Model biomedyczny, redukcjonizm i ich konsekwencje dla percepcji ciała

Autor

DOI:

https://doi.org/10.18778/0208-600X.90.02

Słowa kluczowe:

redukcjonizm medyczny, uprzedmiotowienie, ciało, fenomenologia

Abstrakt

Współczesna medycyna wciąż się rozwija, pozwalając na wykrywanie wczesnych stadiów choroby, oferując różnorodne warianty leczenia, chroniąc przed niepożądanymi chorobami a także zapewniając zaawansowane rozwiązania farmakologiczne. XIX-wieczny model biomedyczny, który zdominował wiek XX zdecydowanie polepszył nasze rozumienie ludzkiego ciała oraz przyczyn chorób. Pomimo rozwoju innych modeli, takich jak model bio-psycho-społeczny, czy model zorientowany na pacjenta, model biomedyczny pozostaje integralną częścią medycyny opartej na dowodach (evidence-based medicine, EBM). Prowadzi to do szeregu konsekwencji takich jak specjalizacja, determinizm biologiczny, podejście obwiniające, redukcjonizm czy uprzedmiotowienie. Artykuł wykorzystuje analityczną ramę fenomenologii. Postawiono dwa pytania badawcze: 1) w jaki sposób model biomedyczny wpływa na fragmentaryzację opieki nad pacjentem? 2) jaki wpływ ma model biomedyczny na percepcję ciała pacjenta? Główna teza artykułu brzmi: model biomedyczny jest wciąż wpływowy w obszarze badań, edukacji oraz praktyki medycznej i wraz z postępami EBM wpływa na postrzeganie ciała pacjenta. Artykuł opiera się na przeglądzie literatury i ma na celu ukazanie nieoczywistych związków między postępem medycznym i postrzeganiem ciała. Analiza wykazała, że model biomedyczny wpływa na fragmentaryzację opieki nad pacjentem poprzez zwiększający się redukcjonizm i wynikającą z niego specjalizację medycyny, prowadząc do uprzedmiotowienia ciała, które dokonywane jest zarówno przez lekarzy, jak i samych pacjentów.

Bibliografia

Acolin J., Fishman P. (2023), Beyond the biomedical, towards the agentic: A paradigm shift for population health science, “Social Science & Medicine”, vol. 326, 115950. https://doi.org/10.1016/J.SOCSCIMED.2023.115950
Google Scholar DOI: https://doi.org/10.1016/j.socscimed.2023.115950

Ahn A.C., Tewari M., Poon C.S., Phillips R.S. (2006), The Limits of Reductionism in Medicine: Could Systems Biology Offer an Alternative? “PLoS Medicine”, vol. 3(6), pp. 0709–0713. https://doi.org/10.1371/JOURNAL.PMED.0030208
Google Scholar DOI: https://doi.org/10.1371/journal.pmed.0030208

Anon. (2023), Nowy lek na odchudzanie jest już w Polsce. Cena to nawet 1600 zł, ale szybko znika, “Rynek Zdrowia”, https://www.rynekzdrowia.pl/Serwis-Diabetologia/Nowy-lek-na-odchudzaniejest-juz-w-Polsce-Cena-to-nawet-1600-zl-ale-szybko-znika,250426,1016.html
Google Scholar

Beresford M.J. (2010), Medical reductionism: lessons from the great philosophers, “QJM: An International Journal of Medicine”, vol. 103(9), pp. 721–724. https://doi.org/10.1093/QJMED/HCQ057
Google Scholar DOI: https://doi.org/10.1093/qjmed/hcq057

Berg S. (2023), Questions patients may have about weight-loss drugs, https://www.ama-assn.org/delivering-care/public-health/questions-patients-may-have-about-weight-loss-drugs.
Google Scholar

Biccard B. (2022), The principles of evidence-based medicine, “Southern African Journal of Anaesthesia and Analgesia”, vol. 28(5 Suppl 1), pp. S72–79. https://doi.org/10.36303/SAJAA.2022.28.5.2914
Google Scholar

Buzzoni M., Tesio L., Stuart M.T. (2022), Holism and Reductionism in the Illness/Disease Debate, “Frontiers Collection”, Part F902, pp. 743–778. https://doi.org/10.1007/978-3-030-92192-7_39/COVER
Google Scholar DOI: https://doi.org/10.1007/978-3-030-92192-7_39

Capra F. (1982), The Turning Point Science Society and The Rising Culture, Flamingo Publisher. http://lib.ui.ac.id
Google Scholar DOI: https://doi.org/10.1063/1.2914857

Carel H. (2016), Phenomenology of Illness, pp. 204–228. https://doi.org/10.1093/ACPROF:OSO/9780199669653.003.0010
Google Scholar DOI: https://doi.org/10.1093/acprof:oso/9780199669653.003.0010

Chao A.M., Tronieri J.S., Amaro A., Wadden T.A. (2023), Semaglutide for the treatment of obesity, “Trends in Cardiovascular Medicine”, vol. 33(3), pp. 159–166. https://doi.org/10.1016/J.TCM.2021.12.008
Google Scholar DOI: https://doi.org/10.1016/j.tcm.2021.12.008

Charmaz K. (1983), Loss of self: a fundamental form of suffering in the chronically ill, “Sociology of Health & Illness”, vol. 5(2), pp. 168–195. https://doi.org/10.1111/1467-9566.EP10491512
Google Scholar DOI: https://doi.org/10.1111/1467-9566.ep10491512

Cockerham W.C. (2022), Medical sociology (15th ed.). Routlege.
Google Scholar DOI: https://doi.org/10.4324/9781003203872

Conrad P., Barker K.K. (2010), The Social Construction of Illness: Key Insights and Policy Implications, “Journal of Health and Social Behavior”, vol. 51(S), pp. S67–S79.
Google Scholar DOI: https://doi.org/10.1177/0022146510383495

de Boer B. (2020), Experiencing objectified health: turning the body into an object of attention, “Medicine, Health Care and Philosophy”, vol. 23, pp. 401–411. https://doi.org/10.1007/s11019-020-09949-0
Google Scholar DOI: https://doi.org/10.1007/s11019-020-09949-0

Dennet D. (1995), Darwin’s Dangerous Idea: Evolution and the Meanings of Life, Simon & Schuster.
Google Scholar

Descartes R. (2019), Rozprawa o metodzie, Vis-à-vis Etiuda.
Google Scholar

Detsky A.S., Gauthier S.R., Fuchs V.R. (2012), Specialization in medicine: How much is appropriate? “JAMA”, vol. 307(5), pp. 463–464. https://doi.org/10.1001/JAMA.2012.44
Google Scholar DOI: https://doi.org/10.1001/jama.2012.44

Dz.U. 2023, poz. 2152. (2023), Rozporządzenie Ministra Edukacji i Nauki z dnia 29 września 2023 r. zmieniające rozporządzenie w sprawie standardów kształcenia przygotowującego do wykonywania zawodu lekarza, lekarza dentysty, farmaceuty, pielęgniarki, położnej, diagnosty laboratoryjnego, fizjoterapeuty i ratownika medycznego.
Google Scholar

Eisenberg L. (1977), Disease and illness. Distinctions between professional and popular ideas of sickness, “Culture, Medicine and Psychiatry”, vol. 1(1), pp. 9–23. https://doi.org/10.1007/BF00114808/METRICS
Google Scholar DOI: https://doi.org/10.1007/BF00114808

Elhauge E. (2010) (ed.), The Fragmentation of U.S. Health Care: Causes and Solutions, Oxford University Press, New York.
Google Scholar DOI: https://doi.org/10.1093/acprof:oso/9780195390131.001.0001

Emanuel E., Emanuel L. (1992), Four models of the physician-patient relationship, “JAMA”, vol. 268(11), pp. 2221–2226. https://doi.org/10.1001/jama.268.11.1410b
Google Scholar DOI: https://doi.org/10.1001/jama.1992.03490110048022

Engel G.L. (1977), The need for a new medical model: a challenge for biomedicine, “Science (New York, N.Y.)”, vol. 196(4286), pp. 129–136. https://doi.org/10.1126/SCIENCE.847460
Google Scholar DOI: https://doi.org/10.1126/science.847460

Farre A., Rapley T. (2017), The New Old (and Old New) Medical Model: Four Decades Navigating the Biomedical and Psychosocial Understandings of Health and Illness, “Healthcare”, vol. 5(4). https://doi.org/10.3390/HEALTHCARE5040088
Google Scholar DOI: https://doi.org/10.3390/healthcare5040088

Fried E.I. (2022), Studying Mental Health Problems as Systems, Not Syndromes, “Current Directions in Psychological Science”, vol. 31(6), pp. 500–508. https://doi.org/10.1177/09637214221114089
Google Scholar DOI: https://doi.org/10.1177/09637214221114089

Germov J. (2019), Imagining health problems as social issues, [in:] Germov J. (ed.), Second opinion. An introduction to health sociology, 6th ed., pp. 2–23, Oxford University Press, USA.
Google Scholar

Giddens A. (2012), Socjologia, Wydawnictwo Naukowe PWN, Warszawa.
Google Scholar

Głębocka A., Wilczek-Rużyczka E. (2016), Zachowania dehumanizujące pacjentów z perspektywy pracowników medycznych w oparciu o skalę behawioralnych wskaźników, “Czasopismo Psychologiczne – Psychological Journal”, vol. 22(2), pp. 253–260. DOI: 10.14691/CPPJ.22.2.253
Google Scholar

Greene J.A., Loscalzo J. (2017), Putting the Patient Back Together – Social Medicine, Network Medicine, and the Limits of Reductionism, “New England Journal of Medicine”, vol. 377(25), pp. 2493–2499. https://doi.org/10.1056/NEJMMS1706744
Google Scholar DOI: https://doi.org/10.1056/NEJMms1706744

Grīnfelde M. (2023), Body objectified? Phenomenological perspective on patient objectification in teleconsultation, “Medicine, Health Care, and Philosophy”, vol. 26(3), 335. https://doi.org/10.1007/S11019-023-10148-W
Google Scholar DOI: https://doi.org/10.1007/s11019-023-10148-w

Haque O.S., Waytz A. (2012), Dehumanization in medicine: Causes, solutions, and functions, “Perspectives on Psychological Science”, vol. 7(2), pp. 176–186.
Google Scholar DOI: https://doi.org/10.1177/1745691611429706

Helman C.-G. (1981), Disease versus illness in general practice, “British Journal of General Practice”, vol. 31(230).
Google Scholar

Hofmann B., Svenaeus F. (2018), How medical technologies shape the experience of illness, “Life Sciences, Society and Policy”, vol. 14(1). https://doi.org/10.1186/S40504-018-0069-Y
Google Scholar DOI: https://doi.org/10.1186/s40504-018-0069-y

Kallivayalil R.A. (2020), Psychiatry – From Biological Reductionism to a Bio-Psycho-Social Perspective, “World Social Psychiatry”, vol. 2(1), pp. 3–6. https://doi.org/10.4103/WSP.WSP_4_20
Google Scholar DOI: https://doi.org/10.4103/WSP.WSP_4_20

Kannel W.B. (2003), Prevalence and Implications of Uncontrolled Systolic Hypertension, “Drugs Aging”, vol. 20(4), pp. 277–286.
Google Scholar DOI: https://doi.org/10.2165/00002512-200320040-00004

Krakauer J.W., Ghazanfar A.A., Gomez-Marin A., MacIver M.A., Poeppel D. (2017), Neuroscience needs behavior: correcting a reductionist bias, “Neuron”, vol. 93, pp. 480–490. https://doi.org/10.1016/j.neuron.2016.12.041
Google Scholar DOI: https://doi.org/10.1016/j.neuron.2016.12.041

Kuskowski P. (2019), Doświadczenia pacjenta w Polsce, Raport badawczy Siemens Healthineers.
Google Scholar

Leder D. (1984), Medicine and paradigms of embodiment, “Journal of Medicine and Philosophy (United Kingdom)”, vol. 9(1), pp. 29–44. https://doi.org/10.1093/JMP/9.1.29
Google Scholar DOI: https://doi.org/10.1093/jmp/9.1.29

Marcum J.A. (2004), Biomechanical and phenomenological models of the body, the meaning of illness and quality of care, “Medicine, Health Care, and Philosophy”, vol. 7(3), pp. 311–320. https://doi.org/10.1007/S11019-004-9033-0
Google Scholar DOI: https://doi.org/10.1007/s11019-004-9033-0

Maslach Ch., Leiter M.P. (2011), Prawda o wypaleniu zawodowym. Co robić ze stresem w organizacji, Wydawnictwo Naukowe PWN, Warszawa.
Google Scholar

Merleau-Ponty M. (2005), Phenomenology of Perception. Routledge.
Google Scholar

Miles A. (2009), On a Medicine of the Whole Person: Away from scientistic reductionism and towards the embrace of the complex in clinical practice, “Journal of Evaluation in Clinical Practice”, vol. 15(6), pp. 941–949. https://doi.org/10.1111/J.1365-2753.2009.01354.X
Google Scholar DOI: https://doi.org/10.1111/j.1365-2753.2009.01354.x

National Institute of Health, Prescription Medications to Treat Overweight & Obesity, https://www.niddk.nih.gov/health-information/weight-management/prescription-medications-treat-overweight-obesity.
Google Scholar

Nielsen T.H. (2022), Issues for a phenomenology of illness – transgressing psychologizations: Author, “Medicine, Health Care and Philosophy”, vol. 25(4), pp. 603–613. https://doi.org/10.1007/S11019-022-10100-4/METRICS
Google Scholar DOI: https://doi.org/10.1007/s11019-022-10100-4

Oleszczuk R., Kozińska I., Gras-Ozimek J., Kozińska U., Oleszczuk A. (2022), Semaglutide for the treatment of obesity, “Journal of Education, Health and Sport”, vol. 12(8), pp. 1111–1123. https://doi.org/10.12775/JEHS.2022.12.08.095
Google Scholar DOI: https://doi.org/10.12775/JEHS.2022.12.08.095

Paladino J. (2016), Can We Improve Serious Illness Care with Training and Systems Change? Paper presented at the Telling the Stories: The Deeper Voice of Hospice, Cleveland, Ohio.
Google Scholar

Parsons, T. (2009), System społeczny, Wydawnictwo Naukowe PWN, Warszawa.
Google Scholar

Petersen S., Heesacker M., Schwartz R.C. (2001), Physical Illness: Social Construction or Biological Imperative? “Journal of Community Health Nursing”, vol. 18(4), pp. 213–222. https://doi.org/10.1207/S15327655JCHN1804_02
Google Scholar DOI: https://doi.org/10.1207/153276501753266056

Prior A., Vestergaard C.H., Vedsted P., Smith S.M., Virgilsen L.F., Rasmussen L.A., Fenger-Grøn M. (2023), Healthcare fragmentation, multimorbidity, potentially inappropriate medication, and mortality: a Danish nationwide cohort study, “BMC Medicine”, vol. 21, 305, https://doi.org/10.1186/s12916-023-03021-3
Google Scholar DOI: https://doi.org/10.1186/s12916-023-03021-3

Rocca E., Anjum R.L. (2020), Complexity, reductionism and the biomedical model, [in:] Rethinking Causality, Complexity and Evidence for the Unique Patient: A CauseHealth Resource for Healthcare Professionals and the Clinical Encounter, pp. 75–94. https://doi.org/10.1007/978-3-030-41239-5_5
Google Scholar DOI: https://doi.org/10.1007/978-3-030-41239-5_5

Sackett D., Rosenberg W., Gray J., Haynes R., Richardson W. (1996), Evidence based medicine: what it is and what it isn’t, “BMJ”, vol. 312(7023), pp. 71–72. https://doi.org/10.1136/bmj.312.7023.71
Google Scholar DOI: https://doi.org/10.1136/bmj.312.7023.71

Shilling C. (2021), Socjologia ciała, Wydawnictwo Naukowe PWN, Warszawa.
Google Scholar

Skrzypek M. (2012), Geneza i ewolucja podstawowych kategorii analitycznych socjologii medycyny, “Medycyna Ogólna i Nauki o Zdrowiu”, vol. 18(47)(4), pp. 371–378.
Google Scholar

Snow K., Galaviz K., Turbow S. (2020), Patient Outcomes Following Interhospital Care Fragmentation: A Systematic Review, “Journal of General Internal Medicine”, vol. 35, pp. 1550–1558, https://doi.org/10.1007/s11606-019-05366-z
Google Scholar DOI: https://doi.org/10.1007/s11606-019-05366-z

Sokołowska M. (1986), Socjologia medycyny, PZWL, Warszawa.
Google Scholar

Srivastava R. (2020), The spread of super-specialisation is an alarming problem of modern medicine, “The Guardian”, https://www.theguardian.com/commentisfree/2020/feb/18/the-spread-of-super-specialisation-is-an-alarming-problem-of-modern-medicine
Google Scholar

Stevens H. (2018), Evidence-based medicine from a social science perspective, “Australian Journal of General Practice”, vol. 47(12), pp. 889–892. https://doi.org/10.31128/AJGP-03-18-4528
Google Scholar DOI: https://doi.org/10.31128/AJGP-03-18-4528

Svenaeus F. (2022), Health and Illness as Enacted Phenomena, “Topoi”, vol. 41, pp. 373–382. https://doi.org/10.1007/s11245-021-09747-0
Google Scholar DOI: https://doi.org/10.1007/s11245-021-09747-0

Svenaeus F. (2023), The Phenomenology of Objectification in and Through Medical Practice and Technology Development, “Journal of Medicine & Philosophy”, vol. 48(2), pp. 141–150. https://doi.org/10.1093/jmp/jhad007
Google Scholar DOI: https://doi.org/10.1093/jmp/jhad007

Szluz B. (2020), O doświadczaniu choroby Parkinsona. Socjologiczne spojrzenie na chorego, “Annales Universitatis Mariae Curie-Skłodowska, Sectio J – Paedagogia-Psychologia”, vol. 33(1), pp. 209. https://doi.org/10.17951/J.2020.33.1.209-218
Google Scholar DOI: https://doi.org/10.17951/j.2020.33.1.209-218

Timmermans S., Almeling R. (2009), Objectification, standardization, and commodification in health care: A conceptual readjustment, “Social Science & Medicine”, vol. 69(1), pp. 21–27. https://doi.org/10.1016/J.SOCSCIMED.2009.04.020
Google Scholar DOI: https://doi.org/10.1016/j.socscimed.2009.04.020

Toombs S.K. (1987), The meaning of illness: a phenomenological approach to the patient-physician relationship, “The Journal of Medicine and Philosophy”, vol. 12(3), pp. 219–240. https://doi.org/10.1093/JMP/12.3.219
Google Scholar DOI: https://doi.org/10.1093/jmp/12.3.219

Topol E. (2015), The Patient will See You Now: The Future of Medicine is in Your Hands, Basic Books, New York.
Google Scholar

van Dijck J. (2005), The Transparent Body: A Cultural Analysis of Medical Imaging, University of Washington Press, Seattle.
Google Scholar

Waitzkin H., Weatherall D.J. (2004), Scientific method and the art of healing, [in:] Warrell D.A., Cox T.M., Firth J.D., Benz E.J. (eds.), The Oxford Textbook of Medicine, 4th edn, vol. 1, pp. 10–13, Oxford University Press.
Google Scholar

World Health Organization (2024), Obesity and overweight, https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
Google Scholar

Wybourn C.A., Mendoza A.E., Campbell A.R. (2017), Fragmentation of Care – The Untold Story, “JAMA Surgery”, vol. 152(3), pp. 249–250. https://doi.org/10.1001/jamasurg.2016.4099
Google Scholar DOI: https://doi.org/10.1001/jamasurg.2016.4099

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26-09-2024 — zaktualizowane 24-10-2024

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Wieczorkowska, M. (2024). Model biomedyczny, redukcjonizm i ich konsekwencje dla percepcji ciała. Acta Universitatis Lodziensis. Folia Sociologica, (90), 19–35. https://doi.org/10.18778/0208-600X.90.02 (Original work published 26 wrzesień 2024)