Research Introduction

What I am doing and why I am doing it

A Research Statement

When asked, the nutshell encapsulation I use to describe what I am doing is:

'My research is concerned with exploring biological and philosophical aspects of the concepts of illness, disease and health and considering what, by extension, these notions say about life and death, living and dying, in general.'

For some reason, the word philosophy seems to frighten many people. Contrary to what many mistakenly assume about philosophy, it is not meant to generate abstract or abstruse utterances that mean little or nothing to anybody other than the person who made them or a small coterie of associates. Especially in the area in which I work, the practical aspects of philosophical deliberations are very important. There is after all something very real about illness, disease and health. We all have had direct and indirect experiences that demonstrate that these are fundamental aspects of being alive and being human. Understanding illness, disease and health in a conceptual as well as a practical (bio-medical) way should be important to each one of us in trying to understand what we are. As such, I like to think of my work as the examination (or consideration) of life in the Socratic sense [1]. As such, it is important that this work be expressed in a way that all interested persons can understand and is disseminated in a form that is as accessible as possible.

Practical Consideration

To some, the idea of worrying about the concepts of illness, disease and health seems pointless. Surely, these notions are so well understood that there can be no point in bothering. Considering disease, Lawrie Reznek (1987, p18) [2] gives an interesting example that might help undermine this sense of complacency. He considers the question of dyschromic spirochaetosis – also called Pinto's disease. Pinto's disease is an infectious condition not without appreciable morbidity and mortality. It is found in some South American Indian tribes. One would assume that these people would welcome antibiotic treatment to rid them of this condition. However, this is not the case. The complicating factor with regards Pinto's disease is that it produces distinctive rose-coloured spots on the skin which many Indians believe to be a sign of being healthy. Indeed, one is more likely to obtain a spouse if one has the condition since those without the spots are excluded from marrying! To treat according to western values, in that it would run counter to Indian values, might be considered unethical. What Pinto's disease is, medically, to us in the West is not how it appears to those South American Indians. So how do we define it?

Ethical conundrums aside, it is not only the intrusion of human values that complicates matters. To simplify a complex story, due to the presence of a particular gene within their parent population, some people have sickle cell disease (a homozygous inherited condition) and suffer from quite unpleasant bouts of life threatening illness. Indeed, the haemoglobin in their blood differs from the most commonly found (some would say 'normal') amino acid sequence. However, having sickle cell trait (a heterozygous inherited state) confers a certain degree of protection against malaria – the parasite is unable to multiply successfully in the blood of someone with sickle cell trait. At the same time, having sickle cell trait - although itself a relatively benign state - means that the person affected is unable to exert himself to the same extent as somebody genetically homozygous for the production of 'normal' haemoglobin; but these people are susceptible to malaria where itis endemic and are at a disadvantage, in terms of survival chances, by comparison with those with sickle cell trait. Thus, taken in purely physical terms, under certain circumstances, having a copy of a gene associated with serious disease and which limits one's physical abilities appears to be advantageous to personal survival. So how do we define the state of these people?

There are other practical examples but these, I hope, help to demonstrate that within both ethical and biological frames of reference, what constitutes a disease is not obvious.

If what constitutes a disease is not obvious, then what about defining health? Unfortunately, health is not easy to define either. Should such a definition be made in terms of an individual's value-system and life goals or simply in functional, physiological terms? If the former, what if the individual has rather unrealistic values or goals? If the latter, at which level of organization within the body of the individual should function be assessed? Should one deny the ascription of health because a certain part is not operating at its optimum or should the operation of the person as a whole be the focus? Then again, if we are concerned about the person as a whole, what place and status do we give to mental conditions – especially those with no obvious organic basis?

Furthermore, if we could fine define health, how justified are we in assuming that disease and health are opposites and that one ensues from the absence of the other? After all, don’t people talk in terms of 'ill-health' as well as 'good-health'?

Furthermore, clinically, practitioners may be able to get by without cast-iron definitions. After all, patients who visit them frequently go away satisfied despite philosophically imprecise language having been used throughout the whole process. From my viewpoint as a detached, non-practitioner, this situation - although good for the patient - is not satisfactory philosophically or biologically. The imprecise vocabulary of medicine has a habit of creeping across into science making the latter less precise than it should be. This is particularly problematic when teaching laypeople subjects of clinical relevance. Illness, disease and health are 'ordinary language' terms; they belong to everyday speech. As a result they have everyday imprecisions. It is a very serious omission to allow everyday (imprecise) speech into science without first being sure of what the words mean.

A Biographical Note

In addition to the intellectual reasons why I am following this particular line of inquiry, there is also a biographical dimension that contributes to understanding what I am doing and why I am doing it.

In about 1997, I was asked (or rather told) to teach a post-graduate module entitled 'The Biology of Degenerative Disease'. I had a background in working as a diagnostic radiographer and teaching anatomy to medical and dental students (amongst others) via dissection, so I was well acquainted with pathological processes and with the people experiencing these processes. It transpired that I was taking over this module from three other colleagues who had each previously taught a different aspect of pathology in which they were particularly interested. Although I could have simply carried on in the same vein and taught the same three topics, I did not find this prospect very inspiring – I wanted to be more comprehensive. Therefore, my first task was to try to define what degenerative disease was and see how I might structure the module in a more satisfactory way for myself and the students. Surprisingly, I found that the phrase degenerative disease was not very common. At that time, it was used only once in a book title – and that in a veterinary rather than human context. Furthermore, what I began to find tended to raise more questions than answers. For example, was cancer a degenerative disease when, after all, it is characterized by tissue proliferation? Were age changes the result of degeneration? If so, was aging a disease? Indeed, how does one define a disease anyway? Was it merely another name for pathology when dis-ease seems to refer to a feeling of illness? I soon happened upon a rather rich literature concerned with these questions from the angle of the philosophy of medicine. As I became more conversant with this literature, I began to realize that although it drew upon bio-medical examples, the emphasis on the philosophy of medicine meant that a philosophical biology was missing [3].

The rest is, as they say, history.

Ironic footnote:

I later found out that the term degenerative disease was only used in the title of the module I was to teach as a way of distinguishing it from its sister module 'The Biology of InfectiousDisease'. The term degenerative disease was just thought up as a device to avoid using the more accurate, but less distinctive term: non-infectious disease!

Notes

1 - Socrates stated that 'the unexamined life was not worth living' (Apology 38a). Socrates would rather have died than give up philosophy. For him and for many after him, there is something all-consuming about the love of knowledge. Indeed, what is the point of being so busy living that we miss what living is. In the context of this website, I am trying to examine life biologically and philosophically.

2 - See: Reznek, L. (1987). The Nature of Disease. London: Routledge and Kegan Paul.

3 - Philosophical biology is different from the philosophy of biology. The latter seeks to scrutinize the thinking involved in the human enterprise, that is, the science called of biology. A philosophical biology, on the other hand, seeks a philosophical understanding of the object of biological study.