Chapter 9. Biomedical model
9.1. Conceptual basis of biomedical model
The important role in the research methodology of sociology of medicine is played by the comparative medico-sociological analysis of the models and conceptions of health and disease, medical systems, the treatment paradigms, and the healthcare systems.
The theoretical basis of modern scientific medical paradigm of a disease is the biomedical model, which became dominant in Western countries from the end of 18th century. The conceptual basis of the biomedical model originates from those changes in medicine, which occurred in 18th century, when the developed potency to reveal a pathology ‘inside an organism’ had been employed in the methods of objective examination to establish diagnosis. This process was accompanied with the changes in the character of ‘genuine essence’ of the disease, which shifted from the humoral model of Galen (it considered a disease as a perturbation of the balance in the organism) to the status of ‘thing in itself’ detached from one’s ‘ego’ and from sensations of the individual.
Medicine relies in the first place on biology, because its object is the human organism, its physiological state, vital activity, abnormalities, pathologies, the recovery process, etc. Separation of biological nature of human organism from the social essence of the human being is not always permissible, although sometimes it is necessary in certain limits. These changes in medical views took place in the period of dramatic social perturbations in Europe, which accompanied the development of capitalism, the growth of population size, and urbanization.
When observing a spectacular variety in the course of the same disease in dependence on social, biological, and other peculiarities of a patient, many physicians conclude that they should treat namely the patient, not the disease. The opponents stress that despite the variety of external manifestations, the basic mechanisms (etiology and pathogenesis) of a particular disease are identical in different patients, so the physicians should treat the disease. In other words, the doctor should always assess the balance of social and biological parts in any pathological process or phenomenon. The need in such assessment is not incidental, because the biological component is intrinsic to even clearly social phenomena and diseases (AIDS, tuberculosis, drug abuse, alcoholism, etc.). Therefore, the correct assessment of the balance of social and biological components in any specific phenomenon or disease is not only the theoretical task, but it is the problem of everyday practice, health improvement, treatment, rehabilitation, etc.
The biomedical model considers a disease as a consequence of severe dysfunctions in human organism viewed as a very complex biochemical system. By drawing an impregnable boundary line between social and biological constituents of human being, the medical model postulates that the cause of a disease can be located only in the human organism.
Based on the objective data of natural sciences (medicine, biochemistry, biophysics, molecular biology, etc.), the biomedical model claims to attain the true and comprehensive scientific interpretation of health and disease. It considers science as a tool to further expand the knowledge on the human organism and its diseases. While possessing this kind of knowledge, the scientific medicine made spectacular progress in a number of avenues: it completely eliminated some infectious diseases and attained significant results in the struggle against existing and newly emerging diseases.
As a result of such biomedical views, the scientists (especially the Western ones) are inclined to consider an individual as ‘an arena for disease performance’ and the diseases as deviation from normal state. Any disease is characterized with its etiology; it is provoked by a certain identifiable factor (virus, bacterium, parasite, etc.), so the human organism and the disease can be viewed separately from each other resulting in the possibility to ‘repair’ the organism like a mechanical apparatus. This conception can overestimate the potency of technological treatment and lead to the development of exclusively technological approach to medicine.
Verification and elaboration of the biomedical facets of a disease and its treatment do not belong to the tasks of sociology of medicine. In the study of the treatment process, sociology of medicine focuses not only on correction of biological processes, but also on elaboration of the measures, which can eventually eliminate the negative effects of environmental social factors. In some cases, the sociological model of a disease is critical and even opposite to the biomedical one. It assumes that the concept of ‘disease’ cannot be characterized with a single causal scheme: both patient and his/her disease cannot be understood outside the historic, social, and cultural context of the individual.
Sociology of medicine critically analyses three basic tenets of the modern biomedical model.
First, this model assumes that the health and disease are the natural states intrinsic to human organism. However, the diseases are characterized with interactions, interrelations, and even causalities between the social and biomedical processes, so revealing the degree of their interplay can pronouncedly accelerate healing or ameliorate severity of the diseases for an individual and society. From this viewpoint, the treatment cannot be based only on the clinical symptoms established by physicians. It is namely sociology of medicine, which should fill the gap in comprehensive treatment of the disease and patient.
Second, the experimental support of biomedical model resulted from substantiation of its tenets by the discovery of specific etiology. Now, a disease can be provoked artificially by the administration of a particular ‘active principle’, i.e., a pathogenic microorganism, into the organism of a healthy subject. However, there are a number of cases when the concept of specific etiology could not completely reveal the origin of a disease, so it had been vigorously criticized. For instance, many infectious agents are spread virtually everywhere affecting almost all the people. However, not all of them fall ill with the infectious disease. The concept of specific etiology does not provide a reasonable explanation of the multifactorial effects of a broad social environment on liability to the diseases provoked by such factors as stress or undernourishment. In addition, the simple ‘cause-and-effect’ model cannot adequately describe the diagnostic process. Such clinical indications as elevated blood pressure are revealed by analyzing a group of symptoms according to doctor’s and patient’s experience in recognition the disease.