Opinion The Disease Loophole: Index Terms and Their Role in Disease Misclassification, 2024, Roberts

https://academic.oup.com/jmp/advance-article-abstract/doi/10.1093/jmp/jhae006/7616027

The Disease Loophole: Index Terms and Their Role in Disease Misclassification
Alex N Roberts
The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine, jhae006, https://doi.org/10.1093/jmp/jhae006
Published:

28 February 2024

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• ORIGINAL RESEARCH

Abstract

The definitions of disease proffered by philosophers and medical actors typically require that a state of ill health be linked to some known bodily dysfunction before it is classified as a disease.

I argue that such definitions of disease are not fully implementable in current medical discourse and practice.

Adhering to the definitions would require that medical actors keep close track of the current state of knowledge on the causes and mechanisms of particular illnesses.

Yet, unaddressed problems in medical terminology can make this difficult to do. I show that unrecognized misuse of “heterogeneous,” “biomarker,” and other important health terms—which I call index terms—can misrepresent the current empirical evidence on illness pathophysiology, such that unvalidated illness constructs become mistaken for diseases.

Thus, implementing common definitions of disease would require closing this “loophole” in medical discourse.

I offer a simple rule that, if followed, could help do just that.

ORIGINAL RESEARCH

Keywords: biomarker, definition of disease, disease, chronic fatigue syndrome, heterogeneous

 

The simple rule —

So, like post-exertional malaise then? As demonstrated uniquely by deterioration on repeat cardiopulmonary exercise testing and reduction in VO2max/AT. A physiological measurement that can not be faked. Sounds at least minimally validated to me.

This paper will age as well as Dorian's picture, though I suspect (and of course hope) over a much shorter timeframe.

 

Also I've made a slight edit here —

 

Possibly a negative timeframe as it turns out.

It's probably worth pointing out that it was published a week after the NIH study. The concluding sentence of that abstract is literally —

 

This is very confused. It starts out by saying that it's not realistic to require a known pathology for every illness, because it's just not feasible. And this is known, especially in toxicology, sometimes you need to know what a patient has come in contact with or you'll simply never be able to do something about it.

But their main argument is that an illness is only an illness if it can be traced back to a known pathophysiology, something that is, as they start with, not realistic? Which happens to be... the current standard. Do they know that? I guess they must know that given the premise. And of course in the case of all chronic illnesses, including ME/CFS, which is singled out, there is plenty of minimally validated evidence, just not a unique biomarker that differentiates from all other diseases without working with patient history and symptomatology.

Whatever, sometimes people just like to sound smart about things they barely understand and this series of words in a particular order can be ignored without much care or consequence, but this is damn weird.

One again I would like to introduce my novel idea of: the wheel. Never before seen, never before used, never before imagined. Give me royalties.

 

Something vile has just from underneath a bridge.

 

This paper is discussed in this editorial: https://www.s4me.info/threads/perso...eath-and-lessened-humanity-2024-maples.37711/