A Complexidade do Conceito de Doença


Por que o conceito de doença é importante para um clínico? Normalmente, os médicos não estão preocupados se o conceito de doença que utilizam é ontológico ou fisiológico, normativo ou descritivo. O que é importante e o que tem sido amplamente discutido é o bombardeio de questões provenientes de pacientes, da mídia, de setores da medicina alternativa e até de outros médicos sobre as bases do raciocínio clínico – cujo ponto de partida é o conceito de saúde e de doença. A crítica principal normalmente gira em torno da medicalização da Medicina e a sua contrapartida teórica: a patologização do curável, nos quais o conceito contemporâneo de doença é altamente implicado.
Sobre isso, segue um excerto do trabalho de Bjorn Hofmann (para o texto completo clique aqui):
“I have argued here that the debate on the concept of disease is complex, and that this complexity can be recognised in the theoretical frameworks of the debate. The profound philosophical issues underlying the debate illustrate the complexity of the concept. That is, the complexity of the concept is displayed by the complexity of the categories of the debate. There is something outstanding to the concept of disease generating logical, ontological, epistemological and normative challenges. The concept appears to be irreducible to a particular perspective or a monistic conception. Even if we could answer the question of the ontological status of instances of disease, its classificatory and normative issues would not be resolved. Correspondingly, if we cleared the evaluative status of disease, the ontological, semantical and epistemological issues would still be open. These issues seem not to be inter-reducible. However, is this only a theoretical complexity? People are actually treated in the health care system without there being any reflections of this kind. Are the challenges only of an abstract kind? The complexity in the theoretical frameworks appears to be more than a mere academic issue, and it is reflected in medical practice. Whether pregnancy, excellence, infertility, whiplash, or a general feeling of incompetence are cases of disease are practical issues, and even the status of homosexuality as a disease has been a topic in clinical practice until recently. Furthermore, the classification of disease entities is a great challenge to modern medicine. A strict and consistent concept of disease, be it theoretical or practical, should result in a strict and consistent taxonomy, which obviously is not the case. Disease entities are classified according to symptoms, syndromes, physical signs, paraclinical signs, abnormalities of morphology, physiological aberrations, genetic abnormalities, ultrastructural abnormalities, etiological agents and according to eponymal origin. Hence, the theoretical complexity discussed in this study corresponds to a practical complexity, and as far as the conceptual debate on disease is concerned, the concept should give practical guidance and pave the way to a tidier practice. In this respect it has certainly failed. The reason for this is reflected in the complexity of the theoretical frameworks. My aim has not been to argue that the profound issues revealed in this study are final and absolute for the debate on the concept of disease. A conceptual debate of human disease may follow other lines of thought. The presentation has been one attempt to structure the categories of the debate. However, I would argue that any investigation of these categories has to take into account the theoretical complexity. The profound philosophical distinctions of the debate show that the concept of disease involves fundamentally different issues. Disease is basically an issue that is so complex that it appears extremely difficult to encompass it by a single monistic theory.”

Discussão - 2 comentários

  1. Aleph disse:

    Karl, dê uma olhada nisto:”2006 Study of CT Screening for Lung Cancer Supported by Tobacco Money”:A study advocating annual screening for lung cancer with spiral computed tomography was sponsored by a tobacco company, the New York Times reports.The study, published Oct. 26, 2006, in the New England Journal of Medicine, concluded that the screening was “highly cost-effective.” Commentators at the time expressed skepticism. NEJM’s editor expressed surprise at the connection, telling the Times that in his tenure the journal has “never knowingly published” tobacco-supported research.The Times reports that the authors’ foundation received some $3.6 million from the parent company of the Liggett Group, a cigarette maker. According to the Times, the authors’ institution holds or is applying for patents related to the screening and follow-up — itself the subject of a late disclosure online in JAMA this week.The authors deny any attempt to conceal the source of the funding, the Times reports, and say that their foundation no longer acceptstobacco-industry grants.Mudamos nós ou o New England?Abraço!

  2. Karl disse:

    De onde é esse reportagem, Caro Aleph?Esse estudo deu muito o que falar. Tem vários problemas metodológicos: realizaram CT de tórax em 30 mil participantes que eram ex-fumantes ou com risco de câncer, diagnosticaram Ca de pulmão em 484, dos quais 412 (85%) tinham a doença no estágio inicial. A sobrevida em 10 anos foi de 88% nesse subgrupo. Entre os 302 participantes com estágio inicial que foram operados no primeiro mês de diagnóstico, a sobrevida subiu para 92%. Os 8 com doença na fase inicial que não receberam tratamento, morreram dentro de 5 anos depois do diagnóstico. Parece bom, né? Mas o editorial já chama a atenção para o título muito bem escolhido: não é um teste para a validade do screening, é a sobrevida de pacientes detectados em estadio I.Por não ser um estudo randomizado e controlado dá margem aos famosos viéses de rastreamento. Como não há um grupo controle, somente podemos comparar os resultados deste estudo com controles históricos.Mas que tinha sido financiado pela indústria do tabaco, eu não sabia. Bem, se a Big Pharma financia estudos, porque não a indústria do tabaco. Ou do vinho? Neste último caso, quero participar também…Abs

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