The sterile human and the biomedical disease model

October 7, 2020

Viruses and bacteria don’t have the best of reputations. They’re dangerous pathogens and in the past century, they’ve mostly been known as the culprits in virus pandemics and well-known infectious diseases. This image is characteristic of the biomedical disease model, according to which intruders threaten our health. The biomedical disease model has led to great progress but is also subject to much criticism. In the past decades, there has been growing interest in alternative disease models with a new outlook on what it means to be a healthy human being.

Our observations

  • Microbiologists are gaining insight into the complex relationships between us and micro-organisms. From these studies on the microbiome, a more positive image of micro-organisms is emerging than the one common to the dominant biomedical disease model. More and more studies highlight the useful or even crucial aspects to our health of viruses, bacteria and fungi. Consequentially, researchers and medical professionals are calling for a better distinction between the normal, good elements of the microbiome and those that are detrimental to us humans.
  • Scientists are also beginning to view nutrition in a different light. Besides a merely mechanical perspective on food, we’re becoming susceptible to a communicative and informative outlook. Dominant in our view on food are metaphors in which food represents nothing more than energy: food as fuel to keep the engine of our bodies running. In an informational perspective on nutrition, food is seen more as a conversation, and is attributed, besides energizing properties, autonomy and communicative skills. For instance, the genes our food contains can regulate our own genes.
  • In psychiatry in the ‘80s, a strong conviction became prevalent that mental disorders could be captured in a biomedical model as brain diseases. The progress that had been made in the neurosciences had created the expectation that, in the near future, it would be possible to classify all disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM) as brain disease with a clear cause. Because of disappointing results, after the turn of the century this neuro-centrism was widely criticized, paving the way for alternative disease models that ascribe more importance to psychosocial factors.

Connecting the dots

Of course, that bacteria can be beneficial to our health isn’t new information in medical science. And yet, the history of medicine in the 20th century can be read as mostly a battle against bacteria, which began with the germ theory of disease and the discovery of penicillin. The germ theory of disease was partly responsible for the dominance of a biomedical disease model in modern medicine.According to this model, there is a straightforward relationship between cause and condition and a clear course of disease, clearly summarized in Koch’s postulates. This functionalist disease model encompasses a mechanical perception of the body. Disease is naturalistically understood as the dysfunction of organs and therapy is focused on recovery and restoring the affected functions. Health then simply comprises the absence of disease; the machine functioning as it should.Historically, the dominance of the biomedical and functionalist disease model has led to great progress. Sterilization techniques were developed, as were medicine and therapies to effectively debilitate invaders, we learned to disinfect and keep our environment “clean”. Our current life expectancy would have been unthinkable without the biomedical disease model. This “sterile human” has a resistance to infectious diseases and a general level of health unparalleled in human history.Despite these successes, the biomedical and functionalist disease model has been under fire for decades. Critics argue that the model is too unilateral and unable to explain a plethora of illnesses and phenomena. Auto-immune diseases, for instance, are difficult to classify within the model, hormone diseases are more likely to be the result of disrupted homeostasis and we underestimate the role of our emotional life in the course of physical disease.Moreover, the dominant biomedical and functionalist disease model still seamlessly fits an anthropocentric worldview, in which the human as a ruling subject is cut off from his environment and is especially attuned to the menacing side of external nature, a nature which can be used for human gain if we so desire. This view of humanity has long been under fire too. New insights from (among others) modern biology, integral medicine, psychiatry and ecology are difficult to reconcile with the dualism of anthropocentrism.In the past decades, these sciences have shed new light on what it means to be human. A different worldview is emerging in which the world is no longer seen as a large mechanical clock, but as an organic whole in which continual mutual interaction and transference of information take place on different levels of existence. “Subjects” then are not cut off from the world, but only are or become something or someone in relation to others and the environment.This new worldview lays the groundwork for a different understanding of disease and health, which have received more attention in the past decades. In this transition from the Anthropocene to what we could call “the Microbiocene”, we are given the impression that being healthy demands continual exchanges between humans and their environment. Our kind is not just in danger, we would also benefit from this continuous exchange between us and, for example, the bacteria and viruses in our surroundings. This exchange, however, encompasses far more than we can comprehend and control. In this view of humankind, the ability to self-heal of nature and the ecosystems in which we live, are highly valued and trusted.Key concepts around this idea of health are balance or homeostasis, self-regulation, adaptation, motivation and adjustment. The phenomenon of being ill also becomes more complicated than in the unilateral biomedical model. Disease arises from an interplay of a number of relationships that are impossible to oversee for us humans, which is why we always overlook some of them.This new perception of disease and health results in contrasting ideas about medical intervention. Intervention and sterilizing humans and their environment can lead to immediate and quantifiable gains for the sterile human, but in accordance with the new worldview, it can also result in imbalances and vulnerabilities in the long-term. One of those new vulnerabilities has come to light in studies on antibiotics. Medics have been expressing increasingly vehement concerns over the unbridled growth of antibiotics, which is leading to antimicrobial resistance, now globally recognized as a serious problem.Should medical practitioners then intervene less, as advocated by the anti-vaccination movement? On the one hand, the new worldview appears to implicitly call for more laissez faire and restraint when it comes to medical intervention. Human hubris regarding nature should make way for more modesty. The worldview prevents us from suffering iatrogenesis, harm caused by medical treatment. On the other hand, the common purpose of medicine lies largely in therapy through intervention, interventions have proved extremely successful (e.g. in the treatment of measles and pox), and the possibility of treatment causing harm is not sufficient reason to refrain from intervening.The question therefore begs nuance: how do we retain what led to progress in the unprecedentedly successful functionalist and biomedical medicine, while also being more attuned to the vulnerabilities and imbalances it may cause?The embedding of biomedical intervention in a more complete disease model that’s better suited to the complexity of disease and health appears to be the right way forward. The more dynamic and procedural disease models found in psychiatry might be a good starting point. In these models, disease and health are not discrete entities but located on a continuum.They often do not have a clear-cut beginning or end, and there is often no apparent distinction between cause and effect or pathogen and symptom. In this ecological perspective, when designing a therapy, all manner of biological, psychological and social factors are weighed against each other. From this perspective, the biomedical model generally fixates on only one point or temporary condition in this complex relational field, such as the point when a virus in a human body begins multiplying uncontrollably, thereby damaging the organs. This interventionism of the biomedical model is an indispensable tool of medicine but is thus also viewed from a broader perspective on health.

Implications

  • The current battle against the coronavirus shows the implications of the contrasting disease models and worldviews. The biomedical model is particularly suited to answering the question how to intervene now, how to contain the spread of the virus and develop an effective vaccine. But if we want to answer the question how to maintain a healthy relationship with viruses in the long term, we need a disease model that is more attuned to the broader ecological embedding of humans and the everyday relationship we have to viruses. Both questions will have to be taken into consideration, even if they invite contrasting answers and thus fail to provide governments and medical institutions with a clear direction for policy.

Series 'AI Metaphors'

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1. The tool
Category: the object
Humans shape tools.

We make them part of our body while we melt their essence with our intentions. They require some finesse to use but they never fool us or trick us. Humans use tools, tools never use humans.

We are the masters determining their course, integrating them gracefully into the minutiae of our everyday lives. Immovable and unyielding, they remain reliant on our guidance, devoid of desire and intent, they remain exactly where we leave them, their functionality unchanging over time.

We retain the ultimate authority, able to discard them at will or, in today's context, simply power them down. Though they may occasionally foster irritation, largely they stand steadfast, loyal allies in our daily toils.

Thus we place our faith in tools, acknowledging that they are mere reflections of our own capabilities. In them, there is no entity to venerate or fault but ourselves, for they are but inert extensions of our own being, inanimate and steadfast, awaiting our command.
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2. The machine
Category: the object
Unlike a mere tool, the machine does not need the guidance of our hand, operating autonomously through its intricate network of gears and wheels. It achieves feats of motion that surpass the wildest human imaginations, harboring a power reminiscent of a cavalry of horses. Though it demands maintenance to replace broken parts and fix malfunctions, it mostly acts independently, allowing us to retreat and become mere observers to its diligent performance. We interact with it through buttons and handles, guiding its operations with minor adjustments and feedback as it works tirelessly. Embodying relentless purpose, laboring in a cycle of infinite repetition, the machine is a testament to human ingenuity manifested in metal and motion.
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3. The robot
Category: the object
There it stands, propelled by artificial limbs, boasting a torso, a pair of arms, and a lustrous metallic head. It approaches with a deliberate pace, the LED bulbs that mimic eyes fixating on me, inquiring gently if there lies any task within its capacity that it may undertake on my behalf. Whether to rid my living space of dust or to fetch me a chilled beverage, this never complaining attendant stands ready, devoid of grievances and ever-willing to assist. Its presence offers a reservoir of possibilities; a font of information to quell my curiosities, a silent companion in moments of solitude, embodying a spectrum of roles — confidant, servant, companion, and perhaps even a paramour. The modern robot, it seems, transcends categorizations, embracing a myriad of identities in its service to the contemporary individual.
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4. Intelligence
Category: the object
We sit together in a quiet interrogation room. My questions, varied and abundant, flow ceaselessly, weaving from abstract math problems to concrete realities of daily life, a labyrinthine inquiry designed to outsmart the ‘thing’ before me. Yet, with each probe, it responds with humanlike insight, echoing empathy and kindred spirit in its words. As the dialogue deepens, my approach softens, reverence replacing casual engagement as I ponder the appropriate pronoun for this ‘entity’ that seems to transcend its mechanical origin. It is then, in this delicate interplay of exchanging words, that an unprecedented connection takes root that stirs an intense doubt on my side, am I truly having a dia-logos? Do I encounter intelligence in front of me?
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5. The medium
Category: the object
When we cross a landscape by train and look outside, our gaze involuntarily sweeps across the scenery, unable to anchor on any fixed point. Our expression looks dull, and we might appear glassy-eyed, as if our eyes have lost their function. Time passes by. Then our attention diverts to the mobile in hand, and suddenly our eyes light up, energized by the visual cues of short videos, while our thumbs navigate us through the stream of content. The daze transforms, bringing a heady rush of excitement with every swipe, pulling us from a state of meditative trance to a state of eager consumption. But this flow is pierced by the sudden ring of a call, snapping us again to a different kind of focus. We plug in our earbuds, intermittently shutting our eyes, as we withdraw further from the immediate physical space, venturing into a digital auditory world. Moments pass in immersed conversation before we resurface, hanging up and rediscovering the room we've left behind. In this cycle of transitory focus, it is evident that the medium, indeed, is the message.
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6. The artisan
Category: the human
The razor-sharp knife rests effortlessly in one hand, while the other orchestrates with poised assurance, steering clear of the unforgiving edge. The chef moves with liquid grace, with fluid and swift movements the ingredients yield to his expertise. Each gesture flows into the next, guided by intuition honed through countless repetitions. He knows what is necessary, how the ingredients will respond to his hand and which path to follow, but the process is never exactly the same, no dish is ever truly identical. While his technique is impeccable, minute variation and the pursuit of perfection are always in play. Here, in the subtle play of steel and flesh, a master chef crafts not just a dish, but art. We're witnessing an artisan at work.
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About the author(s)

Economist and philosopher Sebastiaan Crul writes articles on a wide range of topics, including rule of law in digital societies, the virtualization of the lifeworld and internet culture. He is currently working on his doctoral degree on the influence of digitalization on mental health and virtue ethics, having previously published dissertations on the philosophy of play and systemic risks in the finance industry.

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