Historical Situatedness of Categories' Meanings in Medicine

Abstract

Dichotomies in medicine are real, and the boundaries that define them are constantly shifting. Radical antitheses such as healthy versus ill, reconstructive versus aesthetic, or medical dermatology versus cosmetic dermatology can be more clearly understood by considering the cultural context of medicine. This essay examines the latter two antitheses and asks whether medical dermatology should be a category limited to somatic illness. It also examines how the tendency to create and endorse dichotomies distorts the meaning and delivery of surgical procedures as well as reimbursement practices in contemporary medicine. Shifting Boundaries Between Aesthetic and Reconstructive Surgery In 1992, US Food and Drug Administration (FDA) Commissioner David Kessler, later a distinguished dean of the Yale Medical School, facilitated the FDA's decision to limit access to silicone breast implants. 1 The implants had been allegedly silently leaking their contents and causing a wide range of autoimmune illnesses, including scleroderma, lupus, rheumatoid arthritis, and fibromyalgia, and, it was argued, increasing the risk of breast cancer. 2 Introduced in 1962 by Dow Corning, 3 but not subject to safety testing by the FDA until 1976, 1 the implants replaced a range of substances, from autogenous body fat to paraffin, which had been employed in breast enhancement from the mid-1890s. 3 Kessler, relying on a scientific committee report, halted their general use, but allowedand here was a critical point of contention-"access to silicone breast implants for patients … who undergo reconstructive surgery at the time of mastectomy." 1

Financing future fertility: Women’s views on funding egg freezing

“…It is not clear how these various eligibility criteria are justified, and the lack of consistency in the criteria used may lead to inequity. The medical/non-medical criterion is used in the allocation of EF funding across the world ( Shenfield et al, 2017 ); however, this distinction can be difficult to define, and the categorization of conditions as either medical or non-medical is contested ( Colleton, 2008 ) and subject to change as the views of society evolve ( Gilman, 2018 ). In addition, the results of the present study suggest that some individuals regard medical and non-medical EF as analogous.…”