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Diagnosis as Public Policy

When we think about medical diagnosis, we usually think in terms of science. The conventional (and accurate) wisdom is that diseases are named and classified on the basis of scientific research. For example, the roughly decennial revisions of the World Health Organization’s International Classification of Diseases (ICD) partly reflect advances in scientific understanding of diseases and injuries.

The cataloging and naming of diseases is a condition of scientific research, as well as its product. Indeed, how are doctors to explain and control disease without a common language for the phenomena that they observe? The ICD comprehends the entire spectrum of human disease and injury, and its updates reflect the best new knowledge as well as set the stage for the next wave of medical advances.

But the formal classification of diseases has another aspect, one that concerns a variety of important social functions. It provides a set of disease names and numeric codes for assigning and tracking health-care expenditures and services. Governments, insurance companies, and patients use these names and codes in accounting and budgeting.

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