Benefits and Burdens of Biomedicine
Everything comes with a cost attached. In today’s society, it is difficult for one to justify any action without thinking of the possible benefits or burdens that come with that action. Biomedicine is not exempt from this debate. Western society holds biomedicine in high esteem, but it is not a means to an end. It is important that we can differentiate between the costs and benefits associated with biomedicine and biomedical technologies. However, it is not always easy to separate the benefits from the burdens where biomedicine is concerned.
Critical Medical Anthropology has presented itself with the task of studying and critiquing biomedicine. Many anthropologists use a “critical approach in the belief that social inequality and power are primary determinants of health and health care” (Baer, et. Al, p. 3). Looking at the healthcare systems and class relations in a particular society, it has been determined that biomedicine is hegemonic. Foucault’s idea of power being exercised only by those with the technical knowledge is an expression of the dominance hierarchy seen in biomedicine. Physicians, being the ones with the technical knowledge, are the ones holding the power. Patients feel they are left with no choice but to listen to their physicians.
A major downfall in biomedicine is medicalization and the creation of disease categories. There is a pattern of turning something normal into a disease, leading us to wonder what a disease really is. Is it a biological fact, or a socially constructed entity? The scientific notions of disease are supposedly “free” of cultural content, yet there are a number of cultural obstacles and social views placed upon disease. Biomedicine treats sickness as a momentary irrationality that has to be ordered and controlled. Patients are presented with the cultural obstacles, such as the idea that a needle in their arm will prevent them from falling victim to a disease. According to Medical Ecological Theory, adaptation to a disease reflects a social groups level of health. Developments, such as vaccinations, can aid in adaptation to an environment, and may act as a social response to an aggressive medical condition. Under this approach, disease is treated as a natural object separate from human consciousness.
Our response to disease is shaped by culture and social ideas, as suggested by Baer, Singer and Susser. They stated, “Many medical anthropologists regard health to be a cultural construction whose meaning varies considerably from society to society” (Baer, et. Al, p. 4). The questions regarding biomedicine that most concern the patient are not widely addressed. An understanding of biology, social practice and cultural meanings need to be addressed for a complete understanding of disease. According to Kleinman, to fully understand disease a physician should present the patient with eight questions. These should be presented to better understand the problem through the patient. Instead of the physician taking all the power and applying classifications of diseases to patients, there should be an understanding of the underlying problems. Through somatization, the patient may medicalize personal problems (Kleinman, p. 59). To avoid this, a responsible physician would address underlying problems as well as medical problems. Management of the patients’ emotions is typically dealt with by “non-recognition,” leaving an emotional patient less likely to receive decent care.
Biomedicine has a tendency toward medicalizing social conditions and using medicine as a form of social control. Disagreement with medical opinion is evidence of irrationality (Kirmayer, p. 326). The metaphors
used by physicians are never void of meaning. While metaphors are neither good nor bad, they are based on social images
of the body
. Kleinman recognises this in his Illness Narratives, “perhaps as important as the recognition of the different meanings of illness is the recognition of the limits of interpretation
” (Kleinman, p. 74).
While the burdens of biomedicine are vast, there are positive sides to the practice. Unfortunately, it is difficult to distinguish the positives from the negatives. Although bio sociality could be seen as a burden, groups forming around genetic markers or mutations, it can also be taken as a benefit. Support groups can help individuals differentiate between the disease and the personal elements they are dealing with. Learning from the experiences of others can help a patient face their trials head on, sorting personal problems from medical problems. Rayna Rapp gives examples of support groups in her article Extra chromosomes and blue tulips. She tells us, “local support groups offer rich and reassuring resources for parents learning to normalize a child as a family member, not only as a medical diagnosis” (Rapp, p. 195). In learning what it means to be a parent of a Down syndrome child from the experiences of others, families can better understand the disease and how to fully provide their child with a full and normal life. Not a life centred on physicians and being “different.”
Another important benefit of biomedicine is providing a patient with an explanation as to what is happening, why it is happening, and why it is happening to them. Illness can act as a sponge, soaking up all the negative things in a persons’ life. This has the ability to make both the illness and the individuals’ life problems seem worse. Medicalization can also be a benefit. Although it could go insofar as to culturally construct a disease, medicalization can also provide an explanation. Alcoholism, while seen as a social disease, can also be explained and treated by its medical definition. The creation of anorexia as a disease in the 19th century led to the ability to explain why it was happening. The medicalization of this social and cultural disease gives physicians a way to explain to patients the dire consequences of starving themselves. Unfortunately, the medicalization of eating disorders has done little to eliminate them (O'Connor 2002).
While there can be benefits to biomedicine, the burdens greatly outweigh them. Every benefit comes with a potential burden, making it extremely difficult to distinguish one from the other. Although biomedicine can provide a patient with an explanation for what is happening to them, something greater is missing. Illness narratives are important in understanding disease, yet there is a constant cycle of blaming the victim. The idea that health is the individuals’ responsibility causes physicians to focus on the individual and ignore the social situation. The responsibility for maintaining health or becoming ill is placed on the individual. The disease is instead free of cultural content.
The dominance hierarchy causes medicine to be supported by laws and professional authorities. This causes biomedicine to become depersonalized, treating disease as something strictly physical. Until some revisions can be made to the current handling of biomedicine, including more utilization of illness narrative and empathy in clinical practice, the burdens will continue to outweigh the benefits. Instead of viewing the body as a machine, and disease as an object separate from human consciousness, physicians and those holding the “power” should understand that biology and culture are equally important. To understand suffering, the realization that disease is not just a biological process but also a human experience, should remain in the forefront of biomedicine.
- Baer, Hans A., Merrill Singer, Ida Susser 2003 Medical Anthropology and the World System
- Kleinman, Arthur 1988 The Illness Narratives
- Kirmayer, Laurence J. The Body’s Instance on Meaning: Metaphor as Presentation and Representation in Illness Experience. Volume 6, Medical Anthropology Quarterly
- O’Conner 2002 Analyzing Anorexia: Disentangling Person, Pathology & Society Handout from SMA Meetings, Atlanta
- Rapp, Rayna 2000 Extra Chromosomes and blue tulips: medico-familial interpretations