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possible to enable the different groups to find their own concerns reflected. Because different models of medicine hold, they embody different rules for classifying. This has resulted in the fact that, although the list is in appearance homogeneous, there are at least four classificatory principles involved: |
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1. Topographical. This refers to the seat of the disease, which part of the body it manifests in. |
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2. Etiological. This refers to the origin of the diseasegenetic, viral, bacterial, and so forth. |
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3. Operational. This refers to the responses to certain tests, without there being a necessary one-to-one correspondence between test results and a given topographical or etiological feature (though in general one or the other is asserted). HTLV versus HIV is a case in point. HTLV was defined as a positive reaction to a test searching for antibodies. When what we call HIV initially produced the same reaction, Gallo classified it as an HTLV even though the virus had not been isolated. |
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4. Ethical-political. We have seen examples of this above. The definitions of stillbirth, abortion, suicide, iatrogenesis, and euthanasia, for example, are the outcome of ethical and political decisions. |
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Frequently over the course of the history of the ICD, different groups have found that the list did not serve their purposes and so they have modified it. This sometimes happened in a country with a different range of medical problems not covered by the European ICD. For example, the first ICD was drawn up partly through a comparison of the tables of mortality of six European countries. Naturally, then, little room was left for the whole range of tropical diseases. African and southeast Asian countries were forced to produce their own modifications. Or again, different users of the list might find that the current one did not meet their exigencies. For this reason, for example, medical insurance companies have often produced their own versions, tailored to populations, reimbursement policies, and the company's software configuration. |
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As with many other attempts to standardize (computer languages come to mind), each time an international standard is laid downevery ten years in the ICD's casethere is an immediate efflorescence of modifications. Rather than lose control of this whole process, the ICD committee has chosen rather to issue rules for how the list is to |
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