Editorial
Standards, scales and chronic illness: A brief introduction
Chronic Illness 2014, Vol. 10(1) 3–4 ! The Author(s) 2012 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1742395312468459 chi.sagepub.com
Carsten Timmermann
The articles in September 2013 issue by Stephanie Snow, Carsten Timmermann and Michael Worboys deal with the histories of different clinical scales that have been important in shaping current understandings of chronic disease. As Chronic Illness is not a journal dedicated to the history of medicine, the papers warrant a brief general introduction. Chronic Illness publishes articles that are aimed at enabling practitioners, policy makers and patients to understand and manage chronic diseases more effectively. Our papers aim to do so by drawing the attention of readers to important historical developments, which have contributed to the transformation of acute into chronic conditions (Timmermann, Worboys) and vice versa (Snow): the adoption of standardized scales for quality of life in cancer trials, for depression, and stroke. We tend to take for granted that standards are a useful thing. We are also used to the idea that we live in an era where communicable and acute diseases have given way to non-communicable and chronic disorders as the main causes of mortality and morbidity. Our papers discuss the role that standardization has played in creating the modern notion of chronic illness. Studying the history of issues that we take for granted can help us understand how things have come to be the way they are. If we use a metaphor and view a fact like a ship in a bottle, history helps us to unpack such facts, to understand how the ship got into the bottle.1
Both standardization2–4 and chronic disease5–9 have received some attention by historians of science, technology and medicine in recent years. Standardization is an important feature of our modern age. In medicine and elsewhere, acts of standardization have been associated with redistributions of labor, risk and responsibility. Standardization enabled non-experts to do work that used to be done by experts, and machines to do the work of humans. Importantly, acts of standardization made changes look natural and necessary which were, in fact, the consequences of political decisions and social processes. How does this apply to medicine and especially chronic illness? Historians have shown how the availability of reliably standardized insulin, for example, has not only turned diabetes from an acutely lifethreatening disease into a chronic condition, but also enabled patients to manage it themselves.7,8 Similar arguments have been made for dialysis and kidney disease.9 In our papers we are concerned with attempts to standardize complex acts of clinical judgement in the shape of relatively simple, often Centre for the History of Science, Technology and Medicine, University of Manchester, Simon Building, Manchester M13 9PL, UK Corresponding author: Carsten Timmermann, Centre for the History of Science, Technology and Medicine, University of Manchester, Simon Building, Manchester M13 9PL, UK. Email: [email protected]
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Chronic Illness 10(1)
numerical scales, so that the outcome of such acts can be compared and compiled, and made to work in ways that more discursive descriptions of phenomena cannot. While fundamental questions are a matter of debate at the beginning of such standardization processes, as we show in our articles, they move increasingly to the background. Scales and indices, we argue, make it possible to include the outcome of acts of clinical judgement in statistical calculations. They turn subjective observations into objective facts, which shape the very definitions of diseases, as well as regulatory and political decisions.10 The three articles are products of a research project funded by the Wellcome Trust on the history of translational research in medicine. They exemplify what we mean by contemporary history of medicine: using methods from the medical humanities to engage with key issues in contemporary medicine. The papers were first presented during a conference funded by the European Science Foundation and held at the Charite´ Berlin in September 2011: ‘The view from below: On standards in clinical practice and clinical research’. Our papers have benefitted greatly from comments by the anonymous reviewers for this journal. We are grateful to the editors of Chronic Illness for granting us the space for these explorations, and we hope that readers feel that our histories add a useful perspective for the understanding and management of chronic diseases.
2. Sumner J and Gooday GJN. Introduction. Special Issue: By whose standards? Standardization, stability and uniformity in the history of information and electrical technologies. History Technol 2008; 28: 1–13. 3. Gradmann C and Simon J. Evaluating and standardizing therapeutic agents, 1890-1950. Basingstoke: Palgrave Macmillan, 2010. 4. Bonah C, Masutti C, Rasmussen A, et al. Harmonizing drugs: standards in 20th-century pharmaceutical history. Paris: Editions Glyphe, 2009. 5. Timmermann C. Chronic illness and disease history. In: Jackson M (ed.) The oxford handbook of the history of medicine. Oxford & New York: Oxford University Press, 2011, pp.393–410. 6. Szabo J. Incurable and intolerable: chronic disease and slow death in nineteenth-century France. New Brunswick, NJ: Rutgers University Press, 2009. 7. Tattersall R. Diabetes: the biography. Oxford: Oxford University Press, 2009. 8. Feudtner JC. Bittersweet: diabetes, insulin, and the transformation of illness. Chapel Hill, NC: University of North Carolina Press, 2003. 9. Peitzman SJ. Dropsy, dialysis, transplant: a short history of failing kidneys. Baltimore: Johns Hopkins University Press, 2007. 10. Cambrosio A, Keating P, Schlich T, et al. Regulatory objectivity and the generation and management of evidence in medicine. Soc Sci Med 2006; 63(1): 189–199. Timmermann C, ‘Just give me the best quality of life questionnaire’: the Karnofsky scale and the history of quality of life measurements in cancer trials Chronic Illn 2013; 9(3): 179–190. Snow SJ, Translating new knowledge into practices: reconceptualising stroke as an emergency condition Chronic Illn 2013; 9(3): 191–201. Worboys M, The Hamilton Rating Scale for Depression: The making of a ‘gold standard’ and the unmaking of a chronic illness, 1960–1980 Chronic Illn 2013; 9(3): 202–219.
References 1. Collins HM. Changing order: replication and induction in scientific practice. London: University of Chicago Press, 1992.
Downloaded from chi.sagepub.com at CARLETON UNIV on June 12, 2015
Standards, scales and chronic illness: A brief introduction
Chronic Illness 2014, Vol. 10(1) 3–4 ! The Author(s) 2012 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1742395312468459 chi.sagepub.com
Carsten Timmermann
The articles in September 2013 issue by Stephanie Snow, Carsten Timmermann and Michael Worboys deal with the histories of different clinical scales that have been important in shaping current understandings of chronic disease. As Chronic Illness is not a journal dedicated to the history of medicine, the papers warrant a brief general introduction. Chronic Illness publishes articles that are aimed at enabling practitioners, policy makers and patients to understand and manage chronic diseases more effectively. Our papers aim to do so by drawing the attention of readers to important historical developments, which have contributed to the transformation of acute into chronic conditions (Timmermann, Worboys) and vice versa (Snow): the adoption of standardized scales for quality of life in cancer trials, for depression, and stroke. We tend to take for granted that standards are a useful thing. We are also used to the idea that we live in an era where communicable and acute diseases have given way to non-communicable and chronic disorders as the main causes of mortality and morbidity. Our papers discuss the role that standardization has played in creating the modern notion of chronic illness. Studying the history of issues that we take for granted can help us understand how things have come to be the way they are. If we use a metaphor and view a fact like a ship in a bottle, history helps us to unpack such facts, to understand how the ship got into the bottle.1
Both standardization2–4 and chronic disease5–9 have received some attention by historians of science, technology and medicine in recent years. Standardization is an important feature of our modern age. In medicine and elsewhere, acts of standardization have been associated with redistributions of labor, risk and responsibility. Standardization enabled non-experts to do work that used to be done by experts, and machines to do the work of humans. Importantly, acts of standardization made changes look natural and necessary which were, in fact, the consequences of political decisions and social processes. How does this apply to medicine and especially chronic illness? Historians have shown how the availability of reliably standardized insulin, for example, has not only turned diabetes from an acutely lifethreatening disease into a chronic condition, but also enabled patients to manage it themselves.7,8 Similar arguments have been made for dialysis and kidney disease.9 In our papers we are concerned with attempts to standardize complex acts of clinical judgement in the shape of relatively simple, often Centre for the History of Science, Technology and Medicine, University of Manchester, Simon Building, Manchester M13 9PL, UK Corresponding author: Carsten Timmermann, Centre for the History of Science, Technology and Medicine, University of Manchester, Simon Building, Manchester M13 9PL, UK. Email: [email protected]
Downloaded from chi.sagepub.com at CARLETON UNIV on June 12, 2015
4
Chronic Illness 10(1)
numerical scales, so that the outcome of such acts can be compared and compiled, and made to work in ways that more discursive descriptions of phenomena cannot. While fundamental questions are a matter of debate at the beginning of such standardization processes, as we show in our articles, they move increasingly to the background. Scales and indices, we argue, make it possible to include the outcome of acts of clinical judgement in statistical calculations. They turn subjective observations into objective facts, which shape the very definitions of diseases, as well as regulatory and political decisions.10 The three articles are products of a research project funded by the Wellcome Trust on the history of translational research in medicine. They exemplify what we mean by contemporary history of medicine: using methods from the medical humanities to engage with key issues in contemporary medicine. The papers were first presented during a conference funded by the European Science Foundation and held at the Charite´ Berlin in September 2011: ‘The view from below: On standards in clinical practice and clinical research’. Our papers have benefitted greatly from comments by the anonymous reviewers for this journal. We are grateful to the editors of Chronic Illness for granting us the space for these explorations, and we hope that readers feel that our histories add a useful perspective for the understanding and management of chronic diseases.
2. Sumner J and Gooday GJN. Introduction. Special Issue: By whose standards? Standardization, stability and uniformity in the history of information and electrical technologies. History Technol 2008; 28: 1–13. 3. Gradmann C and Simon J. Evaluating and standardizing therapeutic agents, 1890-1950. Basingstoke: Palgrave Macmillan, 2010. 4. Bonah C, Masutti C, Rasmussen A, et al. Harmonizing drugs: standards in 20th-century pharmaceutical history. Paris: Editions Glyphe, 2009. 5. Timmermann C. Chronic illness and disease history. In: Jackson M (ed.) The oxford handbook of the history of medicine. Oxford & New York: Oxford University Press, 2011, pp.393–410. 6. Szabo J. Incurable and intolerable: chronic disease and slow death in nineteenth-century France. New Brunswick, NJ: Rutgers University Press, 2009. 7. Tattersall R. Diabetes: the biography. Oxford: Oxford University Press, 2009. 8. Feudtner JC. Bittersweet: diabetes, insulin, and the transformation of illness. Chapel Hill, NC: University of North Carolina Press, 2003. 9. Peitzman SJ. Dropsy, dialysis, transplant: a short history of failing kidneys. Baltimore: Johns Hopkins University Press, 2007. 10. Cambrosio A, Keating P, Schlich T, et al. Regulatory objectivity and the generation and management of evidence in medicine. Soc Sci Med 2006; 63(1): 189–199. Timmermann C, ‘Just give me the best quality of life questionnaire’: the Karnofsky scale and the history of quality of life measurements in cancer trials Chronic Illn 2013; 9(3): 179–190. Snow SJ, Translating new knowledge into practices: reconceptualising stroke as an emergency condition Chronic Illn 2013; 9(3): 191–201. Worboys M, The Hamilton Rating Scale for Depression: The making of a ‘gold standard’ and the unmaking of a chronic illness, 1960–1980 Chronic Illn 2013; 9(3): 202–219.
References 1. Collins HM. Changing order: replication and induction in scientific practice. London: University of Chicago Press, 1992.
Downloaded from chi.sagepub.com at CARLETON UNIV on June 12, 2015
