Doctor of Philosophy, The Ohio State University, 2017, Public Policy and Management
Medical diagnoses constitute the basic problem definitions around which many health-related policies are built. Among other things, they inform disease prevention efforts, help direct funding of biomedical research, and can determine who is and is not eligible for disability benefits. In recent years, a number of medical scientists have cast a critical light on “fibromyalgia,” “chronic fatigue syndrome,” and certain other diagnoses, arguing that they medicalize what are really psychosocial problems and have led to counterproductive policy interventions. Unfortunately, our capacity to evaluate this argument is limited. Policymakers tend to defer to medical scientists in interpreting illness. However, because medical scientists generally operate in the biomedical paradigm, they do not necessarily have the resources needed to fully evaluate or act on the critics' arguments.
In the first part of this dissertation, I argue that we can approach this problem from a different angle. Instead of asking what kind of problem “fibromyalgia” itself really is, we can ask whether our adoption of that problem definition was appropriate in the first place. As I demonstrate, there are standards endogenous to medico-political discourse that are supposed to govern how individual diagnostic labels are used. By formalizing these standards, and examining health policy practices in light of them, we can modulate our commitment to “fibromyalgia” and other illness definitions. This basic approach, I argue, is one that policy analysts might use in other situations involving highly unstructured problems.
In the second part of this dissertation, I use this framework to evaluate the medical and policy uses of “chronic fatigue syndrome” (CFS), an illness construct originally defined by the CDC in 1988. Drawing on a multi-layered content analysis of about 300 medical and policy documents, and using AIDS as a comparison case, I examine whether the ways in which CFS has been used in policy disc (open full item for complete abstract)
Committee: Jos Raadschelders (Committee Chair); Anand Desai (Committee Member); David Landsbergen (Committee Member); Alex Wendt (Committee Member)
Subjects: Health Care; Medicine; Public Administration; Public Health; Public Policy