The Engineering of Health: A model for criticizing and evaluating medicalization

Medicalization refers to the process by which human conditions are transformed into medical problems. While originally conceptualized as a critical tool in sociology, medicalization has since evolved, leading to its application beyond disease to enhancement-oriented practices. This paper proposes a new model for evaluating medicalization through the lens of technology, drawing on the philosophy of medicine and technology. It argues that current sociological approaches, particularly Conrad’s framework, often neglect foundational concepts such as disease ontology and the epistemology of medicine. The author introduces the idea of medicalization as a socio-technical system, governed by instrumental rationality akin to engineering sciences, as opposed to the practical wisdom (phronesis) that governs medical practice. Central to the proposed model is a hybrid concept of disease, combining descriptive (biological dysfunction) and normative (harm) criteria, inspired by Wakefield’s “harmful dysfunction” model. This distinction allows for a more precise differentiation between legitimate medical practice and over-medicalization. The paper categorizes medicalization into disease-oriented and health-oriented types, each with distinct evaluation criteria. Disease-oriented medicalization is assessed based on the presence of real pathology, justification of demand, appropriateness of medical intervention, and safety. Health-oriented medicalization—e.g., cosmetic interventions—is judged through technology assessment rather than traditional clinical frameworks. Ultimately, the model aims to protect the integrity of medicine while acknowledging the role of biomedical technology and commercial interests. It calls for a transdisciplinary and contextualized approach to evaluating medicalization that includes public engagement, social sciences, and critical oversight to prevent the commodification of health.