In search of "non-disease"

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What is a disease? Thomas Sydenham (1624-1689) thought that diseases could be classified just like plant and animal species. In other words, diseases have an existence independent of the observer and exist in nature, ready to be “discovered.” In complete contrast, others see the notion of disease as essentially a means of social control.5 Doctors define a patient's condition as a “disease” and are then licensed to take various actions, including perhaps incarceration. “Each civilisation,” wrote Ivan Illich, “defines its own diseases. What is sickness in one might be chromosomal abnormality, crime, holiness, or sin in another.”6 The Oxford Textbook of Medicine wisely stays away from defining a disease. The Chambers Dictionary defines disease as “an unhealthy state of body or mind; a disorder, illness or ailment with distinctive symptoms, caused eg by infection.” Neither definition is operationally helpful, especially as health is even harder to define than disease. Imre Loeffler, surgeon, essayist, and wit, says that the World Health Organization's famous definition of health as “complete physical, psychological, and social wellbeing” is achieved only at the point of simultaneous orgasm, leaving most of us unhealthy (and so, by the Chambers Dictionary definition, diseased) most of the time. “There is no disease that you either have or don't have—except perhaps sudden death and rabies. All other diseases you either have a little or a lot of.” Geoffrey Rose epidemiologist Disease is often defined as a departure from “normal,” and helpfully David Sackett and others offer six definitions of normal in Clinical Epidemiology, “the bible of evidence based medicine”(table 1).7 One common definition is that you lie more than two standard deviations from the mean on whatever measure is used—height, weight, haemoglobin concentration, and tens of thousands of others. By definition, 5% of people are thus “abnormal” (and we might say diseased) on each test. Run enough tests and we are all abnormal (diseased). Or, on a definition of increased risk, we might define almost the entire population of Britain as diseased if we consider all those with a blood cholesterol concentration that carries an extra risk of mortality compared with the cholesterol concentration of those living in less developed communities. View this table: In this window In a new window Table 1 Six definitions of “normal” in common clinical use7

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