Current Dilemmas in Defining the Boundaries of Disease

Area of Science:

• Philosophy of Medicine
• Medical Ethics
• Biostatistics

Background:

• Boorse's biostatistical theory defines disease as objective, value-free disturbances of biological function.
• Contemporary medicine faces challenges in objectively defining disease boundaries.

Purpose of the Study:

• To evaluate the adequacy of Boorse's biostatistical theory in defining disease boundaries.
• To explore the practical implications of disease definition in contemporary medicine.
• To advocate for a revised theoretical approach to disease definition.

Main Methods:

• Analysis of three contemporary medical cases: polycystic ovary syndrome, chronic kidney disease, and myocardial infarction.
• Critical examination of the biostatistical theory's applicability to these cases.
• Assessment of the theory's alignment with medical practices for identifying disease boundaries.

Main Results:

• The biostatistical theory provides insufficient guidance for drawing disease boundaries.
• Ambiguities arise concerning the choice of reference class in disease definition.
• The theory is misaligned with current medical processes for establishing disease boundaries.

Conclusions:

• Disease boundary determination is not a value-free process.
• A new theoretical framework is needed to guide disease definition, addressing medicalization.
• Practical medical realities necessitate a more nuanced approach to defining disease.