3. D. Bio-weapons difficult to produce and handle
• not successful
• us and russia have labs that can make anthrax
powder fine enough to infect people
• exception - small pox over 50 % fatal untreated
• cypro - powerful anti biotic for anthrax
E. The threat from bio-warfare is real, but relatively low
F. The public health system is poorly prepared to deal
with bio-warfare
• hospitals and docs are poorly equipped for bio
warfare. normal hospitals have only one single
isolation room
• they also do not have respirators, hospital has like
2 to 3
4. I. Concepts of disease evolved from diagnostic
process
A. Doc listens to patient
B. Doc examines patient
C. Doc describes symptoms and organizes them into
clusters
D. Doc matches observed symptom clusters with
typologies of known symptoms
• civil war... more soldiers died of infection than of
the actual wound
•
5. II. Best diagnosis
A. Includes theory of etiology (cause of disease)
B. Implies a theory of treatment
• broken bone is an example of a best diagnosis
• tb is another good example
• clear symptoms
•
6. III. Adequate diagnosis
A. Can observe symptoms accurately
B. No good theory of causation
• it may have multiple causes
• can develop treatment from trial and error
• example high blood pressure (you can describe blood pressure
very accurately,)
• systolic and the diastolic pressure
• they look for cystolic over 140 and diastolic over 90
C. Good treatment developed through trial and error rather than theory
C. statistical numbers do not take into account the age difference
or race difference
C. blood pressure of old people is naturally high
7. IV. Poor diagnosis
A. No clear description, no theory of causation, no
theory of treatment
• best example mental illnesses (impossible to
diagnose)
• 10 - 20 % have a psychological diagnoses and most
of them are diagnosed as depression
• sadness
• fatigue
• loss if interpersonal relationships
8. V. Specific problems with diagnoses
A. Individual variability in body functioning complicates diagnosis
• individuals and groups vary in how often they have a symptom
• youth are most active
• old people are always over diagnosed with depression cz they are
always fatigued and dont do anything
• definition of mental health
• resistance to mental stress
• positiveness
• high sense of personal autonomy (you are unique person in this
world
• accurate perception of reality
• froid - you can have an intimate relationship and if you can work
• the problem is they conflict - high self esteem conflicts with
accurate perception of reality
• depressed people are very accurate
• no one can pick which is really correct so the studies in america
have a wildly different percentages of how many people in usa
are depressed- some studies say 1% other say 64%
B. Lack of consensus about symptom clusters and typologies
increases error in description
9. C. Errors in empirical definitions of illness
1. Failure to see clusters of symptoms
– when you have co morbidity (two or more illnesses of the
same time one a mental illness and the second a
substance abuse)
– where you get a diagnosis can have a hugee effect on
what you are diagnosed for
2. Failure to describe symptom clusters completely
– example AIDS
3. Failure to distinguish consistently between
overlapping clusters of symptoms
– severe headache
10. D. Diagnosis affected by social factors
• ceserian birth
1. Convenience and access
2. We often rely on others to judge whether we're
sick or well
3. We observe our own levels of activity to judge
whether we're sick or well
4. Social definitions of deviancy as illness
11. VI. Implications for diagnosis using medical
model
A. Unreliability of diagnosis is common
• always get a second opinion
B. No consensus on treatment for many illnesses
12. VII. Special focus: how good is diagnosis of
mental illness?
A. How do hospitals decide who is "really insane" and
"really sane"?
13. VIII. Being Sane in Insane Places: Study 1
A. Could hospitals distinguish "pseudo-patients" from
"real" patients
B. 8 sane people gained admission to 12 different
hospitals
C. Results
14. IX. Being Sane in Insane Places: Study 2
A. Hospitals were angry, felt tricked
B. Researcher gave them another chance, challenged
them to distinguish pseudo-patients from real
patients for the next 3 months
C. Results
15. X. Other major finding
A. Once a person was diagnosed mentally ill, the label
influenced the interpretation of all behavior, even
normal behavior
16. XI. Conclusions
A. Doc‘s diagnoses were reasonable given their
limited knowledge of the patient
B. BUT a diagnostic process that results in such
massive errors is not very reliable
C. Docs have a bias toward active treatment
17. Stephen Hansell, Ph.D.
Department of Sociology
Institute for Health Research
http://sakai.rutgers.edu
shansell@rci.rutgers.edu
609-203-2830
