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Romano Lecture examines modern medicine and disease

By : Katie Ellis

As the field of medicine has evolved and grown over the past century, so has Charles Rosenberg’s fascination with the way we think about — and manage — disease.

Professor of the history of science and Earnest E. Monrad Professor in the Social Sciences at Harvard University, Rosenberg spoke about the dilemma of discovery and what it means to contemporary medicine at the 19th Mario and Antoinette Romano Lecture on April 13.

“I’m fascinated by the history of disease because it illuminates how we think about the world and how different pieces of the world articulate and relate to each other,” he said. “I believe it’s a revolution in terms of human culture in the sense of how we think about our own health. How we’re treated by the health-care system affects us all.”

Rosenberg’s fascination began when questioning how, in 1880, people died of “old age,” but by 1980, people died of specific diseases — what he termed a “specificity revolution.”

How we think about disease today is time-specific, technology-specific and bureaucracy-specific, Rosenberg said.

“We take it for granted in a world of chronic disease and aging that we will all end up succumbing to one of these specific illnesses,” he said. “But we’ve approached it technologically: there’s a screening for it, a protocol to follow.”

Though oversimplifying the picture, Rosenberg, as an example, traced the treatment of breast cancer from the 1800s when mastectomies were done “as a last resort to bring some comfort” into the 1900s, when cancer surgery became more routine but was sold as an intervention in a process that would stop a proliferation of cancer.

“Think about that history and you see how we’ve learned as a culture that cancer is something that is lurking. That’s why screenings are popular and widely accepted,” he said, whether the data supports it or not.

“It’s characteristic of our period,” he said. “We often treat people who are symptom-free. Disease becomes in the minds of people indistinguishable from the disease itself ... and we’re not living just with symptoms, but with a statistical concept of the likelihood that we will develop cancer; the indicator of a risk factor is confused with the disease.”

Medical interventions have not necessarily cured specific diseases, but have created altered ones, Rosenberg added. “We still have diabetes, but it’s diabetes after insulin. People are alive who would have died before ... but in a sense we’ve created a new disease.”

Though everyone has a stake in this medical culture, there are some essential tensions built into modern medicine, Rosenberg said.

“When you live in a world where there is aggregated medical treatment, it doesn’t involve certainty. You are a unique individual and how you approach a mammogram and the stats that say if you do this it will improve your five-year survival rate — that’s an individual decision. Data won’t solve individual problems for doctors or people.”

Our love of technology represents another pervasive tension that won’t go away, he said. As a result, “our expectations are often too high and present new dilemmas. Faith in technology creates emotional, economic and social costs because it’s easier to deal with things you can do to intervene or try to cure.

“Medicine is involved with the world in so many different ways ... it’s both a mirror of what all of our society is and of the compromises it makes, and it can’t be simply a body of technology applied in the abstract or as a market phenomenon.

“Medicine, dentistry, antiseptic surgery — they do a lot of wonderful things,” Rosenberg said. “But it doesn’t mean they don’t create new dilemmas.”

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Last Updated: 10/14/08