Is that really a disease? Epistemology and crank-ism

And out of the ground the LORD God formed every beast of the field, and every fowl of the air; and brought them unto the man to see what he would call them; and whatsoever the man would call every living creature, that was to be the name thereof. (Genesis 2:19)

Human beings are great organizers. As far back as written history goes, people have named and classified what they observe. In fact, it forms the basis for modern science. Linnaean classification, based on observation of traits, predates modern cladistic and genomic classification of organisms, based on arguably more fundamental characteristics.

The same is true of human disease. Hippocrates was a great observer of human disease and correctly described many conditions in ways easily recognizable to modern doctors. Today, where we know causes of disease, classification has become more precise. For example, we may divide diseases into those caused by bacteria, viruses, genetic defects, etc. When we don’t know the cause of a disease, we still rely on observation. We have various syndromes such as lupus where we do not know the cause, and must fall back on description. This is especially true of psychiatric diseases, where causes are largely unknown, but identifiable patterns of thought and behavior exist.

It is of course most desirable to be able to describe a disease and know its cause, but being able to name less “concrete” disorders is also helpful. It allows researchers to identify cases and test interventions. Even though lupus does not have one easily identifiable cause, we can describe it well enough to study treatments, thereby helping design treatments.

This all leads up to a larger epistemologic question: what is a disease?

I bring this up because I got spammed by my favorite internet doc, Joseph Mercola. The email contained an article from his website written by some other crank. In the title, he asks, “How many of these ridiculous ‘disorders’ do you suffer from?” The premise is a familiar one, dealing in a rather unsophisticated way with the issue of “medicalization” of “normal” states. This is a “real” issue, and is discussed often in such areas as Attention Deficit/Hyperactivity Disorder in children, especially in relation to treating kids with medication.

To decide what is “disease” we also have to know what is “normal”, as disease can reasonably be defined as “a significant deviation from normal that causes discomfort, shortens life, or both.” A blue mood causes discomfort. But how “blue” do you have to be before it is significantly abnormal? Operational definitions have been developed to deal with this problem. There is inherent arbitrariness in this process. What is it about two weeks of severely depressed mood that is different from one week or three weeks? For diseases where the underlying physical mechanism is unclear, rational consensus is usually reached by experts.

So where does the crankery come in? Right about here. Cranks, denialists, and conspiracy theorists shove the crowbar of ignorance into the interstices of our medical knowledge. Into this artificially widened gap, they place their paranoid ideas. This crank follows the usual pattern of decrying “big Pharma” but does it particularly poorly:

Do you have difficulty sleeping after drinking coffee? The problem isn’t a product of your poor judgment in guzzling java immediately before retiring. You are a victim of 292.89 — Caffeine-Induced Sleep Disorder F15.8. If you reflect on your shyness while tossing and turning, the problem could be the epidemic of 300.23 — Social Phobia F40.1. Don’t worry. Drug treatment is available.

What a “friggiot”1. When teaching about and evaluating sleep disorders, for instance, it is helpful to have a framework on which to set the relevant knowledge. For sleep one could divide disorders into medication-induced, circadian rhythm disturbances, mood disorders, improper sleep hygiene, sleep-related breathing disorders, sleep-related movement disorders, etc. If you don’t have framework such as this (and I made it up—this one isn’t from “the book”) then you have no way of organizing, communicating, and using knowledge. When a patient complains of sleep problems, he doesn’t usually say, “I can’t sleep well because I drink coffee at bedtime.” He usually says he can’t sleep well, and the doctor, using her knowledge of sleep disorders, asks questions and examines the patient, formulates a hypothesis, and tests it. It’s called science.

I won’t bother going through the rest of his article, because the same reasoning applies. More ignorance is rarely the answer to a problem. One of the great successes of human intelligence is the ability to describe and name. Even the authors of the Bible knew this well enough to include it “in the beginning”.


1Friggin’ idiot