Information Technology Reference
In-Depth Information
To acknowledge that Medicine, as a discipline, is not independent from society
does not mean that its area of knowledge is arbitrary. In this sense, the normative
role of the World Health Organisation (WHO) must be pointed out; it is similar to
the role of the scientific community when it carries out inter-subjective tests on the
theories and methodologies of scientific research. This normative role is similar to
what in Kuhnian terms would be called the construction of the disciplinary matrix:
the definition of exemplars (typical cases that describe and define an illness), cor-
respondence rules (protocols that standardise a methodology, allowing these exem-
plars to be compared with specific cases) and symbolic generalizations (definition
of aetiology, pandemic, epidemic, etc.) [8].
Two 'exemplar' cases we can cite are Chronic Fatigue Syndrome (CFS) and fi-
bromyalgia. CFS had not been recognised as a physical disease (it was considered
to be a psychological disorder) in the past, but now the WHO has included it as a
disease in ICD-10, classifying it with the G93.3 code. Similarly, until fibromyalgia
was recognised by the WHO in 1992, it had been considered 'neurasthenia'; that is,
a mental and behavioural disorder and not a physical problem.
It must be pointed out that, parallel to the function exercised by the WHO (gen-
erally recognised as a valid source of knowledge), there is social and ideological
pressure which influences what is and is not considered to be an illness. A good
example would be the consideration of homosexuality as an disease. Despite the
fact that in 1973 the American Psychiatric Association rejected the idea that it was
a mental illness and in 1990 the WHO followed suit, in certain social and medical
circles it is still considered to be “
a mental disorder which alters behaviour
”.
Finally, experts also participate in the social construction of the conception of
disease through the diffusion of information. This was starkly illustrated by the
repercussion of the study by Dr. Wakefield published in
The Lancet
, [12], in which
a link was established between the MMR vaccine and autism. The social alarm
generated by this study provoked further research on the matter. Those later stud-
ies produced evidence that refuted Wakefield's findings and exposed his study to
be scientifically unsound. However, despite the scientific community's rejection of
his work due to its numerous methodological and ethical irregularities and despite
the retraction by the researchers who initially supported the results of that study,
there is still a sector of society that continues to accept his hypothesis. As a conse-
quence, a fraction of experts continue to sustain the validity of this study. With this
in mind, it is clear that how we conceive of what is and what is not a disease is so-
cially constructed, and this fact reveals that subjectivity and uncertainty are indeed
incorporated into the field of Medicine.
“If we obscure or discount aspects of the reality in which we engage ourselves,
we are guilty of falsifying not a theory but a problem and, not surprisingly, we tend
to find that the solutions we propose are infected by that falsity.” ([4], p. 737.)
8.5
Experience, Perception and Uncertainty
In practice, a doctor is like an investigator who works to clarify what kind of prob-
lem they are dealing with and discover what its solution might be. In this process
