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Lecture 6

HLTHAGE 1AA3 Lecture 6: Biomedicine

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Health, Aging and Society
Anju Joshi

Feb 8 Biomedical Culture Biomedicine - Disease specificity: the idea that each disease has some very specific cause along with a specific course of symptoms. Because the cause is specific the treatment is also specific. - Body focused, materialist (all diseases have some sort of physical manifestation) not about the mind - Reductionism: Looking at diseases from a cellular level - Machine metaphor: looking at the body as a machine, “fixing” the body - Individual oriented: a disease is something an individual has within their body and this ignores the social determinants of health - Health/disease dichotomy: you are either healthy or have a disease there is no spectrum Rise of Biomedicine - Reformation and Secularization (16th cent) → Removed restrictions on anatomy → Church became less of an authority with anatomy → Health professionals were now able to look inside the body - Scientific Revolution (17th cent) → Technological instruments (microscopes, stethoscopes) - Enlightenment (18th cent) → Quantification, rationality, empiricism → Science became more important than faith when determining health (do not need to look to spirits or god about health anymore) - Rise of the Laboratory (19th cent) → Virchow (cellular pathology), Lister (hygiene), Koch (germ theory) This shifted the focus from patient’s story to measurable body - Dominance vis professionalization, monopolization → had to be a professional with schooling to be a healer → pushed out other types of healers Body seen as controllable through strict regimen - those who “behave” do not get sick - Medicine as social control advice on aspects of everyday life (what to eat, sleep, exercise) - Possible because of cultural elevation science (science becomes more popular than faith) Challenges to Biomedicine - Health knowledge varies by time and place - Operates on the assumption that there is only one correct way of thinking - Cultural knowledge vs biomedical knowledge - Moral and ethical issues (eugenics, lobotomy etc.) underscores fallibility calls into question expertise - Iatrogenesis → examples? When medical treatment causes harm ex. Side effects EBM emerges as a result of these challenges Intro to EBM “A systemic approach to analyze published research as the basis of clinical decision making” - Based on public research ex. Peer reviewed journals - Using mathematical estimates of probability and risk (can determine things mathematically) - Stats heavy approach McMaster University Feb 8 Biomedical Culture David Sackett, Gordon Guyatt introduced “Evidence Based Medicine” - Sees itself as objective, rational and altruistic… other methods baseless, physician-oriented, unhelpful - Easy to sell to public, gov, hospital managers, statisticians (has a good name) Objectivity and Numbers - Trope figures believed to undermine research objectivity → Gullible practitioner (wants to be successful) → Desperate patient (wants cure to work) → treatment producer (wants treatment to succeed) → emotional nurse (who would break the rules of the experiment out of an emotional need to help patients) - Had to be replaced by something depersonalized… numbers - Part of wider quantification revolution Principles of RCTs (Randomized controlled trial) - Multiple groups, one that is a placebo and one that actually got the medicine - Blind study (researche
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