A risk-informed concept of disease

a tool for medicine

Abstract

To determine what defines the concept of disease and whether that concept is value laden, some authors (Lemoine 2013; 2015) advocate for an inductive approach. Lemoine argues that this examination should avoid considering value-laden disease judgments by looking at scientific descriptions of disease. I examine what medicine considers a scientific description of disease, finding that diseases are increasingly described in terms of risk. But in the face of uncertainty about what level of risk constitutes disease, decision-makers turn to non-epistemic values, like economic payoffs of diagnosis, to establish a clinical threshold of risk which determines where a biological variable counts as disease. An inductive examination of diseases described in terms of risk results in a concept of disease that is not value-free. This historically informed examination of the concept of disease demonstrates that the concept is a tool which is sculpted by specific actors to serve the goals of diagnosis.