5.05.2008

The Problem with Normal

WIRED Magazine has an interesting, and semi-provocative essay on how medical science does little to distinguish between "normal" and illness by only focusing upon the latter.
Medicine has become all about finding a problem — a tumor, a heart attack, a failing kidney — and deploying advanced treatment technologies. In the process, we seem to have given up on measuring and tracking what constitutes normal.

Thomas Goetz asserts, I think correctly, that this results in overmedicalization (something sport's research uncovers as often being hyper-gendered).
Imaging and scanning tools are now so good at peering inside our bodies, they've surpassed our capacity to interpret the results. Many findings are what doctors call "incidentalomas," smudges that look like cancer but turn out — often after surgery — to be benign.

The article goes awry in two ways. The logical leap at the end of the article ("all [NIH] grants are given a "priority score," an indication of a project's novelty, originality, and "scientific merit." Normal need not apply") is poorly teased out. The NIH may consider the massive effects of a change of perspective as nonmeritorious, but that needs to be more firmly established. More important, there are many, MANY problems with linking boundary conditions of health with "normal." I don't have time to list them all here now (although I will try to write more on this later), but I will say that a more productive line of inquiry might emerge from embodied or phenomenological examination of these things. We should let people define what is livable and help them (as well as the experts) understand what lies ahead and give them the tools to make the most informed choice.

3 comments:

sport said...

They can watch your insides just as well as your outsides, and there IS a gitmo for inappropriate use of your insides. Just ask Michelle Behles. "Behles was accused of causing the death of her unborn child by overdosing on prescription pain and muscle relaxant drugs last September." You cannot even attempt suicide without being convicted of spawn murder.

DC said...

I don't know how much I agree with this. Specifically the part where it's the medical technology and research that causes these effects. (I do agree that these effects are there.) I suggest that the bigger factors are (1) the internet, so that people can figure out for themselves that they want medical attention, and (2) the legal situation, which makes it a far better decision for a doctor to, for example, operate on something that may be benign than to not operate on something that may be malignant.

Of course, I work for a medical technology company...

Doc Mara said...

The author is contending it is a philosophical problem. What he ham-handedly labels as "normal" is really a balanced functionality that our bodies strive for. Medical philosophy is so in love with the technology that we go after every smudge or speck without knowing if it is actually dangerous. If you read the article, you will see that 80% of people with untreated prostate cancer die from something else. Treating it leads to all sorts of nasty possibilities (like peeing and pooping on oneself, and sexual dysfunction). While it is theoretically easy to say it is "a far better decision for the doctor to operate on something that may be benign than to not operate on something that may be malignant," it's harder in practice. Do you tell your wife "too bad, so sad that they don't know what that bump deep inside your reproductive organs could lead to--better cut it out," or do you weigh what the odds are that the blob is truly bad vs. the high odds that it may leave her without the ability to have a child (or even die or be maimed on the operating table). The author is contending that we should look at medical technology through the philosophical lens of what the human body can heathily coextist with rather than taking a "cut it off...we don't know what that is!" approach. Do you think we should continue to just look for the threat and ignore what human bodies generally do O.K. with? Because that's the current approach of medicine (and, frankly, I think the litigation you talk about is VERY connected to the "doctors must be gods because they have all these tools that can extend life indefinitely" philosophy underpinning this drive).