Clinch, Megan
(2009)
Muddling through with non-compliant biology: An ethnographic investigation the meaning and practice of evidence in an NHS thyroid disease out-patients clinic.
PhD thesis, London School of Economics and Political Science.
Abstract
Thyroid diseases number amongst the most widespread and chronic conditions in the population. They are symptomatically vague, difficult to diagnose, and are more prevalent in women than men. Since the hormones produced by the gland control cell metabolism in the body, symptoms of glandular failure are elusively diverse and non-specific and are easily attributable to other diseases or no disease at all. Consequently, a definitive diagnosis conventionally relies on a blood test to measure the function of the gland. However, as observed in the clinic, such a diagnosis is often partial and is not compatible with the clinical symptoms some patients present. Predictably, many patients feel such tests are inaccurate measures of the extent of their disease and do not match their own interpretations of clinical symptoms or experiences of suffering. In response, many clinicians express concern that patients are incorrectly attributing their symptoms to thyroid disease and as a consequence are demanding treatments which are not necessary This qualitative study investigates the indeterminate aspects of thyroid dysfunction by exploring how a contest over meaning is manifest in the clinic, particularly with regards to how embodied clinical symptoms and disembodied biochemical measures are used as evidence for and against decisions over diagnosis and treatment. The thesis identifies that, due to the vague nature of both symptomatic and biochemical evidence, thyroid disease is a location where medicalisation is impossible. Subsequently, using the available discourses of the clinic, specifically EBM and patient centred medicine, clinicians and patients construct various orders of thyroid biology and pathology, in an attempt to satisfy diagnostic strategies and treatment needs. As a consequence the thesis can add to the analytical purchase of the anthropologist Paul Rabinow's concept of biosociality and theories of governmentality more generally. That is, it demonstrates how practices of re-making thyroid biology are possible, not because of a new found molecular control over thyroid biology, but due to the non-compliant nature of thyroid biology and the technical deficiency of current diagnostic and treatment strategies deployed to attend to it within the clinic.
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