Boundaries of disease: disease and risk
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Sep 14, 2024
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Abstract
Increasingly, medical care targets conditions, like hypertension and hypercholesterolemia, which are defined as ranges of some clinical variable, not by any concrete physical pathology. These ranges are usually chosen from data on modifiable risk, as well as by other empirical consequences. Such purported disease categories face three main criticisms, one practical and two conceptual. The practical issue is overdiagnosis: the fear that more people suffer harm than benefit from such diagnoses. The second issue is Schwartz’s and Accad’s complaint that disease and risk of disease must not be confused. The third issue is that most of the literature on risk-based diseases wrongly assumes a conceptual connection between disease and medical treatment. In this essay I analyze these issues about risk-based diseases from the viewpoint of my biostatistical analysis of health and disease. I reach no conclusion on the first, the overdiagnosis of specific conditions. But I conclude that the two conceptual criticisms are wholly valid: in traditional medical thought, neither risk nor treatability implies pathologicity. So Pickering was right: current categories of hypertension, high cholesterol, and the like are not true diseases, nor even diagnostic criteria for true diseases. They are, at best, only categories of justified medical treatment.
Keywords:
disease, pathology, risk, overdiagnosis, hypertension, hypercholesterolemia, diabetes mellitus, osteoporosis, biostatistical theory
Article Details
How to Cite
BOORSE, Christopher.
Boundaries of disease: disease and risk.
Medical Research Archives, [S.l.], v. 12, n. 3, sep. 2024.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/3599>. Date accessed: 31 dec. 2024.
doi: https://doi.org/10.18103/mra.v11i4.3599.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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7 Boorse C. A second rebuttal on health. Journal of Medicine and Philosophy 2014;39:683-724.
8 Wakefield JC. The concept of mental disorder: on the boundary between biological facts and social values. American Psychologist 1992;47:373-88.
9 Wakefield JC. Evolutionary vs. prototype analyses of the concept of disorder. Journal of Abnormal Psychology 1999; 108:374-99.
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14 National Institutes of Health. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III): Executive Summary [NCEP-III]. Washington, DC: NIH Publication No. 01-3670; 2001.
15 Schwartz LM, Woloshin S. Changing disease definitions: implications on disease prevalence. Effective Clinical Practice 1999;2:76-85.
16 Welch HG, Schwartz L, Woloshin S. Overdiagnosed: Making People Sick in the Pursuit of Health. Boston: Beacon Press; 2011.
17 Accad M, Fred HL. Risk-factor medicine: an industry out of control? Cardiology 2010;117:64-67.
18 Accad M, Fred HL. On redefining hypertension. Texas Heart Institute Journal 2010;37:439-41.
19 World Health Organization. Obesity: Preventing and Managing the Global Epidemic. Geneva: WHO; 2000.
20 Oliver JE. Fat Politics. NY: Oxford; 2006.
21 World Health Organization. Definition and Diagnosis of Diabetes Mellitus and Intermediate Hyperglycemia. Geneva: WHO; 2006.
22 Boorse C. Wright on functions. Philosophical Review 1976;85:70-86.
23 Giroux É. Les facteurs de risque et le problème de la démarcation entre le normal et le pathologique: une analyse épistémologique. Revue de médecine interne 2010;31:651-4.
24 Prohaska A et al. Human disease variation in the light of population genomics. Cell 2019;177 (March 21):115-131.
25 Law MR, Wald NJ. Risk factor thresholds: their existence under scrutiny. BMJ 2002;324:1570-76.
26 Chobanian AV et al. Seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure [JNC-7] Hypertension 2003;42:1206-52.
27 Stamler J et al. Relationship of baseline serum cholesterol levels in three large cohorts of younger men to long-term coronary, cardiovascular, and all-cause mortality and to longevity. JAMA 2000;284(3):311-18.
28 Wootton D. Bad Medicine. NY: Oxford University Press; 2006.
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31 Whelton P K. et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Hypertension 2018;71:e13-e115.
32 Doust J et al. Guidance for modifying the definition of diseases: a checklist. JAMA Internal Medicine 2017;177(7):1020-25.
33 Culver C M, Gert B. Philosophy in Medicine. NY: Oxford; 1982..
34 Clouser KD, Culver CM, Gert B. Malady. In Humber JM, Almeder RF, ed., What is Disease? Totowa, NJ:
Humana Press; 1997:175-217.
35 Temple LKF, McLeod RS, Gallinger S, Wright, J G. Defining disease in the genomic era. Science 2001;293:807-8.
36 U.S. Health and Human Services. Health, United States, 2003. Washington, DC: US Government Printing Office; 2003.
37 Singh SP. Somatotype and disease: a review. Anthropologist Special Volume no. 3:251-61; 2007.
38 Koleva M, Nacheva A, Boer M. Somatotype and disease prevalence in adults. Rev Environ Health 2002;17:65-84.
39 Wilson BR et al. Somatotype and longevity of former university athletes and nonathletes. Res Q Exerc Sport 1990;61:1-6.
40 Hamilton JB, Mestler GE. Mortality and survival: comparison of eunuchs with intact men and women in mentally retarded populations. Journal of Gerontology 1969;24:395-411.
41 Cherouveim P, Vagios S, Hammer K, Fitz V, Jiang V, James K, Dimitriadis I, Bormann C, Souter I. The impact of cryopreserved sperm in intrauterine insemination (IUI) outcomes: Is frozen as good as fresh? Human Reproduction 2022;37(Supp): 30 June. https://doi.org/10.1093/humrep/deac105.098
42 Viera AJ. Predisease: when does it make sense? Epidemiologic Reviews 2011;33:122-34.
43 Rogers WA, Walker MJ. Precising definitions as a way to combat overdiagnosis. Journal of Evaluation in Clinical Practice 2018;2018:1-3.
44 Vickers AJ, Basch E, Kattan MW. Against diagnosis. Annals of Internal Medicine 2008;149(3):200-3.
45 World Health Organization. Assessment of Fracture Risk and its Application to Screening for Postmenopausal Osteoporosis. Geneva: WHO; 1994.
46 Silverthorn DU. Human Physiology: An Integrated Approach. 5th ed. San Francisco: Pearson; 2010.
47 Hucklenbroich P. (2014). ‘Disease entity’ as the key theoretical concept of medicine. Journal of Medicine and Philosophy 2014;39(6):609-33.
48 Boorse C. Concepts of health and disease. In Gifford F, ed., Philosophy of Medicine. NY: Elsevier; 2011:13-64.
49 Binney N. Osteoporosis and risk of fracture: reference class problems are real. Theoretical Medicine and Bioethics 2022.
50 Binney N. Health-adjusted reference classes and low bone mineral density. Forthcoming in Journal of Medicine and Philosophy.
51 Gard M, Wright J. The Obesity Epidemic: Science, Morality, and Ideology. NY: Routledge; 2005.
52 Gard M. The End of the Obesity Epidemic. NY: Routledge; 2011.
53 Taubes G. Why We Get Fat and What to Do About It. NY: Knopf; 2011.
54 Teicholz N. The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet. NY: Simon and Schuster; 2014.
55 Rubin E, Gorstein F, Rubin R, Schwarting R, Strayer D. Pathology: Clinicopathologic Foundations of Medicine. 4th ed. Philadelphia: Lippincott Williams and Wilkins; 2004.
56 Cotran RS, Vinay K, Collins T. Pathologic Basis of Disease. 6th ed. Philadelphia: W.B. Saunders; 1999.
57 Pickering GW. The concept of essential hypertension. Ann Intern Med 1955;43(6):1153-60.
58 Wald NJ, Law MR. A strategy to reduce cardiovascular disease by more than 80%. BMJ 2003;326:1419-23.
59 National Heart Foundation of Australia. Guidelines for the Diagnosis and Management of Hypertension in Adults. Melbourne: NHFA;2016.
60 Mancia G et al. 2007 ESH-ESC practice guidelines for the management of arterial hypertension. Journal of
Hypertension 2007;25(9):1751-62.
61 Williams B et al. Guidelines for management of hypertension, report of the fourth working party of the British Hypertension Society. Journal of Human Hypertension 2014;18(3):139-85.
62 Moynihan RN, Clark J, Albarqouni L. Media coverage of the benefits and harms of the 2017 expanded definition of high blood pressure. JAMA Internal Medicine 2019;179(2):272-3.
63 Whelton PK, Williams B. The 2018 European Society of Cardiology and 2017 American College of Cardiology/American Heart Association blood pressure guidelines: more similar than different. JAMA 2018; 320(17):1749-50.
64 Bell KJL, Doust J, Glasziou P. Incremental benefits and harms of the 2017 American College of Cardiology/American Heart Association high blood pressure guideline. JAMA Internal Medicine 2018;178(6):755-7.
65 Jungner G, Wilson JM. Principles and Practice of Screening for Disease. Geneva: World Health Organization; 1968.
66 Rose G. Rose’s Strategy of Preventive Medicine. 2nd ed. NY: Oxford University Press; 2008.
67 Accad M. Moving Mountains: A Socratic Challenge to the Theory and Practice of Population Medicine. Green Publishing; 2011.
68 Priest G. An Introduction to Non-Classical Logic. 2nd ed. NY: Cambridge University Press; 2008.
69 Hesslow G. Do we need a concept of disease? Theoretical Medicine 1993;14:1-14.
70 Boorse C. The meaning of clinical normality. Medical Research Archives 2022;10(7):1-16. https://doi.org/10.18103/mra.v10i7.2866
2 Accad M. More reasons statin drugs are shunned. American Journal of Cardiology 2011;106:957.
3 Greene JA. Prescribing by Numbers: Drugs and the Definition of Disease. Baltimore: Johns Hopkins Press; 2007.
4 Boorse C. Health as a theoretical concept. Philosophy of Science 1977;44:542-73.
5 Boorse C. Concepts of health. In VanDeVeer D, Regan T, ed., Health Care Ethics: An Introduction. Philadelphia: Temple University Press; 1987.
6 Boorse C. A rebuttal on health. In Humber JM, Almeder RF, ed., What is Disease? Totowa, NJ: Humana Press; 1997: 1-134.
7 Boorse C. A second rebuttal on health. Journal of Medicine and Philosophy 2014;39:683-724.
8 Wakefield JC. The concept of mental disorder: on the boundary between biological facts and social values. American Psychologist 1992;47:373-88.
9 Wakefield JC. Evolutionary vs. prototype analyses of the concept of disorder. Journal of Abnormal Psychology 1999; 108:374-99.
10 National Center for Health Statistics, www.cdc.gov/nchs, Publications: Health, United States, Fast Stats, and Key statistics from NHANES.
11 Centers for Disease Control. National Diabetes Statistics Report, 2020.
12 World Health Organization. International Statistical Classification of Diseases and Related Health Problems [ICD-10]. Geneva: WHO; 1992.
13 Boorse C. Goals of medicine. In Giroux E, ed., Naturalism in the Philosophy of Health: Issues and Implications. Switzerland: Springer International Publishing; 2016:145-77.
14 National Institutes of Health. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III): Executive Summary [NCEP-III]. Washington, DC: NIH Publication No. 01-3670; 2001.
15 Schwartz LM, Woloshin S. Changing disease definitions: implications on disease prevalence. Effective Clinical Practice 1999;2:76-85.
16 Welch HG, Schwartz L, Woloshin S. Overdiagnosed: Making People Sick in the Pursuit of Health. Boston: Beacon Press; 2011.
17 Accad M, Fred HL. Risk-factor medicine: an industry out of control? Cardiology 2010;117:64-67.
18 Accad M, Fred HL. On redefining hypertension. Texas Heart Institute Journal 2010;37:439-41.
19 World Health Organization. Obesity: Preventing and Managing the Global Epidemic. Geneva: WHO; 2000.
20 Oliver JE. Fat Politics. NY: Oxford; 2006.
21 World Health Organization. Definition and Diagnosis of Diabetes Mellitus and Intermediate Hyperglycemia. Geneva: WHO; 2006.
22 Boorse C. Wright on functions. Philosophical Review 1976;85:70-86.
23 Giroux É. Les facteurs de risque et le problème de la démarcation entre le normal et le pathologique: une analyse épistémologique. Revue de médecine interne 2010;31:651-4.
24 Prohaska A et al. Human disease variation in the light of population genomics. Cell 2019;177 (March 21):115-131.
25 Law MR, Wald NJ. Risk factor thresholds: their existence under scrutiny. BMJ 2002;324:1570-76.
26 Chobanian AV et al. Seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure [JNC-7] Hypertension 2003;42:1206-52.
27 Stamler J et al. Relationship of baseline serum cholesterol levels in three large cohorts of younger men to long-term coronary, cardiovascular, and all-cause mortality and to longevity. JAMA 2000;284(3):311-18.
28 Wootton D. Bad Medicine. NY: Oxford University Press; 2006.
29 Sydenham T, Latham RG. The Works of Thomas Sydenham, MD. Printed for the Sydenham Society; 1850.
30 Sheps SG et al. The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure [JNC-6]. National Institutes of Health, Publication No. 98-4080; 1997.
31 Whelton P K. et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Hypertension 2018;71:e13-e115.
32 Doust J et al. Guidance for modifying the definition of diseases: a checklist. JAMA Internal Medicine 2017;177(7):1020-25.
33 Culver C M, Gert B. Philosophy in Medicine. NY: Oxford; 1982..
34 Clouser KD, Culver CM, Gert B. Malady. In Humber JM, Almeder RF, ed., What is Disease? Totowa, NJ:
Humana Press; 1997:175-217.
35 Temple LKF, McLeod RS, Gallinger S, Wright, J G. Defining disease in the genomic era. Science 2001;293:807-8.
36 U.S. Health and Human Services. Health, United States, 2003. Washington, DC: US Government Printing Office; 2003.
37 Singh SP. Somatotype and disease: a review. Anthropologist Special Volume no. 3:251-61; 2007.
38 Koleva M, Nacheva A, Boer M. Somatotype and disease prevalence in adults. Rev Environ Health 2002;17:65-84.
39 Wilson BR et al. Somatotype and longevity of former university athletes and nonathletes. Res Q Exerc Sport 1990;61:1-6.
40 Hamilton JB, Mestler GE. Mortality and survival: comparison of eunuchs with intact men and women in mentally retarded populations. Journal of Gerontology 1969;24:395-411.
41 Cherouveim P, Vagios S, Hammer K, Fitz V, Jiang V, James K, Dimitriadis I, Bormann C, Souter I. The impact of cryopreserved sperm in intrauterine insemination (IUI) outcomes: Is frozen as good as fresh? Human Reproduction 2022;37(Supp): 30 June. https://doi.org/10.1093/humrep/deac105.098
42 Viera AJ. Predisease: when does it make sense? Epidemiologic Reviews 2011;33:122-34.
43 Rogers WA, Walker MJ. Precising definitions as a way to combat overdiagnosis. Journal of Evaluation in Clinical Practice 2018;2018:1-3.
44 Vickers AJ, Basch E, Kattan MW. Against diagnosis. Annals of Internal Medicine 2008;149(3):200-3.
45 World Health Organization. Assessment of Fracture Risk and its Application to Screening for Postmenopausal Osteoporosis. Geneva: WHO; 1994.
46 Silverthorn DU. Human Physiology: An Integrated Approach. 5th ed. San Francisco: Pearson; 2010.
47 Hucklenbroich P. (2014). ‘Disease entity’ as the key theoretical concept of medicine. Journal of Medicine and Philosophy 2014;39(6):609-33.
48 Boorse C. Concepts of health and disease. In Gifford F, ed., Philosophy of Medicine. NY: Elsevier; 2011:13-64.
49 Binney N. Osteoporosis and risk of fracture: reference class problems are real. Theoretical Medicine and Bioethics 2022.
50 Binney N. Health-adjusted reference classes and low bone mineral density. Forthcoming in Journal of Medicine and Philosophy.
51 Gard M, Wright J. The Obesity Epidemic: Science, Morality, and Ideology. NY: Routledge; 2005.
52 Gard M. The End of the Obesity Epidemic. NY: Routledge; 2011.
53 Taubes G. Why We Get Fat and What to Do About It. NY: Knopf; 2011.
54 Teicholz N. The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet. NY: Simon and Schuster; 2014.
55 Rubin E, Gorstein F, Rubin R, Schwarting R, Strayer D. Pathology: Clinicopathologic Foundations of Medicine. 4th ed. Philadelphia: Lippincott Williams and Wilkins; 2004.
56 Cotran RS, Vinay K, Collins T. Pathologic Basis of Disease. 6th ed. Philadelphia: W.B. Saunders; 1999.
57 Pickering GW. The concept of essential hypertension. Ann Intern Med 1955;43(6):1153-60.
58 Wald NJ, Law MR. A strategy to reduce cardiovascular disease by more than 80%. BMJ 2003;326:1419-23.
59 National Heart Foundation of Australia. Guidelines for the Diagnosis and Management of Hypertension in Adults. Melbourne: NHFA;2016.
60 Mancia G et al. 2007 ESH-ESC practice guidelines for the management of arterial hypertension. Journal of
Hypertension 2007;25(9):1751-62.
61 Williams B et al. Guidelines for management of hypertension, report of the fourth working party of the British Hypertension Society. Journal of Human Hypertension 2014;18(3):139-85.
62 Moynihan RN, Clark J, Albarqouni L. Media coverage of the benefits and harms of the 2017 expanded definition of high blood pressure. JAMA Internal Medicine 2019;179(2):272-3.
63 Whelton PK, Williams B. The 2018 European Society of Cardiology and 2017 American College of Cardiology/American Heart Association blood pressure guidelines: more similar than different. JAMA 2018; 320(17):1749-50.
64 Bell KJL, Doust J, Glasziou P. Incremental benefits and harms of the 2017 American College of Cardiology/American Heart Association high blood pressure guideline. JAMA Internal Medicine 2018;178(6):755-7.
65 Jungner G, Wilson JM. Principles and Practice of Screening for Disease. Geneva: World Health Organization; 1968.
66 Rose G. Rose’s Strategy of Preventive Medicine. 2nd ed. NY: Oxford University Press; 2008.
67 Accad M. Moving Mountains: A Socratic Challenge to the Theory and Practice of Population Medicine. Green Publishing; 2011.
68 Priest G. An Introduction to Non-Classical Logic. 2nd ed. NY: Cambridge University Press; 2008.
69 Hesslow G. Do we need a concept of disease? Theoretical Medicine 1993;14:1-14.
70 Boorse C. The meaning of clinical normality. Medical Research Archives 2022;10(7):1-16. https://doi.org/10.18103/mra.v10i7.2866