PhD, Associate Professor E.L. Panova¹
PhD, Associate Professor P.A. Shamin^1
1I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)

Keywords: health, disease, human image, biomedicine, nature, model.

Background. Since the second half of the 19 century, the system of medical and biological sciences has been subject to global transformations – from natural-sciences-based medicine largely driven by the biological knowledge system to modern biomedicine increasingly applied as a highly effective tool for the individual social and biological activity control. The biomedical knowledge evolution was triggered by the serious reforms in theories, practices and even world outlooks with concern to a human identity. This purely anthropological dimension of the biomedical knowledge is referred to by the notions of health [5] and disease that provide a notional framework for medical influences on the bodily processes and social relationship.

Objective of the study was to identify fundumental health models in the biomedical knowledgebase evolution by analysis of the national and foreign studies in the theory and philosophy of medicine.

Study results and discussion. Our analysis of the health models provided by the national and foreign studies in the theory and philosophy of medicine in the context of the fundamental concepts of human identity – made it possible to prioritize the following three health models in the biomedical knowledgebase evolution: bio-centric, socio-centric and techno-centric ones.

The bio-centric health model considers man only as an evolutionary biological organism having the only objective to survive by adapting to the natural environment. This model was central in the medical theory and practice in the 1860s when the biological conception of the world was dominated in the natural sciences. Russian physicians (S.P. Botkin, A.A. Ostroumov) and scientists (I.M. Sechenov, I.I. Mechnikov, A.O. Kovalevskiy, I.P. Pavlov) were the first among those who tried to put medicine in compliance with the Darwin’s theory of evolution. It was due to their works that the notions and meanings of health and disease were increasingly interpreted in the context of many other important definitions like adaptation, self-protection, vital capacity, accommodation, external and internal environments etc.

S.P. Botkin, a prominent national therapist, defined health as the bodily ability to maintain the internal environment in balance with the external environment. “Life manifestations with due balance of every life function may be interpreted as the normal healthy life ready for reproduction” [2, p. 4]. In addition, a key function of every living being is adaptation that may be interpreted as the recovery of disorders in the life balancing process. Disease may be described as “every imbalance that may not be readily recovered by the bodily adaptive abilities” [2, p. 5]. Disease may also be defined as the “manifestation of life in unfavourable or harmful conditions” [2, p. 5] i.e. the conditions of potential risk for life.

Acting within the interpretation of health and disease as the biological phenomena, I.V. Davydovskiy, a renowned Soviet pathologist, offered somewhat different definitions for both of the notions. As provided by I.V. Davydovskiy, the pathological processes in a human body cannot be differentiated from the normal ones by some specific qualities. Unlike S.P. Botkin, I.V. Davydovskiy interpreted the adaptation process in much broader terms – as including both the normal and pathological manifestations of the bodily life processes. “Adaptation to an external environment often moves via significant morphological and functional shifts that go even to the nosological domain”: [4, p. 13]. “It is unreasonable to expect that the bodily adaptation processes should always be painless and absolutely harmless”: [4, p. 306]. Notwithstanding some differences in the interpretations of the pathological and normal bodily conditions, the bio-centric health model is generally designed to offer such controls for medical interference that are largely based on the natural scientific knowledge, with the degrees and priorities of such interference directly determined by whether or not the health condition is associated with risks for life.

The foreign biomedical research has been leaded by W. Cannon, an American physiologist who was among the founders of the doctrine of homeostasis [10]; and G. Selye, Canadian pathologist who came up with the stress theory [7].

The socio-centric health model interpreting a human being as mostly a social creature [1, p. 104] was dominant in the Soviet theory and philosophy of medicine. As provided by the material dialectics of the latter with their interpretation of different forms of material movement and their relationship [6, p. 34], a human being exists in the social and natural realities that cannot be fully integrated; with the biological bodily regularities viewed as secondary and subordinate to the social process logics and indirectly controllable by the supreme social form of existence [1, p. 104]. Human relationships with both realities are viewed as opposite since “man reforms nature as required by his needs” [1, p. 110]; and at the same time adapts to the social environment: “Individual adaptation to the social environment is highly important since man is a social creature” [1, p. 195].

Within the socio-centric health model logics, normal health is defined as the “way of existence giving a fully-fledged opportunity for contribution to social and labour activity” [1, p. 202]; whilst a disease/ pathology is interpreted as the malfunction of the bodily defenses and disorder associated with a failure to adapt to the environment and, hence, detrimental to the working capacity and potentially destructive for the body [1, p. 216]. It may be noted, therefore, that whilst this socio-centric health model rates normal health by the working capacity i.e. mostly the biological ability to work, it still defines health and disease by the social standards rather than biological norms. The top priority given to the social aspects of human life at sacrifice of the biological ones resulted in the situation when biologically normal bodily conditions were rated as pathological and, hence, calling for a medical interference. It may be pertinent to mention in this context that the USSR pioneered in legalizing abortions in 1920 much ahead of the western nations, since the socio-centric health model required the Soviet women to be released on their discretion of the maternity and its responsibilities for the sake of their labour accomplishments and social progress.

The latest developments in the biomedical technologies have largely contributed to the newest techno-centric heath model that implies a human being free to redesign own biological body in a sort of technical system to make a breakthrough in the individual psychophysical qualities and abilities. This new health model has been accepted as fundamental by the modern international trans-humanistic movement with its Russia-2045 Project on the national turf [8]. 

This health model accepts and promotes sex reassignment surgeries; genotyping of stem cells and germ tracks; modern reproductive technologies including extra-corporal insemination and soon expected reproductive cloning, artificial womb etc. These technologies and developments may result in the situations when “it is very difficult to find a clear borderline between health protection/ rehabilitation and interference driven by non-medical considerations” [3, p. 165]. The danger of modern medicine being applied to improve and redesign a human body rather than to heal was emphasized by F. Fukuyama, American philosopher: “One of the most serious risks of the modern biotechnologies are associated with their attempts to change the human nature and, hence, make a transition to the post-human historical stage” [9, p. 19]. The technology promoters and project designers use to state that the main mission of medicine, in their view, is to create and maintain an immortal human body. 

Conclusion. The study of the key modern health interpretation models and their world outlooks forming a basis for the human nature understanding – has analyzed bio-centric, socio-centric and techno-centric health models with their transformation conditions and mechanisms with progress of the biomedical knowledgebase. The key driver for evolution of the health models, in our opinion, is the imbalance of the natural and social aspects of a human nature, with the imbalance in its utmost techno-centric health model casting doubts on the further existence of man as a biological species. 

References

1. Ado A.D. Voprosy obschey nozologii [Questions of general nosology]. Moscow: Meditsina publ., 1985, 239 p.
2. Botkin S.P. Obschie osnovy klinicheskoy meditsiny [General principles of clinical medicine]. St. Petersburg: M.M. Stasyulevich publ., 1887, 20 p.
3. Gnatik E.N., Liseev I.K. Problemy tsennosti zhizni i zdorovya cheloveka v svete perspektiv geneticheskoy inzhenerii [Problems of value of human life and health in light of prospects of genetic engineering]. Filosofiya nauki. no. 13: Zdorovye kak problema estestvennykh i biomeditsinskikh nauk [Health as problem of natural and biomedical sciences]. Moscow, 2008, pp. 144-169.
4. Davydovskiy I.V. Obschaya patologiya cheloveka [General human pathology]. Moscow: Meditsina publ., 1969, 612 p.
5. Zhirnov V.D. Zdorovye – atribut antropnosti [Health as attribute of anthropism]. Filosofiya zdorovya [Health philosophy], Moscow, 2001, pp. 130-148.
6. Sarkisov D.S., Paltsev M.A., Khitrov N.K. Obschaya patologiya cheloveka [General human pathology]. Moscow: Meditsina publ., 1997, 608 p.
7. Selye G. Stress bez distressa [Stress without distress]. Moscow: Progress publ., 1982, 68 p.
8. Strategicheskoe obschestvennoe dvizhenie «Rossiya-2045» [Strategic social movement 'Russia-2045']. Available at: http://www.2045.ru/ (Date of access 05.01.2017)
9. Fukuyama F. Nashe postchelovecheskoe buduschee. Posledstviya biotehnologicheskoy revolyutsii [Our posthuman future. Consequences of biotechnological revolution]. Transl. fr. Engl. M.B. Levin. Мoscow, 2004, 349 p. 
10. Cannon W.B. The Wisdom of the Body. New York. Norton. 1963, 333 p.

Corresponding author: e-travina@rambler.ru

Abstract

The study analyzes accomplishments of the national and global science in the medical theory and philosophy to identify the basic health models generated in the biomedical knowledgebase evolution. The study data demonstrate the key heuristic value of a human identity shaping conception to analyze a variety of design approaches to the health models. Subject to analysis under the study were the base conceptions of the human nature invariables; human interactions with the natural and manmade environments; and their effects on the human body. Based on the study data and analyses, we offered the following three health models in the biomedical knowledgebase evolution: bio-centric, socio-centric and techno-centric ones. The bio-centric health model popular in medicine since the late XIX century considers man only as a biological organism with the only objective to survive by adapting to the natural environment. The socio-centric health model that was particularly popular in the Soviet health service philosophy basically considers man as a creature evolving in the natural and social environments. The techno-centric health model has emerged lately with progress of the modern biomedical technologies to interpret man as a living being capable of restructuring own body into a kind of technical system to develop a variety of basically new psychophysical qualities and abilities. This health model has been accepted as a basis for the global trans-humanistic movement on the whole and its national Russia-2045 Project in particular.