{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T15:53:15Z","timestamp":1770911595162,"version":"3.50.1"},"reference-count":15,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,4,16]],"date-time":"2020-04-16T00:00:00Z","timestamp":1586995200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2020,4,16]],"date-time":"2020-04-16T00:00:00Z","timestamp":1586995200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Philos Ethics Humanit Med"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>What is considered normal determines clinical practice in medicine and has implications at an individual level, doctor-patient relationship and health care policies. With the increase in medical information and technical abilities it is urgent to have a clear concept of normality in medicine so that crucial discussions can be held with unequivocal terms.<\/jats:p><jats:p>The different meanings for normality were analyzed throughout the literature and grouped according to their relevance in the academic community in models, namely the Biostatistical Theory (BST), Health, Ideal, Process and Biological advantage. The BST is the most established naturalistic approach, however normal variability can arguably constitute a problem. Health is similar and raises the question of setting the boundaries of pathology. Normality as an Ideal is an useful tool but is naturally unrealistic. As a Process it is comprehensible but is hard to frame for practical purposes. If considered as a Biological Advantage, seems intuitive but abnormality should tend to disappear.<\/jats:p><jats:p>After, three examples were presented to discuss these models. They were Anemia, Psychiatric diseases and Psychopathy. In the case of Anemia the BST was applied and the arbitrary boundaries but with social impact were exposed. Psychiatric diseases was discussed under the process of self-organization and non-suffering ideal. With Psychopathy the boundaries of biological advantage are questioned.<\/jats:p><jats:p>This review appeals to the importance of redesigning of the concept of normality in medicine according to current times and stresses the importance of integrating concepts such as variability and autonomy.<\/jats:p>","DOI":"10.1186\/s13010-020-00087-2","type":"journal-article","created":{"date-parts":[[2020,4,16]],"date-time":"2020-04-16T02:02:49Z","timestamp":1587002569000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Normality in medicine: a critical review"],"prefix":"10.1186","volume":"15","author":[{"given":"Marisa","family":"Catita","sequence":"first","affiliation":[]},{"given":"Artur","family":"\u00c1guas","sequence":"additional","affiliation":[]},{"given":"Pedro","family":"Morgado","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2020,4,16]]},"reference":[{"issue":"5","key":"87_CR1","doi-asserted-by":"publisher","first-page":"1747","DOI":"10.1182\/blood-2005-07-3046","volume":"107","author":"E Beutler","year":"2006","unstructured":"Beutler E, Waalen J. The definition of Anemia: what is the lower limit of Normal of the blood hemoglobin concentration? Blood. 2006;107(5):1747\u201350. https:\/\/doi.org\/10.1182\/blood-2005-07-3046.","journal-title":"Blood"},{"issue":"6","key":"87_CR2","doi-asserted-by":"publisher","first-page":"683","DOI":"10.1093\/jmp\/jhu035","volume":"39","author":"C Boorse","year":"2014","unstructured":"Boorse C. A second rebuttal on health. J Med Philos. 2014;39(6):683\u2013724. https:\/\/doi.org\/10.1093\/jmp\/jhu035.","journal-title":"J Med Philos"},{"key":"87_CR3","volume-title":"The Normal and the Pathological. Translated by","author":"G Canguilhem","year":"1991","unstructured":"Canguilhem G, Foucault M. In: Carolyn R, New F, editors. The Normal and the Pathological. Translated by. New York: Zone Books; 1991."},{"issue":"4286","key":"87_CR4","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1126\/science.847460","volume":"196","author":"GL Engel","year":"1977","unstructured":"Engel GL. The Need for a New Medical Model: A Challenge for Biomedicine. Science. 1977;196(4286):129\u201336. https:\/\/doi.org\/10.1126\/science.847460.","journal-title":"Science"},{"key":"87_CR5","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1007\/978-94-010-1506-6_6","volume-title":"Boston Studies in the Philosophy of Science","author":"Y Fried","year":"1976","unstructured":"Fried Y, Agassi J. \u201cThe paradoxes of paranoia revisited.\u201d In Paranoia: A Study in Diagnosis. In: Fried Y, Agassi J, editors. Boston Studies in the Philosophy of Science. Dordrecht: Springer Netherlands; 1976. p. 52\u201360. https:\/\/doi.org\/10.1007\/978-94-010-1506-6_6."},{"issue":"2","key":"87_CR6","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1111\/j.1365-2753.2010.01393.x","volume":"16","author":"RP Hamilton","year":"2010","unstructured":"Hamilton RP. The concept of health: beyond Normativism and naturalism. J Eval Clin Pract. 2010;16(2):323\u20139. https:\/\/doi.org\/10.1111\/j.1365-2753.2010.01393.x.","journal-title":"J Eval Clin Pract"},{"issue":"1","key":"87_CR7","first-page":"47","volume":"83","author":"JH Koeslag","year":"1993","unstructured":"Koeslag JH. \u201cWhat is Normal?\u201d South African. Med J. 1993;83(1):47\u201350 50.","journal-title":"Med J"},{"issue":"4","key":"87_CR8","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1007\/BF00996335","volume":"14","author":"L Nordenfelt","year":"1993","unstructured":"Nordenfelt L. Concepts of health and their consequences for health care. Theor Med. 1993;14(4):277\u201385.","journal-title":"Theor Med"},{"issue":"5","key":"87_CR9","doi-asserted-by":"publisher","first-page":"569","DOI":"10.1076\/0360-5310(200010)25:5;1-W;FT569","volume":"25","author":"A Rudnick","year":"2000","unstructured":"Rudnick A. The ends of medical intervention and the demarcation of the Normal from the pathological. J Med Philos. 2000;25(5):569\u201380. https:\/\/doi.org\/10.1076\/0360-5310(200010)25:5;1-W;FT569.","journal-title":"J Med Philos"},{"issue":"3","key":"87_CR10","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1016\/j.homp.2010.05.004","volume":"99","author":"JM Schmidt","year":"2010","unstructured":"Schmidt JM. The concept of health - in the history of medicine and in the writings of Hahnemann. Homeopathy. 2010;99(3):215\u201320. https:\/\/doi.org\/10.1016\/j.homp.2010.05.004.","journal-title":"Homeopathy"},{"issue":"6","key":"87_CR11","doi-asserted-by":"publisher","first-page":"572","DOI":"10.1093\/jmp\/jhu039","volume":"39","author":"PH Schwartz","year":"2014","unstructured":"Schwartz PH. Reframing the disease debate and defending the biostatistical theory. J Med Philos. 2014;39(6):572\u201389. https:\/\/doi.org\/10.1093\/jmp\/jhu039.","journal-title":"J Med Philos"},{"issue":"3","key":"87_CR12","doi-asserted-by":"publisher","first-page":"227","DOI":"10.1007\/s11017-006-9003-z","volume":"27","author":"WE Stempsey","year":"2006","unstructured":"Stempsey WE. Emerging medical technologies and emerging conceptions of health. Theor Med Bioeth. 2006;27(3):227\u201343. https:\/\/doi.org\/10.1007\/s11017-006-9003-z.","journal-title":"Theor Med Bioeth"},{"issue":"2","key":"87_CR13","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1023\/B:MHEP.0000034320.45018.d8","volume":"7","author":"I-B T\u00e4ljedal","year":"2004","unstructured":"T\u00e4ljedal I-B. Strong holism, weak holism, and health. Med Health Care Philos. 2004;7(2):143\u20138 discussion 149-152.","journal-title":"Med Health Care Philos"},{"issue":"1","key":"87_CR14","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1177\/014107689408700113","volume":"87","author":"AI Tauber","year":"1994","unstructured":"Tauber AI. Darwinian aftershocks: repercussions in late twentieth century medicine. J R Soc Med. 1994;87(1):27\u201331.","journal-title":"J R Soc Med"},{"issue":"6","key":"87_CR15","doi-asserted-by":"publisher","first-page":"648","DOI":"10.1093\/jmp\/jhu038","volume":"39","author":"JC Wakefield","year":"2014","unstructured":"Wakefield JC. The biostatistical theory versus the harmful dysfunction analysis, part 1: is part-dysfunction a sufficient condition for medical disorder? J Med Philos. 2014;39(6):648\u201382. https:\/\/doi.org\/10.1093\/jmp\/jhu038.","journal-title":"J Med Philos"}],"container-title":["Philosophy, Ethics, and Humanities in Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13010-020-00087-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13010-020-00087-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13010-020-00087-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,10,21]],"date-time":"2022-10-21T12:01:45Z","timestamp":1666353705000},"score":1,"resource":{"primary":{"URL":"https:\/\/peh-med.biomedcentral.com\/articles\/10.1186\/s13010-020-00087-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,4,16]]},"references-count":15,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["87"],"URL":"https:\/\/doi.org\/10.1186\/s13010-020-00087-2","relation":{},"ISSN":["1747-5341"],"issn-type":[{"value":"1747-5341","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,4,16]]},"assertion":[{"value":"12 December 2019","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 March 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 April 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Not applicable.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"3"}}