter 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Chapter Endnotes

  1. 1.
    Explaining“ is from the Greek planus,which means to make smooth or intelligible (Achinstein, 1983). Disease is an explanatory notion in that accounts of clinical problems set out to make intelligible the pathological findings and processes associated with the complaints or actual mal-experiences of patients (Engelhardt and Spicker, 1975).Google Scholar
  2. 2.
    Some scientists believe HIV spread from monkeys to humans between 1926 and 1946 and first appears in Africa in the 1930s. Others claims that, in 1959, a man died in the Congo of what we now call AIDS. Others report that gay men in the U.S. and Sweden—and heterosexuals in Tanzania and Haiti—begin showing signs of what we now call AIDS. In And The Band Played On, journalist Randy Shilts designates Gaetan Dugas (at the 1980 San Francisco gay pride parade) as “Patient Zero,” the man whose erotic penchants and compulsion put him causally at ground zero of the American AIDS epidemic ( 1987, p. 11 ).Google Scholar
  3. 3.
    The term “AIDS” first appeared in the Morbidity and Mortality Report (MMWR) of the Centers for Disease Control (CDC) in 1982 to describe “a disease, at least moderately predictive of a defect in cell-mediated immunity, occurring with no known cause for diminished resistance to that disease” (Centers for Disease Control, 1982). The initial CDC list of AIDS-defining conditions includes Kaposi’s sarcoma (KS), Pneumocystis carnii pneumonia (PCP), Mycobacterium avium complex (MAC), and other conditions. It has been updated on several occasions, with significant revisions (e.g., Centers for Disease Control, 1985, 1986, 1987, 1992).Google Scholar
  4. 4.
    The phenomena of dealing with so-called “emerging disease” is not new. Consider here Lyme’s disease, Legionnaire’s disease, Junta virus, Ebola, and Chronic Disease Syndrome (Cowley, with Hager and Joseph, 1990; National Institutes of Health et al., 1999b). A major cause of the emergence of new diseases is environmental change (e.g., human encroachment into wilderness areas and increased human traffic through previously isolated areas). The re-emergence of some diseases can be explained by the evolution of the infectious agent (e.g., mutations in bacterial genes that confer resistance to antibiotics used to treat disease). The re-emergence of some diseases can be explained by the failure to immunize enough individuals, which results in a greater proportion of individuals susceptible in a population and an increased reservoir of the infectious agent. Increases in the number of individuals with compromised immune systems (due to the stress of famine, war, crowding, or disease) also explain increases in the incidence of emerging and re-emerging infectious diseases.Google Scholar
  5. 5.
    By “clinical problem,” I mean that which patients bring to the attention of health care professionals. Clinical problems include disease, illness, deformity, dysfunction, impairment, trauma, and injury. There has been debate in the literature regarding the use of the term “clinical problem.” Engelhardt, for example, uses the term in a general way to refer to disease, illness, deformity, and medical abnormalities (1996, p. 189ff). It has been suggested that not all foci of attention in the clinical setting are problems (Jennings, 1986; Goosens, 1980), and hence, Engelhardt’s term is misguided. What critics of Engelhardt and others fail to appreciate is that the phenomena brought to clinicians’s attentions are problems from someone’s perspective-whether this is the patient’s, a family member’s, an advocate’s, or an experienced clinician’s. Frankly, most patients are not going to spend the time, energy, and money seeking a clinician if they are not worried about their health. It is important to note that clinical problems do not only include what we refer to as somatic ones involving physical pain, but what we refer to as psychological ones involving mental pain, though the two can never be seen to be distinct and separable.Google Scholar
  6. 6.
    The pattern, which we call a “disease,” has reasonable stability when the criteria remain sharp, the elements cohere, and its utility in clarifying experience remains high (King, 1981 [1954], p. 117).Google Scholar
  7. 7.
    The term “plague” comes from the Gr. term plég4 a blow or misfortune, and refers in some contexts to divine punishment. According to Susan Sontag (1990), in popular culture, AIDS becomes known as the “gay plague.”Google Scholar
  8. 8.
    A positive ELISA test does not mean that you have AIDS; a negative ELISA test does not mean that you don’t have AIDS ( Centers for Disease Control and U.S. Public Health Services, 1998 ).Google Scholar
  9. 9.
    AZT is developed in the late 1980s. The recommended dose is one 100 mg capsule every four hours around the clock.Google Scholar
  10. 10.
    In its 1995 report, the National Institute of Allergy and Infectious Diseases (NIAID) uses the term “HIV disease” (1995, p. 9).Google Scholar
  11. 11.
    In fact, in the early to mid 1990s, such combination drug therapies significantly lead to a decrease in HIV infections. According to a Centers for Disease Control and Prevention Study, 1994–1995 was the first time numbers of AIDS cases began to decrease. During the first quarter of 1994, AIDS death rate was 35.2 per 100 person years. In the first quarter of 1995, the rate dropped to 31.2 per 100 person years when physicians started using the antiviral drugs ZDV (also known as AZT) and 3TC in combination. In 1996, protease-inhibiting drugs came into widespread use and death rates plunged. In the first quarter of 1996, death rates dropped from 29.4 per 100 to 15.4; in the first quarter of 1997, death rates dropped to 8.8 (Munson, 2000, pp. 332–333 ).Google Scholar
  12. 13.
    One is reminded of studies that establish the intimate connection between socio-economic status and health, where the lower the socio-economic status, the poorer the health. See World Health Association (2003).Google Scholar
  13. 14.
    By “theory-praxis dyad” (Gr. dyas,two, consisting of two, a pair of units considered as one), I mean the inextricable relation between theory and practice. A “theory” (Gr. theorib) is a set of hypotheses that posits such entities and properties. Various reductionist, eliminationist, and instrumentalist approaches to theory agree that the full cognitive content of a theory is exhausted by its observational consequences reported by its observations sentences, a claim denied by those who espouse realist accounts of theory. By “praxis” (Gr. prasso,doing, acting), I mean a broad interpretation of practice, or that which is associated with production or exchange (Marx, 1961 [1844]), deed or affair (Dewey, 1925), and the entwined phenomena of discourse, communication, and social practices (Horkheimer, 1982). As Chapter 5 argues, there is a necessary connection between theory and practice in medicine because how one understands the world is a function of one’s interaction in the world, and how one interacts in the world is a function of one’s understanding. As human beings, we know by doing, and do by knowing, a topic that is taken up at greater length in Chapter 5.Google Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2003

Authors and Affiliations

  • Mary Ann G. Cutter
    • 1
  1. 1.University of ColoradoColorado SpringsUSA

Personalised recommendations