Debating point - The artificial and elusive demarcation between health and disease

A number of problems and uncertainties have been raised by this brief review. Although they are well-known in philosophical and social scientific circles they are otherwise consistently ignored. But I call for a wider debate about them. If medicine cannot come to terms with its own confusing terminology and methodology; if medicine cannot stop raising expectations it cannot fulfil; if medicine does not deliberately restrict its boundaries; and if medicine does not take serious steps to explain why it chooses to call some conditions states of health and others states of disease; then the result must be that health policy (which medicine largely continues to direct) will either be simply an arbitrary matter, or will be implemented on the basis of economic arguments. Where everything else is imprecise the discipline that offers precision will triumph. And the evidence of the moment is that this is exactly what is happening.

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