Assignment Guide for Chapter 10
‘Critiques of the biomedical model of health fail to offer any satisfactory alternative to scientific medicine.’ How far do you agree with this view?
This question falls into three distinct parts. Your first task is to explain exactly what the biomedical model of health is. The second is to discuss some of the critiques of the biomedical model. Thirdly you will discuss the alternatives on offer and whether any of these can be considered ‘satisfactory’.
A good place to start is with Table 10.1 on p. 394, which summarizes the main assumptions of the biomedical model: disease is a breakdown of the body caused by specific biological agents; the patient’s sick body should be treated separately from their mind; medical specialists have expert, science-based knowledge which is superior to other types; treatment is best carried out in specialized medical settings such as hospitals. From here, a little more detail can be had from pp. 391-2 including a sketch of the origins and rise to dominance of this scientific model. At this point the essay could move on to the second part. However, it would be useful for your overall evaluation later on if you briefly charted some of the major successes claimed by biomedicine in order to flesh out the picture.
Having set the scene, you can move on to describe and explain some important critiques of biomedicine. This requires your judgement on which of the many critiques in the chapter are most pertinent. McKeown’s historically informed critique suggests that basic improvements in sanitation, food supplies and public hygiene have been more influential than biomedicine in producing better public health, in spite of the widespread assumption that medical advances have been more effective (pp. 392-3). Illich’s radical position sees medicine not just as less effective than its advocates propose but also as positively harmful (pp. 393-4). Using the concept of iatrogenesis (physician-created illness), Illich argues that medical treatments fail to bring about cures and also cause more illness via ‘side effects’ (clinical iatrogenesis). As medical treatments expand an artificial demand is created for them (social iatrogenesis), which results in people becoming increasingly dependent on medics for conditions they feel powerless to deal with themselves (cultural iatrogenesis). The chapter also includes alternative and complementary therapies, many of which operate on principles of illness and health far removed from scientific biomedicine (pp. 394-6). Drawing on one or two of these would make for an effective alternative understanding of health and illness. You might also consider the development of the social model of disability, which shows how the individualistic medical model is linked to discriminatory practices and attitudes towards disabled people (pp. 416-20).
In a short essay you cannot cover all of the different critiques, so you will have to choose two or three that you think pose particular challenges and, perhaps, also offer their own alternative models.
In the final part you will provide an evaluation of biomedicine and its alternatives. Do the critiques merely attack biomedicine without offering concrete alternatives? Or do they offer genuine alternatives that have long been dominated by the medical profession’s power and superior organization? To broaden the conclusion out, you might include evidence from elsewhere in the chapter and the book. For example, what might we learn about the effectiveness of biomedicine from HIV/AIDS and its treatment (pp. 399-403)? How has biomedicine worked in the developing countries (Chapter 13 contains relevant material)? Higher grades can usually be achieved by demonstrating the ability to link bodies of evidence in different contexts and to think outside of the confines of a specific sub-field.