In Quest of ‘Good’ Medical Classification Systems

Abstract

Medical classification systems aim to provide a manageable taxonomy for sorting diagnoses into their proper classes. The question, this paper wants to critically examine, is how to correctly systematise diseases within classification systems that are applied in a variety of different settings. ICD and DSM, the two major classification systems in medicine and psychiatry, will be the main subjects of this paper; however, the arguments are not restricted to these classification systems but point out general methodological and epistemological challenges of classifying diseases for differing purposes. Deciding what qualifies as a disease to be included into a classification system as well as choosing a specific validator for correctly systematising diseases is complicated because the broad applicability of medical classification systems simultaneously appears as aim and challenge. Drawing upon the case study of classifying Alzheimer's disease, this paper will address three dilemmas in designing 'good' medical classification systems. They are due to general epistemological problems of medicine, such as the relationship between individual manifestations of diseases and the necessity of building groups in order to scientifically elucidate causes of diseases. Moreover, they involve pragmatic issues of designing usable classifications that allow for easily discriminating between classes of diseases, restricting, however, the completeness of disease representations. This paper wants to trace how the choice of certain validators is unavoidably value-laden and deeply intertwined with epistemological assumptions of how different uses relate to each other, resulting either in a prioritisation of (constrained) coherence or of (vague) pluralistic connectibility.

Psychiatric Progress and the Assumption of Diagnostic Discrimination

“…Instead of relying on DSM categories to gather research populations, NIMH researchers gather whatever populations are pertinent to their domain of interest. This method makes unnecessary the roundabouts researchers have always used to precisify generic diagnostic screens to meet their own needs (Meehl 1986;Kutschenko 2011a). One of the aims of RDoC is to allow for the inclusion of patients typically ignored in research because they fall into an "not otherwise specified" category, or are below the threshold for diagnosis.…”

The Case of Pharmacological Neuroenhancement: Medical, Judicial and Ethical Aspects from a German Perspective

“…▶ It will be necessary to monitor how drugs used for enhancement are obtained and to analyze the extent of increase in off-label prescriptions [71]. ▶ Another important aspect is to investigate the shift of boundaries between health and disease and the expansion of medical categories [71][72][73]. Policymakers have a responsibility to act if the results of the research based on these questions give reasons to do so.…”

Disease as a theoretical concept: The case of “HPV-itis”

“…Kendler & Parnas, 2012), and in the philosophical literature on medicine more generally, classification issues have drawn attention in the more clinically oriented end of the philosophical literature (e.g. Jutel, 2011;Kutschenko, 2011;Nordenfelt, 2013).…”