Do health professionals have a prototype concept of disease? The answer is no
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RESEARCH
Open Access
Do health professionals have a prototype concept of disease? The answer is no Bjørn Hofmann1,2
Abstract Background: Health and disease are core concepts in health care and have attracted substantial interest and controversy. In recent and interesting contributions to the debate it has been argued that the challenges with the concept of disease can be resolved by a prototype concept of disease. As a robin is a more prototypical of a bird than a penguin, some diseases are more prototypical than others. If disease is a prototype concept, it would change nosology, but also health care and the study of health and disease. However, the statement that “disease is a prototype concept” forms an empirically testable hypothesis. Therefore, this study aims to test the hypothesis that health professionals have a prototype concept of disease. Methods: Two hundred twenty-three health care professionals in Norway were invited to participate in a survey where they were asked to rank a wide range of diseases according to how typical they considered them to be as diseases. Results were analysed with descriptive statistics. Results: The response rate was 90%. Lung cancer, leukemia, colon cancer, myocardial infarction, and AIDS are the diseases ranged to be most typical, while homosexuality, pregnancy, drapetomania, dissidence, and nostalgia are considered to be the least typical diseases. The results also show that the answers to how typical various diseases are vary greatly, even amongst a relatively homogenous group of health professionals. Conclusion: This study falsifies the hypothesis that disease is a prototype concept for health professionals. This has implications for the debate on core concepts for health care. If health professionals do not have a prototype concept of disease, it is unlikely that there is a prototype concept of disease in general. Consequently, nosologies should not be based on prototypes. Keywords: Disease, Concept, Prototype, Falsification, Language
Background Health and disease are core concepts in health care and have attracted substantial interest and controversy [1–16]. The eager to define disease is fuelled by the strong needs for demarcation, i.e., to differentiate those who are entitled to attention, treatment, and care by health professionals, who are freed from duties, such as work (sick leave), and who are entitled to economic support from those who are not [17–19]. As such, the concept of disease is of great theoretical and practical import for health care. However, the concept of disease poses profound (ontological, epistemological, and ethical) challenges, yet not settled [20], and defining disease has turned out to be demanding [16]. Correspondence: [email protected]; [email protected] 1 Institute for the Health Sciences, The Norwegian University Science and Technology, PO Box 1, N-2802 Gjøvik, Norway 2 Centre for Medical Ethics at the University of Oslo, Oslo, Norway
Some even argue that it is impossible or even quite unnecessary [8, 21]. It has been a
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