Knowing and Treating Disease
Clinical medicine is an applied science. It is the search for explanation and prediction in the service of practical goals, e.g., the achievement of well-being and the avoidance of impairments. Since one is interested in applying knowledge, the success of such applications is judged primarily by practical standards. Disease concepts involve a complex interplay between two major goals: (1) to know clinical reality, and (2) to alleviate pain and suffering and to prevent premature death and disability. Clinicians wish to establish through concepts of disease the regularities of occurrences among clinical phenomena and to find enlightening and useful models to account for these regularities. In this way, clinicians function as medical scientists seeking to know the world. Ingredient to the task of knowing disease are judgments concerning how to alleviate pain and suffering. As this chapter shows, such judgments are complex and varied. Theory and practice are two aspects of human endeavor that clinicians’ intellectual interests sustain.
KeywordsSevere Acute Respiratory Syndrome Symptomatic Treatment Severe Acute Respiratory Syndrome Public Health Official Health Care Practitioner
Unable to display preview. Download preview PDF.
- 1.There is little analysis of therapy and the relation between knowing and treating in medicine.Fordiscussion of therapy, see Lasagna (1962), Reiser (1978), Rosenberg (1979), Davis (1971), Achterberg (1991), Vogel and Rosenberg (1979). For discussion of medical technology, see Reiser (1978), Davis and Appel (1979), Davis (1971), and Davis (1981). General discussion of the relation between theory and practice is found in Bernstein (1971) and Lobkowicz (1967). Discussion specific to disease may be found in Engelhardt (1986), Pellegrino (1983), Wartofsky (1975, 1975, 1977, 1992), and Hudson (1983, Chs. 9 and 10 ).Google Scholar
- 2.In other ways, symptomatic treatments provide little prediction and control. It is difficult to imagine, for instance, that any beneficial somatic effect was obtained by the treatment ofa mad dog’s bite with angelica root (13th C Denmark), diabetes or piss-pot disease with burnt hedgehog (18th C. England), or gastric ulcer with cantharides (19th C. Denmark) (Wulff, 1981b, p. 123). It was difficult to achieve success absent sufficient knowledge of the course of particular diseases and an appreciation of random variation, the placebo effect, and clinician bias in interpreting results.Google Scholar
- 3.Also see Wartofsky (1992, pp. 137–138) and Pellegrino and Thomasma, 1981, p. 27).Google Scholar
- 4.For Marx ( 1961 ), humans are what they do; their social praxis shapes and is shaped by the complex web of historical institutions and practices within which they function and work. Marx reveals to us and focuses his attention on the “paradox” of human activity in its social forms. For it is the human individual, or rather classes of human individuals, that constantly and continuously create and reinforce the social institutions that pervade human life. These are the objectivications of social praxis. And yet these institutions-especially when understood in terms of political economy-have the consequences not of freeing praxis and creating those conditions which allow for enjoyment of individuality, but of enslaving or stifling the human individual, dehumanizing and alienating him or her. On this analysis, a goal might be to revise the objectivication of social praxis and thus the alienation of groups of individuals. Again we are reminded of the importance of incorporating the empirical order into our analysis.Google Scholar
- 5.Some might, of course, as in the case of faith healers (Torkelson, 2000, p. 5A).Google Scholar
- 6.The view that theory drives practice is expressed in Hegel’ s account of the theory-practice relation. As he says: “The ultimate aim and business of philosophy is to reconcile thought with reality” (Hegel, 684, tr. Haldane and Simson, 1955, III, p. 545), not to tell the world how it ought to be, and not to try to reform it or to revolutionize it. As a feature of reality, thought or reason is that character of being that permits the mind to penetrate the whole of reality without presupposing anything except itself. As a human capacity, it is the mind’s ability to recognize itself in whatever it approaches. Thought is that which is common to all minds and to all reality, the basic character of what is, the substance and the infinite power of all natural and spiritual life. For Hegel, theory has precedence over practice. “In knowledge alone it knows itself as absolute spirit; and this knowledge, or spirit, is its only true existence” (Hegel, 690, tr. Haldane and Simson, 1955,111, p. 552). The view that practice precedes theory is supported by Karl Marx. In the history ofphilosophy, Marx argues that there are “key points” during which philosophy becomes universal and all embracing, thus interrupting its own “linear progress.” In the aftertimes, philosophy abandons its purely theoretical attitude and appears on the historical scene as a “practical person (praktische Person),hatching intrigues with the world” (Marx, 1961 , 131, as quoted in Lobkowicz, 1967, p. 241). In short, after philosophy has reached a definite degree of universality, it ceases to be contemplative and becomes active. The spectator or philosopher becomes an actor. The philosopher does not become an actor only because the door to further theoretical developments is slammed. Philosophy throws its eyes away “because its heart has become strong enough to create aworld” (Marx, 1961 , p. 131, as quoted in Lobkowicz, 1967, p. 241). As Marx puts it, once spirit has reached a definite level of universality, and thus also freedom, it turns into “energy.” It becomes will (Marx, 1961 , p. 64, as quoted in Lobkowicz, 1967, p. 241); it becomes action.Google Scholar
- 7.Innatism (e.g., Ralph Cudworth [1617–1688])) refers to the view that human reason has inherited immutable intellectual, moral, and religious notions, which negate the claims of empiricism.Google Scholar
- 8.Phenomenalism (e.g., C.I. Lewis [1898–1963], 1946) refers to the study of direct description of our experience as it is in itself without taking into account its psychological origin and its causal explanation.Google Scholar