Primary Health Care - JOHN J. HADDAD, Ph.D.

The ‘ologies’ (underpinning academic disciplines) of primary health care 25
substance and processes can be broken down into the behaviour of molecules,
compounds, fluids, and gases (mostly dissolved ones, and some attached to
transfer proteins). And whilst the molecules, compounds, mixtures and processes
that make up the living world tend to be more complex than those of
the non-living world, the same fundamental physical principles apply.
The logical and causal nature of ill health. When I was a medical student, I spent
my life learning lists: the 20 causes of chest pain; the 20 causes of an old person
going ‘off legs’; the 20 causes of fever in a person recently returned from a trip
to Africa. The small print of these lists was (sometimes implicitly, though you
never knew when you might have to set it out in full in an exam answer) a particular
sequence of causation such as ‘mosquito bites man → malaria parasite
enters bloodstream as sporozoite → sporozoite takes up residence in man’s
liver → dormant period ensues while sporozoite reproduces asexually →
sporozoites are periodically released from liver and enter red blood cells →
dying red blood cells produce chemical with pyrogenic properties ‡ → man’s
homeostatic thermostat is shifted up two degrees every few days → man gets
periodic fever’ – and thus, the disease and its symptoms could (or should) be
explicable entirely in terms of what had ‘gone wrong’ with the body, in what
order.
The logical and causal nature of therapeutic interventions. It follows from the
previous two concepts that the treatment of ill health is about correcting the
physical abnormality that set the undesired causal sequence in motion. Correcting
pathological processes at the molecular level is, of course, the raison
d’etre of the pharmaceutical industry. Millions of people worldwide owe their
lives to anti-malarial drugs that were developed by the logical analysis of the
disease sequence outlined briefly above.
As Table 1.2 in the previous chapter shows, the biomedical model of diabetes
is not ‘incorrect’ in any simple sense. Diabetes is indeed the product of a
pancreas that makes too little of the hormone insulin and/or the result of cells
becoming resistant to its effect (so that more is needed to do the job). But I hope
you can see that this is only one ‘framing’ of the problem of diabetes – and it
is a framing that drives us down a very particular approach to managing the
problem of diabetes. Patients will be put on medication to boost their insulin
levels (or improve their sensitivity to insulin); they will need to have this medication
prescribed by a doctor and ‘comply’ with instructions on how to take
it; and they will need to attend for regular blood tests to check-up on how the
biological repair work is going. The right-hand column in Table 1.2 illustrates
how going beyond the biomedical model can open up new framings of what
diabetes is and new opportunities for how it is managed. Sections 2.3–2.8 of this
‡ You may have spotted the tautological (circular) nature of this explanation. A ‘pyrogen’ is
something that causes a fever. The man gets a fever because he produced a pyrogen – which
hasn’t said much except to imply that there must be a pyrogen since a fever has to have a
cause. Such reasoning is, sadly, very common in biomedical textbooks.