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Keynote speak presentation at the 2nd OEMC Research Day held in King Fahad Medical City, Riyadh on 11 April 2019. By: Prof. Omar Hasan Kasule Sr. MB ChB (MUK), MPH (Harvard) DrPH (Harvard) Chairman, Institutional Review Board - KFMC
DISEASE vs ILLNESS?:
} Genes vs. environment?
} Disease vs. behavior?
} Pathology vs. patient?
} Fragmentation vs integration?
PHILOSOPHICAL BACKGROUND OF THE BIOMEDICAL MODEL:
} Current medical practice is based on the
biomedical model.
} The biomedical model is the culmination of
philosophical developments in Europe over the past 500 years that have
transformed metaphysical medicine into scientific medicine.
} The philosophical changes that led to
biomedicine.
§
materialization of life
(empiricism),
§
marginalization of spiritual
and other considerations in health (secularism),
§
physical reductionism (i.e.
understanding by breaking up into components) while missing the complete
picture.
PROBLEMS OF THE MATERIALISTIC BASIS OF BIOMEDICINE - 1:
} Commodification: Health as a commodity that
can be bought/sold with money.
} Dehumanization: demystifies the body and
treating it like a ‘machine’, a ‘thing’ or a ‘physio-chemical phenomenon’.
} Depersonalization: patient who is looked at
as a case of pathology and not as a human.
} It is more interested in the disease and not
the person.
PROBLEMS OF THE MATERIALISTIC BASIS OF BIOMEDICINE - 2:
} A technical relation replaces the human
physician-patient bond.
} Patients do not get emotional and
psychological satisfaction from encounters with physicians even if their
pathological disorders are resolved satisfactorily.
} Biomedicine relies exclusively on the
scientific disease theory which asserts that symptoms reflect specific disease
entities and that each disease entity has a unique cause and a unique
therapy.
PROBLEMS OF THE MATERIALISTIC BASIS OF BIOMEDICINE - 3:
} Biomedicine is not holistic. It ignores
cultural, social, spiritual, and psychological aspects of illness and concentrates
only on somatic aspects.
} Biomedicine de-emphasizes overall wellness
and welfare and narrowly focusses on pathological anatomy and pathophysiology.
} Biomedicine has fails to handle psychosomatic
disorders that have no obvious anatomical or physiological origin.
} Biomedicine marginalizes environmental
medicine and behavioral medicine.
ILLNESS AND DISEASE:
} Biomedicine equates illness with disease.
Illness is wider and more holistic than disease.
} Illness is affected by both somatic and
non-somatic factors whereas disease is affected by somatic factors alone.
} The elderly may for example be ill but with
no specific disease.
} In the same way people with serious
pathological conditions may not be aware of them or may not be concerned and
they feel that they are in good health.
} Biomedicine concerns itself with the body and
not the mind. It rejects the body-mind dualism that human traditions have accepted
throughout history. It also rejects the dualism of soul and matter that is the unique
characteristic of humans.
THREE IMPORTANT CONCEPTS:
} Moderation, wasatiyyah
} Equilibrium, iitidaal
} Balance, mizaan
OUR RESEARCH MUST BE HOLISTIC:
} We need more holistic research that will deal
with the complete person.
} We need to integrate psycho-social dimensions
in our research.
} We need to undertake more multi-disciplinary research.
} We need to be more multi-disciplinary.