All Finns think that myocardial infarction, breast cancer, malaria and pneumonia are diseases. People are equally unanimous that wrinkles, grief and homosexuality are not diseases. What about drug addiction or absence of sexual desire? Or erectile dysfunction, infertility or obesity?
“The word disease seems to be as difficult to define as beauty, truth or love, although the concept of disease lies at the heart of medicine,” Tikkinen says.
Currently on leave from the Helsinki University Central Hospital, Tikkinen works as a visiting research fellow at McMaster University in Hamilton, Ontario, Canada.
The FIND Survey examined, across a wide range of conditions, which should be classified as a disease. The respondents included four relevant stakeholders: laypeople, doctors, nurses and legislators.
Perceptions of disease were surveyed using a questionnaire that listed 60 states of being related to health and well-being, from breast cancer and pneumonia to burnout, grief and wrinkles. Using a 5-point Likert-scale ranging from “strongly disagree” to “strongly agree”, the respondents were asked to evaluate whether states of being should be considered diseases and be funded through public revenue.
The survey was sent to 6,200 Finns: 1,500 doctors, 1,500 nurses, 3,000 laypeople and the 200 members of the Parliament of Finland. The doctors and nurses were randomly selected from the databases of their professional organisations and the laypeople from the Finnish Population Register. A total of 3,280 people responded to the survey (53%).
The 60 states of being presented in this survey included 12 that at least 80 percent of the respondents considered to be diseases. Five states were considered not to be diseases by at least 80 percent of the respondents. The responses to the remainder of the states showed large disagreement whether they should be considered, or not, diseases.
Public funding only for the treatment of “real” diseases
Doctors were the most inclined to consider states of being diseases. Laypeople were the least inclined, and nurses and legislators were in between. However, the differences between the groups were not large, and were very small in comparison to the disagreement within each group.
In all groups, willingness to pay for treatment from public funds was very strongly correlated with the perception of disease (that is, whether respondents regarded a particular state of being as a disease).
“The substantial disagreement we found in classifying of states of being as diseases, and the parallel disagreement regarding the legitimacy of public funding for those that warrant treatment provides insight into the attitudes underlying a number of current high profile social debates. The solutions and management of drug addictions, for example, may vary greatly depending on whether addiction is seen as a disease or as a moral failing.” Tikkinen says.
Full bibliographic informationReference: Kari A.O. Tikkinen, Janne S. Leinonen, Gordon H. Guyatt, Shanil Ebrahim and Teppo L.N. Järvinen. What is a disease? Perspectives of the public, health professionals, and legislators. BMJ Open 2012;2:e001632.