1. Constructing Realities

2. The Problem of Reality

3. The Problem of Reality
• Reality is dependent on social reasoning and
social practices

4. The Problem of Reality
• Reality is dependent on social reasoning and
social practices
• Medical knowledge sets out to create diseases
by constructing classification criteria which are
socially derived

5. The Problem of Reality
• Reality is dependent on social reasoning and
social practices
• Medical knowledge sets out to create diseases
by constructing classification criteria which are
socially derived
• Medical theorising reflects social theorising

6. The Problem of Reality
• Reality is dependent on social reasoning and
social practices
• Medical knowledge sets out to create diseases
by constructing classification criteria which are
socially derived
• Medical theorising reflects social theorising
• Perceptions of the body and disease change over
time

8. Medicalisation

9. Medicalisation
• Medicine has increasingly deposed
competing knowledge bases

10. Medicalisation
• Medicine has increasingly deposed
competing knowledge bases
• Sex

11. Medicalisation
• Medicine has increasingly deposed
competing knowledge bases
• Sex
• Interpersonal relationships

12. Medicalisation
• Medicine has increasingly deposed
competing knowledge bases
• Sex
• Interpersonal relationships
• Childbirth

13. Hierarchy of Scientific Research

14. Hierarchy of Scientific Research
Case Study

15. Hierarchy of Scientific Research
Cohort Study
Case Study

16. Hierarchy of Scientific Research
Randomised Control Study
Cohort Study
Case Study

17. Hierarchy of Scientific Research
Reliability
Randomised Control Study
Cohort Study
Case Study

18. Hierarchy of Scientific Research
Reliability
Randomised Control Study
Cohort Study
Case Study
Authenticity

19. Thomas Kuhn: Paradigms

20. What is observed
Thomas Kuhn: Paradigms

21. What is observed
Questions to be asked
Thomas Kuhn: Paradigms

22. What is observed
Questions to be asked
Structure of Inquiry
Thomas Kuhn: Paradigms

23. What is observed
Questions to be asked
Structure of Inquiry
Form of Interpretation
Thomas Kuhn: Paradigms

24. Science
Measureable
What is observed
Questions to be asked Observable
Structure of Inquiry Controllable
Form of Interpretation Testable
Thomas Kuhn: Paradigms

25. Science
Measureable
What is observed
Questions to be asked Observable
Structure of Inquiry Controllable
Form of Interpretation Testable
Thomas Kuhn: Paradigms

26. Science
Measureable
What is observed
Questions to be asked Felt Observable
Structure of Inquiry Controllable
Form of Interpretation Testable
Thomas Kuhn: Paradigms

27. Science
Measureable
What is observed
Questions to be asked Felt Observable
Structure of Inquiry Controllable
Form of Interpretation Testable
Thought
Thomas Kuhn: Paradigms

28. Science
Measureable
What is observed
Questions to be asked Felt Observable Implied
Structure of Inquiry Controllable
Form of Interpretation Testable
Thought
Thomas Kuhn: Paradigms

29. Constructed
Science
Measureable
What is observed
Questions to be asked Felt Observable Implied
Structure of Inquiry Controllable
Form of Interpretation Testable
Thought
Thomas Kuhn: Paradigms

30. Medical Evidence: Paradigm Shift

31. Medical Evidence: Paradigm Shift

32. Medical Evidence: Paradigm Shift
Pathophysiology

33. Medical Evidence: Paradigm Shift
Medical training +
common sense evaluation
Pathophysiology

34. Medical Evidence: Paradigm Shift
Medical training +
common sense evaluation
Pathophysiology
Clinical experience

35. Medical Evidence: Paradigm Shift
Individual expertise
Medical training +
common sense evaluation
Pathophysiology
Clinical experience

36. Medical Evidence: Paradigm Shift
Individual expertise Rules of evidence
Medical training + Pathophysiology necessary
common sense evaluation but not sufficient
Pathophysiology Reproducible
Clinical experience Systematic

37. Medical Knowledge and
Social Relations

38. Medical Knowledge and
Social Relations
• Disease categories may reinforce
social relations

39. Medical Knowledge and
Social Relations
• Disease categories may reinforce
social relations
• Anorexia Nervosa and sexual
development

40. Medical Knowledge and
Social Relations
• Disease categories may reinforce
social relations
• Anorexia Nervosa and sexual
development
• Attention Deficit Disorder

41. Counting the Dead
“We are still unable to count the dead in the vast majority
of the world’s poorest countries” (Evans and Stansfield
2003)
Less than 10 Sub Saharan African Countries can produce
‘useable mortality data’ (Evans and Stansfield 2003)
9