Is disease in the eye of the beholder?

Diseases, like beauty, are in the eye of the beholder

A lot of us spend our time working on disease awareness campaigns, but what is a disease?

You probably think that’s an easy one to answer – not so clinicians, policy makers and academics who are still trying to agree a definition. Indeed recently in the BMJ a group of Finnish researchers said that ‘disease’ “can be as difficult to define as beauty, truth or love”.

They go on to say that the definition of ‘disease’ strongly influences which drugs insurers and governments reimburse. So, in turn, the definition of ‘disease’ must strongly influence medical education, communications and marketing.

Research carried out in Finland among members of the public, doctors, nurses and MPs found that while some conditions were universally accepted as diseases – such as breast, lung and prostate cancer, diabetes, HIV/AIDS, schizophrenia and myocardial infarctions – others were not.

An equal number of people thought erectile dysfunction, infertility, drug addiction and premenstrual syndrome were diseases, as did not. And eight out of 10 said conditions such as ageing, grief and smoking were definitely not diseases. An interesting one seeing Cancer Research UK says smoking causes 86% of lung cancer deaths.

Unsurprisingly doctors were most likely to consider a condition as a disease, something which might contribute to the continuing controversy surrounding the ‘medicalisation’ of ‘normal life events’.

In the Finnish study, willingness to pay for a treatment from public funds correlated “very strongly” with whether patients, doctors, nurses and MPs saw a condition as a disease. The “large disagreement among the public, health professionals and legislators” as to whether the management of some conditions should be publicly funded might court controversy in this time of austerity.

The BMJ research says that understanding such differences in attitude can “inform social discourse” about several contentious public policy issues. And, of course, understanding these differences can also inform pharmaceutical marketing, communications and policies.

To a certain extent, we need to develop campaigns that recognise some diseases are, like beauty, in the eye of the beholder.

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