To what extent has the 'Biomedical Model' been challenged by recent developments in the thinking about the body, health and medicine.

To what extent has the ‘Biomedical Model’ been challenged by recent developments in the thinking about the body, health and medicine.

The most dominant paradigm view in Modern Western medicine of health illness held by many official health practitioners such as doctors, consultants, and surgeons has been labelled the ‘biomedical approach’ or by some as the ‘medical model’. Throughout the history of Western science, the development of biology has gone hand in hand with that of medicine. Biomedicine was born in the age of scientific revolution of the 17th century however this view did not gain prominence in Britain until the 19th century. The biomedical model assumes that bacteria, a faulty gene, a virus or an accident such as falling down the stairs causes an illness. Furthermore that illness is the result of an identifiable cause. Conversely it is not the result of an evil spirit or curse.

Illness can be identified and classified into different types for example diseases of the nervous system, respiratory diseases and chronic diseases. This whole process of identifying and classifying is viewed as that of an objective nature that has created very little disagreement amongst the medical profession. In addition medical officials identify illnesses for instance doctors and not ‘lay people’, which can be seen as those outside the medical profession. The biomedical model has an emphasis on an Illness being treated and hopefully cured, for example with the use antibiotics can be use to treat infections. Biomedical treatments often involve the removal the cause, for example the virus or bacteria.

Modern biomedicine rests upon two major developments, both of which remain influential to this day. It is first important to consider the Cartesian revolution, after the 17th century French philosophy René Descartes. The Cartesian revolution encouraged the idea that the body and mind are independent or not closely related. In this mechanistic view, the body is perceived to function like a machine, with its individual parts individually treatable.

The second conceptual shift that transformed medical thinking was Louis Pasteur’s development from the 1850s of ‘germ theory’ and Robert Koch’s further development of it. The Germ theory claimed that in certain (for example infectious) diseases, tiny micro-organisms invisible to the naked eye. As Pasteur stated ‘these germs that float in the air’ are always present. By the 1870s Pasteur was able to demonstrate that germs were the cause rather the product of disease. By the 1880s, Robert Koch had elaborated Pasteur’s germ theory into the ‘doctrine of specific aetiology’, which claimed that each disease is always caused by a particular micro-organism.

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A more concise explanation is given by Nettleton states that the biomedical model is based on five assumptions. The first is that the mind and body can be treated separately. This is better known as mind-body dualism. The second assumption is that the body can be ‘repaired like a machine; thus medicine adopts a mechanical metaphor presuming that doctors can act like enginners to mend which is dysfunctioning.’ Thirdly the ‘merit of technological interventions are sometimes overplayed, which results in medicine adopting a technological imperative.’ The fourth point is that is illustrated in Nettleton is that biomedicine is seen as reductionists regime. It is reductionist in a sense that the explanation given of a disease tends only focus on biological factors and to ‘neglect [of] social and psychological factors’. Finally the development of ‘germ theory’ of disease in the 19th century helped to strengthen further social and psychological reductionism.

The main assumptions of the biomedical model are not held by all doctors, nurses and consultants, and some of the assumptions may be held to different degrees. However the biomedical is claimed to dominate the health profession. The issue of the biomedical model is an important one because it has had a great deal of influence on the way in which the National Health Service (NHS) was designed.

The strength of the biomedical is that it attempts to research the cause of each illness rather than assume that there is no identifiable explanation for an illness. For example it is difficult to disbelieve that the heart disease is to do with restricted arteries or that lung cancer is related to smoking cigarettes. It can be argued that knowledge of the cause of an illness is one way in which it can help to be prevented.

Although the biomedical model has its strengths its has been challenged by recent developments. For example Postmodernists are critical of theories that try to explain all phenomena, in this case illness. They are very cautious referring the biomedical model as ‘metathories’.

Social constructionists claim that medical knowledge is only one way of examining health and illness: the biomedical model has just been very successful in attempting to make its knowledge appear superior and legitimate. However social constructionists are very critical of the biomedical model. They are keen to illustrate how the biomedical model gained dominance to illustrate how a dominant group of people have come to shape peoples views of health and illness.

The French theorist Focault(1963) claims that illness has been reformulated by the bio-medical model, by what he calls the ‘new gaze’. This notion of the ‘new gaze’ became a dominant way of looking at and thinking about the body and disease. Diseases were identified and classified, observable causes were tested and spiritual explanations of diseases for example curses were discredited. Propaganda was released to place a distinctive dividing line between official physicians and unofficial ‘quacks’ (unqualified healers). Most of Foucault’s ideas were presented in Birth of the Clinic (1963), which was a treatise on the rise of the biomedical model. One major criticism of Foucault’s work is that it mainly describes the development of the model in France rather than Britain. A further criticism of Foucault is that he concentrated on language or ‘discourse’ as the main way in which medical establishments gained dominance. For Foucault, knowledge was power. His critics saw him as too ‘discourse deterministic’ (Turner 1984) meaning that not all power comes through being able to dominate language.

Foucault claimed discourse led to power through the creation of new terms to describe the body and its conditions. The language can be seen as alien to many ‘lay’ people creating ‘scientific discourse’ and superiority.

Mckeown(1976), a professor of social medicine, demonstrated with the use of historical demographic studies that the decline in mortality which has occurred within Western societies has had more to do with the improvement of nutrition, hygiene and patterns of reproduction rather than vaccinations created by biomedicine

Illich (1976) claims that those in the medical profession have a vested interest in ensuring there is plenty of disease. They do this by claiming health issues are medical problems. This can be seen as ‘medicalising human behaviour’. As controversial as it may seem Illich claims that the medical industry generates illness that it claims it can successfully treat. According to Illich life has been ‘medicalised’.

‘Thus experiences once seen as a normal part of the human condition, such as childbirth, pregnancy, unhappiness, ageing and dying have now been brought under medical scrutiny and control’

The medicalisation of human conditions as stated by Illich is called ‘ social iatrogenesis’. Iatrogenesis basically meaning doctor caused illness.

Once a set of symptoms is defined as an illness drugs can be supplied and technology to the health professionals. Health can be seen a lucrative business, so health companies ‘sponsor illness’ to create sales (Taylor 1994). It is argued by critics of the biomedical model that health care has become focused on treatment, by the use of expensive drugs, labour and technology. In opposed to say prevention, for instance better sanitation, housing, diet and lifestyle. However it can be argued that this trend is beginning to change as there has been an increase in the few years of health prevention campaigns for instance heart disease, breast cancer, and HIV/Aids.

Although there has been a rise in illness narratives, Illich (1976) claims that the medical industry has robbed people of the ability to cope with pain and illness, therefore know need drugs to help them through periods of perceived illness. This process is called ‘cultural iatrogensis’. Medical treatment itself can be damaging. For example the side effects of some drugs like tardiv diskonesia has lead to involuntary moments such as sporadic shaking and also there has been negative consequences of surgery. Illich calls this ‘clinical iatrogensis. In summary, medicalising human conditions, for example ‘worry’ becomes a medical condition called ‘anxiety’. This creates a demand for treatment. Thus social iatrogensis makes us define human conditions as an illness. Cultural iatrogensis makes us seek medical treatment. Clinical iatrogensis can be a result of resulting this treatment.

Although the iatrogensis model put forward by Illich is highly critical of the biomedical model it tends to ignore the fact that medicalising behaviour, as an illness may be a positive process. For example certain problems may benefit from being medicalised like childbirth, which with the aid of medical knowledge can prevent things like death of mother and child.

There is also a feminist critique of the biomedical model. According to Abbott and Wallace (1990) male control over women’s health has evolved deliberately exercising a monopoly over health care. In the process of ‘professionalising’ health care men have assumed control over nearly all aspects of health, including gynaecology and childbirth.

Oakley (1993) claims that men see themselves as the ‘norm’ by which women are judged. Due to this factor she argues that male doctors still hold very inadequate notions of female health, which leads to female problems not being taken seriously. For example depression has sometimes been viewed as an example of female weakness in failing to cope with children and housework. Therefore it argued by feminists that the biomedical model looks to weaknesses in the body rather than the social causes of stress.

There are alternatives to the biomedical model, for example the Patient Centred Model of illness which states that rather than starting with the idea that patient has an identifiable cause such as a bacteria or virus, the doctor could examine the patients perspectives of their own bodily and psychological condition. Arksey (1994) carried out a study to examine how doctors and patients sometimes view their conditions in different ways. He uses the example of RSI (Repetitive Strain Injury) that is seen by many health officals to have no identifiable cause.

‘When we started the project, one of the GP’s said, ‘Well, I think that sounds like quite a good idea but I’m not really into this RSI thing. I think that’s a load of nonsense; I’m not really into it’. Since then, however, he has said that he’s learned a hell of a lot from the experience of talking to the patients and that he now recognises RSI as a problem, quite a major problem at that’ (Arksey, 1994)

The study by Arskey shows that medical knowledge cannot be taken for granted as objective truth. Patients are able to evaluate the advice given by health professionals and perhaps seek for second opinions.

In Britain, there has been a growth in popularity of ‘alternative’ medicines and therapies and recognition ironically of a certain public disenchantment with orthodox medicine provided by biomedicine. Many medical practitioners prefer the term ‘complementary’ medicines to emphasise that they do not necessarily claim to treat all disorders and that they can accept a legitimate role for biomedicine. In general, these therapies are based upon naturalistic theories of health and disease, which are claimed to be holistic, which treat the body as a whole entity. Two of the most institutionalised ‘alternative’/‘complementary’ medicines are osteopathy and chiropractic. This rise can be seen due to this holistic approach to the body. Alternative practitioners are seen to be generally able to offer patients more time, in opposition to the busy doctor who may not stop to discuss problems in detail.

In conclusion, although the biomedical model has been criticised and challenged, it still does not change the fact that it is still the most predominate approach to health. It has been argued by Virilio and Fukuyama that the biomedical has developed in new directions to coincide with the rise of the ‘transplant-revolution’ for example genetic cloning. This can be seen as the beginning of the ‘bio-medical science’ model.