Ciba Foundation Symposium 44 - Research and Medical Practice: Their Interaction: Ciba/Research

The dysfunctional consequences of the Cartesian dichotomy have been enhanced by the power of biomedical technology. Technical virtuosity reifies the mechanical model and widens the gap between what patients seek and doctors provide. Patients suffer 'illnesses'; doctors diagnose and treat 'diseases'. Illnesses are experiences of discontinuities in states of being and perceived role performances. Diseases, in the scientific paradigm of modern medicine, are abnormalities in the function and/or structure of body organs and systems. Traditional healers also redefine illness as disease: because they share symbols and metaphors consonant with lay b-liefs, their healing rituals are more responsive to the psychosocial context of illness. Psychiatric disorders offer an illuminating perspective on the basic medical dilemma. The paradigms for psychiatric practice include multiple and ostensibly contradictory models : organic, psychodynamic, behavioural and social. This melange of concepts stems from the fact that the fundamental manifestations of psychosis are disordered behaviours. The psychotic patient remains a person ; his self-concept and relationships with others are central to the therapeutic encounter, whatever pharmacological adjuncts are employed. The same truths hold for all patients. The social matrix determines when and how the patient seeks what kind of help, his 'compliance' with the recommended regimen and, to a significant extent, the functional outcome. When physicians dismiss illness because ascertainable 'disease' is absent, they fail to meet their socially assigned responsibility. I t is essential to reintegrate 'scientific' and 'social' concepts of disease and illness as a basis for a functional system of medical research and care. In the Gospel according t o St Matthen,' Jesus eluded the efforts of the Pharisees and the Herodians t o lure him into treason by his cautious injunction: 'Render therefore unto Caesar the things that are Caesar's and t o G o d the things that a r e God's.'' Similarly, the Cartesian dichotomy between matter a n d soul' can be viewed a s a device that. since it surrendered a domain the church Content: Chapter 1 Introduction (pages 1–2): Sir Douglas Black Chapter 2 Delineation of Clinical Conditions: Conceptual Models of ‘Physical’ and ‘Mental’ Disorders (pages 3–23): Leon Eisenberg Chapter 3 Structural Determinants of Disease and their Contribuition to Clinical and Scientific Progress (pages 25–40): Alexander G. Bearn Chapter 4 Clinical Science (pages 41–52): E.J.M. Campbell Chapter 5 The Value to Medical Practice of Basic and Applied Medical Research Done Twenty Years Ago (pages 53–71): C.J. Dickinson Chapter 6 The Assessment of Efficacy, Toxicity and Quality of Care in Long?Term Drug Treatment (pages 73–95): C.T. Dollery Chapter 7 Problem?Solving in Science (pages 97–114): Michael Woodruff Chapter 8 Fundamental Research in Molecular Biology: Its Relevance to Medicine (pages 115–135): M.F. Perutz Chapter 9 French Medical Research: The Risk of ‘Demedicalization’ (pages 137–149): Philippe Meyer Chapter 10 Health Services Research: Why and How? (pages 151–167): Peter F. Hjort Chapter 11 Client?Oriented Medicine (pages 169–183): Douglas Black Chapter 12 Government Needs and Public Expectations (pages 185–195): Sir Philip Rogers Chapter 13 International Coordination of Biomedical Research (pages 197–213): S.G. Owen The Novartis Foundation Series is a popular collection of the proceedings from Novartis Foundation Symposia, in which groups of leading scientists from a range of topics across biology, chemistry and medicine assembled to present papers and discuss results. The Novartis Foundation, originally known as the Ciba Foundation, is well known to scientists and clinicians around the world.