The Disease Philosophy
I'm procrastinating very hard for my finals, so I thought I'd take the time to share some thoughts I've had along the way.
One of the things that has consistently puzzled me during my medical education is that lots of the things that are considered diseases are things many or most of us will eventually get. Hypertension, obesity, depression, high cholesterol, all those chronic diseases that plague our species, are as common as blue eyes or freckles. The only thing that defines them as a disease is their consequences.
I've got a background in biochem, and studied quite a bit of genetics along the way. In genetics, any variant present in more than 10% of the population is considered "normal". I have trouble wrapping my mind around the idea that something like hypertension, which most people will experience if they live long enough, is a disease in any meaningful sense. People have different lifespans and they have different challenges. Not all of these have to represent an illness.
But the problem goes deeper than that. Many of these diseases represent an inability for the individual to function adequately in society. That's clear-cut with the psychiatric illnesses, but it's just as true with many physical chronic diseases as well. Hypertension, high cholesterol, type 2 diabetes- they essentially don't exist in populations who eat well and exercise, whatever their age or genetics. These diseases represent an war betwen biology and culture, with the indvidual getting caught in the crossfire.
And yet, it is the individual, the unfortunate patient with depression or diabetes, who is considered sick. Treatment focuses on either allowing them to participate fully in the culture without suffering the consequences of disease, or on encouraging them to withdraw from the culture to the point that the disease won't be a problem anymore. We give them medications and send them back to their desk job and their fast food meals, or we tell them to get a different job, start cooking vegetables. We give them prozac, or we help them arrange their lives so that the situations that trigger their depression don't arise. But we never shift the responsibility for this disease off of the patient and onto the place it belongs- the society itself.
It's not the people who are sick, it's the world we all live in. A world where fried grease is cheaper than vegetables. A world where we work at computer desks getting paid to offer services to people who offer services to people who pay workers in China less than minimum wage to make us computers and desks. A world where dreams are encouraged only as long as they're American. We're part of a great social machine, and any part of the machine that can't function appropriately is considered diseased. Take the parts out into the sunlight, and they'd do just fine.
So I'm starting to wonder about a question that one of my professors keeps putting to us: what would it take to make a healthy society? How could we actually fix the real disease here, instead of just slapping band-aids on its symptoms? Most importantly, how could we do it while still leaving people freedom of choice? Because this mess we're all in- we've gotten here for the noblest of reasons. And I'm not sure the noblest of reasons will get us out again.
But it's worth thinking about.
One of the things that has consistently puzzled me during my medical education is that lots of the things that are considered diseases are things many or most of us will eventually get. Hypertension, obesity, depression, high cholesterol, all those chronic diseases that plague our species, are as common as blue eyes or freckles. The only thing that defines them as a disease is their consequences.
I've got a background in biochem, and studied quite a bit of genetics along the way. In genetics, any variant present in more than 10% of the population is considered "normal". I have trouble wrapping my mind around the idea that something like hypertension, which most people will experience if they live long enough, is a disease in any meaningful sense. People have different lifespans and they have different challenges. Not all of these have to represent an illness.
But the problem goes deeper than that. Many of these diseases represent an inability for the individual to function adequately in society. That's clear-cut with the psychiatric illnesses, but it's just as true with many physical chronic diseases as well. Hypertension, high cholesterol, type 2 diabetes- they essentially don't exist in populations who eat well and exercise, whatever their age or genetics. These diseases represent an war betwen biology and culture, with the indvidual getting caught in the crossfire.
And yet, it is the individual, the unfortunate patient with depression or diabetes, who is considered sick. Treatment focuses on either allowing them to participate fully in the culture without suffering the consequences of disease, or on encouraging them to withdraw from the culture to the point that the disease won't be a problem anymore. We give them medications and send them back to their desk job and their fast food meals, or we tell them to get a different job, start cooking vegetables. We give them prozac, or we help them arrange their lives so that the situations that trigger their depression don't arise. But we never shift the responsibility for this disease off of the patient and onto the place it belongs- the society itself.
It's not the people who are sick, it's the world we all live in. A world where fried grease is cheaper than vegetables. A world where we work at computer desks getting paid to offer services to people who offer services to people who pay workers in China less than minimum wage to make us computers and desks. A world where dreams are encouraged only as long as they're American. We're part of a great social machine, and any part of the machine that can't function appropriately is considered diseased. Take the parts out into the sunlight, and they'd do just fine.
So I'm starting to wonder about a question that one of my professors keeps putting to us: what would it take to make a healthy society? How could we actually fix the real disease here, instead of just slapping band-aids on its symptoms? Most importantly, how could we do it while still leaving people freedom of choice? Because this mess we're all in- we've gotten here for the noblest of reasons. And I'm not sure the noblest of reasons will get us out again.
But it's worth thinking about.