To Be [sick] Or Not To Be [sick] — That Is The Question

I present this with the explicit purpose of generating a philosophical discussion. I am setting a bounty on this post (see below), and only truly thoughtful and engaging comments will be rewarded.

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The following are two real-life cases of patients of mine when I was a professional health practitioner.

Both women described themselves as sufferers of Rheumatoid Arthritis (RA), and had been receiving Chinese Medicine (TCM) treatment for the condition, as well as mainstream Western Medicine (WM).

Sarah — 60yo female

Sarah is a chronic sufferer from RA. She has recently begun a treatment of Actemra , a new drug which is very difficult to get, requiring a rigorous series of attempted treatments before being accepted on the program. This is a drug which costs the Australian taxpayer $30,000 per year, the program lasting indefinitely.

After 3 treatments, the markers in her blood have gone from an "incredibly high level to almost non-existent”. Her specialist Rheumatologist is very pleased, as is she. This drug is considered a breakthrough in the treatment of RA.

I ask her how she feels. She says there is still some stiffness in her hands, which is causing her a little pain, but she attributes that to the new air-conditioned office she is working in, at a desk working at a computer. However, after a few months this increased, although the blood tests continue to show all markers as being at relatively normal levels.

Mary — 90yo female

Mary has suffered from arthritis "all her life" (her words). She began seeing an experienced TCM practitioner a little over ten years ago. She claims, albeit her age, that her arthritis has never been better. She claims to have suffered from extreme pain, swelling, and stiffness considerably when she was younger, but the TCM management has been working incredibly well. She has continued to use the same mainstream WM , the only thing different now is the Acupuncture sessions fortnightly, and daily Chinese herbal medicine.

She has reduced swelling, reversal of the rheumatic nodules on her fingers, less pain, and less stiffness. Pathology tests however show no change in the levels of the markers in her blood.

What is Rheumatoid Arthritis (RA)?

RA is defined as autoimmune disease that causes chronic inflammation of the joints. Typical presentation is pain, stiffness, and swelling of the joints.

Blood tests can also reveal the presence of Rheumatoid Factor (RF) antibodies, ANA antibodies, and higher levels of blood sedimentation rates and and C-Reactive protein. These are not unique to RA, and can also be found in other auto-immune disorders.

The question

Given this definition, who is suffering from arthritis?

On one hand, there is clear objective, quantitative data to show that Sarah doesn't have arthritis; but she still experiences pain, stiffness, and swelling.

On the other hand, we have a woman using natural medicine to reduce and manage pain, stiffness, and swelling, and yet her blood tests reveal the continued presence of the factors which led to her initial diagnosis in the first place.

Sarah truly believes her RA is being managed, even though she still experiences the symptoms; Mary believes her condition is managed because she doesn't experience the symptoms even though according to the medical diagnosis she still suffers from the condition.

My intention is not to suggest one treatment method over another; but to ask the question raised: which of these two have RA?

What, to you, does “sick” mean?

The TCM paradigm does not concern itself with 'diseases'; instead, practitioners seek to determine a “pattern of disharmony” from the signs and symptoms that a patient presents with clinically.

While in WM illness is defined nowadays by the values found in pathology tests (objective data), in TCM the patient’s experience of symptoms (subjective) matters more.

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To be eligible for a share of the bounty set on this post, please address the following questions for discussion:

• Which of these two patients has RA?
• When you imagine your health own complaint, how do you characterise it, how do you represent it?
• When you are sick, do you believe you have an illness, or merely suffering from a number of symptoms?

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Image courtesy of Kira auf de Heide at Unsplash

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