3. The Problem of Reality
• Reality is dependent on social reasoning and
social practices
4. The Problem of Reality
• Reality is dependent on social reasoning and
social practices
• Medical knowledge sets out to create diseases
by constructing classification criteria which are
socially derived
5. The Problem of Reality
• Reality is dependent on social reasoning and
social practices
• Medical knowledge sets out to create diseases
by constructing classification criteria which are
socially derived
• Medical theorising reflects social theorising
6. The Problem of Reality
• Reality is dependent on social reasoning and
social practices
• Medical knowledge sets out to create diseases
by constructing classification criteria which are
socially derived
• Medical theorising reflects social theorising
• Perceptions of the body and disease change over
time
23. What is observed
Questions to be asked
Structure of Inquiry
Form of Interpretation
Thomas Kuhn: Paradigms
24. Science
Measureable
What is observed
Questions to be asked Observable
Structure of Inquiry Controllable
Form of Interpretation Testable
Thomas Kuhn: Paradigms
25. Science
Measureable
What is observed
Questions to be asked Observable
Structure of Inquiry Controllable
Form of Interpretation Testable
Thomas Kuhn: Paradigms
26. Science
Measureable
What is observed
Questions to be asked Felt Observable
Structure of Inquiry Controllable
Form of Interpretation Testable
Thomas Kuhn: Paradigms
27. Science
Measureable
What is observed
Questions to be asked Felt Observable
Structure of Inquiry Controllable
Form of Interpretation Testable
Thought
Thomas Kuhn: Paradigms
28. Science
Measureable
What is observed
Questions to be asked Felt Observable Implied
Structure of Inquiry Controllable
Form of Interpretation Testable
Thought
Thomas Kuhn: Paradigms
29. Constructed
Science
Measureable
What is observed
Questions to be asked Felt Observable Implied
Structure of Inquiry Controllable
Form of Interpretation Testable
Thought
Thomas Kuhn: Paradigms
34. Medical Evidence: Paradigm Shift
Medical training +
common sense evaluation
Pathophysiology
Clinical experience
35. Medical Evidence: Paradigm Shift
Individual expertise
Medical training +
common sense evaluation
Pathophysiology
Clinical experience
36. Medical Evidence: Paradigm Shift
Individual expertise Rules of evidence
Medical training + Pathophysiology necessary
common sense evaluation but not sufficient
Pathophysiology Reproducible
Clinical experience Systematic
38. Medical Knowledge and
Social Relations
• Disease categories may reinforce
social relations
39. Medical Knowledge and
Social Relations
• Disease categories may reinforce
social relations
• Anorexia Nervosa and sexual
development
40. Medical Knowledge and
Social Relations
• Disease categories may reinforce
social relations
• Anorexia Nervosa and sexual
development
• Attention Deficit Disorder
41. Counting the Dead
“We are still unable to count the dead in the vast majority
of the world’s poorest countries” (Evans and Stansfield
2003)
Less than 10 Sub Saharan African Countries can produce
‘useable mortality data’ (Evans and Stansfield 2003)
9