A new trend in medicine: redefining disease

Paul Wolpe, PhD

You may have already heard that last month Emory held its fifth annual predictive health symposium “Human Health: Molecules to Mankind.” Researchers, physicians, health care workers and members of the community from throughout the country met to learn about intriguing research and provocative commentary by health care experts.

One of those experts, Paul Wolpe, director of the Emory Center for Ethics, says health care has changed as more and more aspects of ordinary life or behaviors are being redefined as medical. For example, being drunk and disorderly has become alcoholism. Now, virtually all of life is being redefined in biological terms, he says. And that, says Wolpe, has led to an increase in health care costs. We have an enormous amount of new things that we are calling illness, and we expect our health care system to treat them, he says. “We are creating a new category of disease called pre-symptomatic.”

Wolpe says that if one looks at how disease was conceptualized in the first half of the 20th century, it was done at the level of organs and cells. Now, we conceptualize disease at the level of genes, molecules and proteins. “The very shift of our fundamental way of conceptualizing what disease is changes the way we look at regular diseases,” he says.

For example, schizophrenia was once considered a disease, now it’s conceptualized as many, many diseases. This will mean new treatment strategies depending on what form of schizophrenia one has, he says.

And we’re generating diseases in other way, too. We greatly expand what we consider to be dysfunction through the creation of new ways to treat them. “The existence of the treatment changes the nature of the disorder, or it creates actual new disorders,” says Wolpe.

For example, there used to be a disorder called social phobia. But with the creation of Paxil, that disorder was replaced by a more marketable term “social anxiety disorder,” he says. So, what we have is a treatment generating a newly conceptualized disorder, which “many, many” more people now have, he explains. “Before Paxil that was a very rare diagnosis. Now it’s actually fairly common because we have something to treat it with. This is the process of modern disease generation.”

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