thesis meaning in medicine

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Writing a thesis

A thesis is a written report of your research, and generally contains the following chapters: introduction, methods, results, discussion and conclusion. It will also have a list of references and appendices. Check with your faculty/department/school for degree-specific thesis requirements. You may also find it helpful to look at published theses (in your department) to see how they are structured. (Internationally, the ‘thesis’ may be referred to as a ‘dissertation’).

• Gruba, P., & Zobel, J. (2014). How to write a better minor thesis . Melbourne, Australia: Melbourne University Publishing.
• Stoddart, K. (1991) Writing Sociologically: A Note on Teaching the Construction of a Qualitative Report. Teaching Sociology (2), 243-248.
• Mullins, G. and M. Kiley (2002). It’s a PhD, not a Nobel Prize: how experienced examiners assess research theses. Studies in Higher Education . 27(2): 369-386 .
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A step-by-step guide on how to write an ideal medical thesis.

What do you need to write a medical thesis?

Of course, a knowledge about how to conduct a research and how to pen down its results in an appropriate format.  Even if you are adept in clinical research, it doesn’t mean writing a thesis comes easily to you. A  medical thesis  has a structure that is important to follow.

So, here we provide a step-by-step guide on how to write an ideal medical thesis.

Step 1:  Start your thesis with a suitable  ‘Title’ . The title is an intro to the contents of your thesis. An ideal title should be within 65 characters, devoid of all abbreviations and grammatical mistakes, and not contain stop words like ‘a’, ‘an’, ‘the’, ‘of’, ‘but’, etc.

Step 2:  Next, write your thesis  ‘Abstract’ . An abstract is an introduction that tells the readers why you conducted the particular study.  What has already been done in the field, what were the gaps, and how you fill those gaps with your study?

To write an ideal abstract:

• Give a brief background information about your topic
• State the importance of the problem and what is unknown about it
• Tell the readers about the objectives of your study clearly
• Give references to the research papers written on your research topic. However, do not cite the well-known facts. For example, “Isaac Newton discovered gravity…”
• Include no information other than the problem being examined

Step 3:  After the abstract, follow it with the title  ‘Method and Material’ . Format this section as below:

• Setting – the environmental conditions in which you conducted your research
• Sample – what materials were used in research and details about the participants in the study
• Inclusion and exclusion criteria – what factors were considered to include or exclude any participant in the study
• Measurement tools – details about the methods and equipment used to measure the outcomes of the study
• Independent and Dependent variables – what were the factors you controlled or changed during the experiment and what you measured as the outcome

Step 4:  Write the  “Analysis of Data “.

Step 6:  Write the  ‘Results’  where you will show the conclusion of your study.  You can present your results as a text, table, figure, or illustrative graphs, but keep in mind the aim of your study. Include no result that doesn’t satisfy the aim of your study.

Step 7:  It is the most crucial step where you include the  ‘Discussion’  of your results. An ideal discussion should include:

• The principal findings of your study
• Strengths and weaknesses of your study in relation to other studies in the field
• A take-home message for the clinicians and policymakers
• Questions that your study can’t answer to propagate further research

Step 8:  Follow the discussion with the ‘ Limitations of your study’

Step 9:  At the end of your thesis, include your  ‘References’ . Track all your references so you don’t miss out on anyone.

Finally, the quality of your thesis depends upon the topic you choose, whether you opt for a purely scientific experiment or a clinical trial or a social research study addressing the experiences of the patients, etc.

Seek help from your mentor at every stage of clinical research as well as  medical thesis writing . To be ideal, the study should be carried out ethically in compliance with the legal regulations.

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EliScholar > Medicine > Medicine Thesis Digital Library

Yale Medicine Thesis Digital Library

Starting with the Yale School of Medicine (YSM) graduating class of 2002, the Cushing/Whitney Medical Library and YSM Office of Student Research have collaborated on the Yale Medicine Thesis Digital Library (YMTDL) project, publishing the digitized full text of medical student theses on the web as a valuable byproduct of Yale student research efforts. The digital thesis deposit has been a graduation requirement since 2006. Starting in 2012, alumni of the Yale School of Medicine were invited to participate in the YMTDL project by granting scanning and hosting permission to the Cushing/Whitney Medical Library, which digitized the Library’s print copy of their thesis or dissertation. A grant from the Arcadia Fund in 2017 provided the means for digitizing over 1,000 additional theses. IF YOU ARE A MEMBER OF THE YALE COMMUNITY AND NEED ACCESS TO A THESIS RESTRICTED TO THE YALE NETWORK, PLEASE MAKE SURE YOUR VPN (VIRTUAL PRIVATE NETWORK) IS ON.

Theses/Dissertations from 2024 2024

Refractory Neurogenic Cough Management: The Non-Inferiority Of Soluble Steroids To Particulate Suspensions For Superior Laryngeal Nerve Blocks , Hisham Abdou

Percutaneous Management Of Pelvic Fluid Collections: A 10-Year Series , Chidumebi Alim

Behavioral Outcomes In Patients With Metopic Craniosynostosis: Relationship With Radiographic Severity , Mariana Almeida

Ventilator Weaning Parameters Revisited: A Traditional Analysis And A Test Of Artificial Intelligence To Predict Successful Extubation , John James Andrews

Developing Precision Genome Editors: Peptide Nucleic Acids Modulate Crispr Cas9 To Treat Autosomal Dominant Disease , Jem Atillasoy

Radiology Education For U.s. Medical Students In 2024: A State-Of-The-Art Analysis , Ryan Bahar

Out-Of-Pocket Spending On Medications For Diabetes In The United States , Baylee Bakkila

Imaging Markers Of Microstructural Development In Neonatal Brains And The Impact Of Postnatal Pathologies , Pratheek Sai Bobba

A Needs Assessment For Rural Health Education In United States Medical Schools , Kailey Carlson

Racial Disparities In Behavioral Crisis Care: Investigating Restraint Patterns In Emergency Departments , Erika Chang-Sing

Social Determinants Of Health & Barriers To Care In Diabetic Retinopathy Patients Lost To Follow-Up , Thomas Chang

Association Between Fine Particulate Matter And Eczema: A Cross-Sectional Study Of The All Of Us Research Program And The Center For Air, Climate, And Energy Solutions , Gloria Chen

Predictors Of Adverse Outcomes Following Surgical Intervention For Cervical Spondylotic Myelopathy , Samuel Craft

Genetic Contributions To Thoracic Aortic Disease , Ellelan Arega Degife

Actigraphy And Symptom Changes With A Social Rhythm Intervention In Young Persons With Mood Disorders , Gabriela De Queiroz Campos

Incidence Of Pathologic Nodal Disease In Clinically Node Negative, Microinvasive/t1a Breast Cancers , Pranammya Dey

Spinal Infections: Pathophysiology, Diagnosis, Prevention, And Management , Meera Madhav Dhodapkar

Childen's Reentry To School After Psychiatric Hospitalization: A Qualitative Study , Madeline Digiovanni

Bringing Large Language Models To Ophthalmology: Domain-Specific Ontologies And Evidence Attribution , Aidan Gilson

Surgical Personalities: A Cultural History Of Early 20th Century American Plastic Surgery , Joshua Zev Glahn

Implications Of Acute Brain Injury Following Transcatheter Aortic Valve Replacement , Daniel Grubman

Latent Health Status Trajectory Modelling In Patients With Symptomatic Peripheral Artery Disease , Scott Grubman

The Human Claustrum Tracks Slow Waves During Sleep , Brett Gu

Patient Perceptions Of Machine Learning-Enabled Digital Mental Health , Clara Zhang Guo

Variables Affecting The 90-Day Overall Reimbursement Of Four Common Orthopaedic Procedures , Scott Joseph Halperin

The Evolving Landscape Of Academic Plastic Surgery: Understanding And Shaping Future Directions In Diversity, Equity, And Inclusion , Sacha C. Hauc

Association Of Vigorous Physical Activity With Psychiatric Disorders And Participation In Treatment , John L. Havlik

Long-Term Natural History Of Ush2a-Retinopathy , Michael Heyang

Clinical Decision Support For Emergency Department-Initiated Buprenorphine For Opioid Use Disorder , Wesley Holland

Applying Deep Learning To Derive Noninvasive Imaging Biomarkers For High-Risk Phenotypes Of Prostate Cancer , Sajid Hossain

The Hardships Of Healthcare Among People With Lived Experiences Of Homelessness In New Haven, Ct , Brandon James Hudik

Outcomes Of Peripheral Vascular Interventions In Patients Treated With Factor Xa Inhibitors , Joshua Joseph Huttler

Janus Kinase Inhibition In Granuloma Annulare: Two Single-Arm, Open-Label Clinical Trials , Erica Hwang

Medicaid Coverage For Undocumented Children In Connecticut: A Political History , Chinye Ijeli

Population Attributable Fraction Of Reproductive Factors In Triple Negative Breast Cancer By Race , Rachel Jaber Chehayeb

Evaluation Of Gastroesophageal Reflux And Hiatal Hernia As Risk Factors For Lobectomy Complications , Michael Kaminski

Health-Related Social Needs Before And After Critical Illness Among Medicare Beneficiaries , Tamar A. Kaminski

Effects Of Thoracic Endovascular Aortic Repair On Cardiac Function At Rest , Nabeel Kassam

Conditioned Hallucinations By Illness Stage In Individuals With First Episode Schizophrenia, Chronic Schizophrenia, And Clinical High Risk For Psychosis , Adam King

The Choroid Plexus Links Innate Immunity To Dysregulation Of Csf Homeostasis In Diverse Forms Of Hydrocephalus , Emre Kiziltug

Health Status Changes After Stenting For Stroke Prevention In Carotid Artery Stenosis , Jonathan Kluger

Rare And Undiagnosed Liver Diseases: New Insights From Genomic And Single Cell Transcriptomic Analyses , Chigoziri Konkwo

“Teen Health” Empowers Informed Contraception Decision-Making In Adolescents And Young Adults , Christina Lepore

Barriers To Mental Health Care In Us Military Veterans , Connor Lewis

Barriers To Methadone For Hiv Prevention Among People Who Inject Drugs In Kazakhstan , Amanda Rachel Liberman

Unheard Voices: The Burden Of Ischemia With No Obstructive Coronary Artery Disease In Women , Marah Maayah

Partial And Total Tonsillectomy For Pediatric Sleep-Disordered Breathing: The Role Of The Cas-15 , Jacob Garn Mabey

Association Between Insurance, Access To Care, And Outcomes For Patients With Uveal Melanoma In The United States , Victoria Anne Marks

Urinary Vegf And Cell-Free Dna As Non-Invasive Biomarkers For Diabetic Retinopathy Screening , Mitchelle Matesva

Pain Management In Facial Trauma: A Narrative Review , Hunter Mccurdy

Meningioma Relational Database Curation Using A Pacs-Integrated Tool For Collection Of Clinical And Imaging Features , Ryan Mclean

Colonoscopy Withdrawal Time And Dysplasia Detection In Patients With Inflammatory Bowel Disease , Chandler Julianne Mcmillan

Cerebral Arachnoid Cysts Are Radiographic Harbingers Of Epigenetics Defects In Neurodevelopment , Kedous Mekbib

Regulation And Payment Of New Medical Technologies , Osman Waseem Moneer

Permanent Pacemaker Implantation After Tricuspid Valve Repair Surgery , Alyssa Morrison

Non-Invasive Epidermal Proteome-Based Subclassification Of Psoriasis And Eczema And Identification Of Treatment Relevant Biomarkers , Michael Murphy

Ballistic And Explosive Orthopaedic Trauma Epidemiology And Outcomes In A Global Population , Jamieson M. O'marr

Dermatologic Infectious Complications And Mimickers In Cancer Patients On Oncologic Therapy , Jolanta Pach

Distressed Community Index In Patients Undergoing Carotid Endarterectomy In Medicare-Linked Vqi Registry , Carmen Pajarillo

Preoperative Psychosocial Risk Burden Among Patients Undergoing Major Thoracic And Abdominal Surgery , Emily Park

Volumetric Assessment Of Imaging Response In The Pnoc Pediatric Glioma Clinical Trials , Divya Ramakrishnan

Racial And Sex Disparities In Adult Reconstructive Airway Surgery Outcomes: An Acs Nsqip Analysis , Tagan Rohrbaugh

A School-Based Study Of The Prevalence Of Rheumatic Heart Disease In Bali, Indonesia , Alysha Rose

Outcomes Following Hypofractionated Radiotherapy For Patients With Thoracic Tumors In Predominantly Central Locations , Alexander Sasse

Healthcare Expenditure On Atrial Fibrillation In The United States: The Medical Expenditure Panel Survey 2016-2021 , Claudia See

A Cost-Effectiveness Analysis Of Oropharyngeal Cancer Post-Treatment Surveillance Practices , Rema Shah

Machine Learning And Risk Prediction Tools In Neurosurgery: A Rapid Review , Josiah Sherman

Maternal And Donor Human Milk Support Robust Intestinal Epithelial Growth And Differentiation In A Fetal Intestinal Organoid Model , Lauren Smith

Constructing A Fetal Human Liver Atlas: Insights Into Liver Development , Zihan Su

Somatic Mutations In Aging, Paroxysmal Nocturnal Hemoglobinuria, And Myeloid Neoplasms , Tho Tran

Illness Perception And The Impact Of A Definitive Diagnosis On Women With Ischemia And No Obstructive Coronary Artery Disease: A Qualitative Study , Leslie Yingzhijie Tseng

Advances In Keratin 17 As A Cancer Biomarker: A Systematic Review , Robert Tseng

Regionalization Strategy To Optimize Inpatient Bed Utilization And Reduce Emergency Department Crowding , Ragini Luthra Vaidya

Survival Outcomes In T3 Laryngeal Cancer Based On Staging Features At Diagnosis , Vickie Jiaying Wang

Analysis Of Revertant Mosaicism And Cellular Competition In Ichthyosis With Confetti , Diana Yanez

A Hero's Journey: Experiences Using A Therapeutic Comicbook In A Children’s Psychiatric Inpatient Unit , Idil Yazgan

Prevalence Of Metabolic Comorbidities And Viral Infections In Monoclonal Gammopathy , Mansen Yu

Automated Detection Of Recurrent Gastrointestinal Bleeding Using Large Language Models , Neil Zheng

Vascular Risk Factor Treatment And Control For Stroke Prevention , Tianna Zhou

Theses/Dissertations from 2023 2023

Radiomics: A Methodological Guide And Its Applications To Acute Ischemic Stroke , Emily Avery

Characterization Of Cutaneous Immune-Related Adverse Events Due To Immune Checkpoint Inhibitors , Annika Belzer

An Investigation Of Novel Point Of Care 1-Tesla Mri Of Infants’ Brains In The Neonatal Icu , Elisa Rachel Berson

Understanding Perceptions Of New-Onset Type 1 Diabetes Education In A Pediatric Tertiary Care Center , Gabriel BetancurVelez

Effectiveness Of Acitretin For Skin Cancer Prevention In Immunosuppressed And Non-Immunosuppressed Patients , Shaman Bhullar

Adherence To Tumor Board Recommendations In Patients With Hepatocellular Carcinoma , Yueming Cao

Clinical Trials Related To The Spine & Shoulder/elbow: Rates, Predictors, & Reasons For Termination , Dennis Louis Caruana

Improving Delivery Of Immunomodulator Mpla With Biodegradable Nanoparticles , Jungsoo Chang

Sex Differences In Patients With Deep Vein Thrombosis , Shin Mei Chan

Incorporating Genomic Analysis In The Clinical Practice Of Hepatology , David Hun Chung

Emergency Medicine Resident Perceptions Of A Medical Wilderness Adventure Race (medwar) , Lake Crawford

Surgical Outcomes Following Posterior Spinal Fusion For Adolescent Idiopathic Scoliosis , Wyatt Benajmin David

Representing Cells As Sentences Enables Natural Language Processing For Single Cell Transcriptomics , Rahul M. Dhodapkar

Life Vs. Liberty And The Pursuit Of Happiness: Short-Term Involuntary Commitment Laws In All 50 US States , Sofia Dibich

Healthcare Disparities In Preoperative Risk Management For Total Joint Arthroplasty , Chloe Connolly Dlott

Toll-Like Receptors 2/4 Directly Co-Stimulate Arginase-1 Induction Critical For Macrophage-Mediated Renal Tubule Regeneration , Natnael Beyene Doilicho

Associations Of Atopic Dermatitis With Neuropsychiatric Comorbidities , Ryan Fan

International Academic Partnerships In Orthopaedic Surgery , Michael Jesse Flores

Young Adults With Adhd And Their Involvement In Online Communities: A Qualitative Study , Callie Marie Ginapp

Becoming A Doctor, Becoming A Monster: Medical Socialization And Desensitization In Nazi Germany And 21st Century USA , SimoneElise Stern Hasselmo

Comparative Efficacy Of Pharmacological Interventions For Borderline Personality Disorder: A Network Meta-Analysis , Olivia Dixon Herrington

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Definition of thesis

Did you know.

In high school, college, or graduate school, students often have to write a thesis on a topic in their major field of study. In many fields, a final thesis is the biggest challenge involved in getting a master's degree, and the same is true for students studying for a Ph.D. (a Ph.D. thesis is often called a dissertation ). But a thesis may also be an idea; so in the course of the paper the student may put forth several theses (notice the plural form) and attempt to prove them.

Examples of thesis in a Sentence

These examples are programmatically compiled from various online sources to illustrate current usage of the word 'thesis.' Any opinions expressed in the examples do not represent those of Merriam-Webster or its editors. Send us feedback about these examples.

Word History

in sense 3, Middle English, lowering of the voice, from Late Latin & Greek; Late Latin, from Greek, downbeat, more important part of a foot, literally, act of laying down; in other senses, Latin, from Greek, literally, act of laying down, from tithenai to put, lay down — more at do

14th century, in the meaning defined at sense 3a(1)

Dictionary Entries Near thesis

the sins of the fathers are visited upon the children

thesis novel

Cite this Entry

“Thesis.” Merriam-Webster.com Dictionary , Merriam-Webster, https://www.merriam-webster.com/dictionary/thesis. Accessed 2 Jun. 2024.

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What is medicine? Why it’s so important to answer this question

Executive Dean, Faculty of Humanities and Director, African Centre for Epistemology and Philosophy of Science, University of Johannesburg

Disclosure statement

Alex Broadbent receives funding from the National Research Foundation of South Africa.

University of Johannesburg provides support as an endorsing partner of The Conversation AFRICA.

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What is medicine? We recognise it in all societies past and present. But the nature of medicine differs so greatly from place to place and time to time that it’s difficult to offer a single answer. So what is it that we see in common between a traditional healer’s throwing of bones and the cardiologist’s incisions?

One of the answers that often seems to be implicit in what we say and think about medicine is a curative thesis : medicine’s goal is to cure the sick. Curing the sick is the core medical competence, whose exercise is medicine’s core business.

But if the curative thesis is true, then most medicine throughout history – as well as much contemporary medicine – isn’t medicine at all. Much medicine was and is ineffective, or at best partially effective. The curative thesis leads to a dismissive attitude towards the past efforts upon which any current medicine is built, as well as failing to promote profitable collaboration between traditions.

A second idea is an inquiry thesis about medicine: although the goal of medicine is to cure, its core business is something quite different. It’s this thesis I explore in my latest article .

That “something” has to do with inquiring into the nature and causes of health and disease. The idea is that we don’t necessarily expect someone to be able to cure us. We will accept that they are a medical expert if they can show an understanding of our ailment, often by issuing an accurate prognosis. Perhaps they won’t have a complete understanding, but they should somehow be engaged with the larger project of inquiry into the nature and causes of health and disease.

The inquiry thesis offers a way to understand the history of medicine that makes it more than a tale of quackery and gullibility. It also provides a way to understand medical traditions that practised outside the West, or in the West in defiance of the mainstream. They may offer or at least engage with a project of obtaining; a kind of understanding that Western medicine cannot.

The inquiry model of medicine lays the ground for fruitful and respectful discussions between medical traditions that doesn’t descend into an untenable relativism about what works.

Towards understanding

The curative thesis faces a difficulty that I believe it cannot overcome.

We do not define an activity by its goal alone, unless it has at least some success in that respect. A blacksmith cannot be defined as one who makes horseshoes if he simply throws lumps of hot metal onto his anvil and hammers them randomly – occasionally producing something horseshoe-like, but more often producing a mess.

Yet, taking a historical perspective, something of this kind has been true of medicine for much of its history, before it developed a serious curative arsenal. Historian of medicine Roy Porter has remarked that

the prominence of medicine has lain only in small measure in its ability to make the sick well. This was always true, and remains so today.

What, then, could be the business of medicine – the thing in which we recognise expertise, even when we accept that there is no cure to be had?

This is where the inquiry model enters the picture. I propose that the business of medicine is understanding the nature and causes of health and disease, for the purpose of cure.

The core of the argument is simple: what could medical persons be good at doing, that relates to the goal of cure without achieving it? The most likely candidate is understanding. Understanding is something that we can gain without corresponding curative success.

Tackling objections

As with the curative thesis, there are several objections to the inquiry model. First, it is obvious that many doctors either don’t (fully) understand what they treat or, if they do, don’t (successfully) communicate this understanding to the patient. Who, then, understands? In what sense is the doctor’s competence understanding?

The answer is that understanding isn’t a binary. You can partially understand something. You can be one the road to understanding it better, by inquiring into it. Hence the inquiry model of medicine. The idea is not that medicine is a sack full of answers, but rather that it is an ongoing effort to find answers.

Another objection is that so-called understanding is often bogus, and that medicine is as unsuccessful in this regard as in cure. This fails to account for the historical record, which – at least for Western medicine –- is precisely a case of understanding without curative success.

And, just as false scientific theories have contributed to developing scientific understanding , so false medical theories have provided a foundation for what we now accept.

Medicine is an ancient and complex social phenomenon, variously seen as art, science and witchcraft. These visions share the goal of curing disease. But it is too crude to think medicine as only the business of curing, since in that case, few doctors would be in business.

The distinctive feature of medicine is that it tries to cure by obtaining some understanding of the nature and causes of health and disease: by inquiry, in short. This understanding of medicine permits a much healthier dialogue between proponents of different traditions, and enables a non-defensive perspective on areas where we remain sadly lacking in curative ability.

This is an edited, shortened version of an article that first appeared in the Canadian Medical Association Journal, ‘The inquiry model of medicine’ , accompanied by a podcast available on the article’s page and also here .

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Creating the Thesis

The thesis, like all Yale MD theses, is to be based on original research on an aspect of the history of medicine or public health, including attitudes and institutions of the medical profession, medical ethics and policies, the conceptual foundation of the biomedical sciences, the management of health and disease in their cultural and social contexts, or the life of a selected historical actor.

Students are expected to undertake their research in light of extant historical scholarship, which will therefore involve the preparation of a bibliography and the discussion of the readings at prearranged meetings with the thesis advisor. On the basis of this collaborative activity, the student will define the historical questions the thesis will address and develop with his or her advisor an appropriate research strategy.

Research will focus largely on primary works, typically published texts or unpublished manuscript documents, clinical patient records, letters, diaries, and other archival materials. For some theses, students may use films, television, or other visual materials, as well as museum objects and other artifacts or oral interviews.

Presenting the Thesis

Examples of recent md theses in history of medicine.

• "I Viewed Them Sick: Photography and Addiction Medicine as Activism During the "Speed Freak" Crisis of the Long 1960s"
• “Shoot the Abortionist Twice: The Crisis in Abortion Training in the United States”
• “Medicine in the Margins: Access, resistance and Health Care Utilization Among the Tuareg of Niger”
• “Mish-Mash: How the Health Care „Crisis‰ of 1970 Resulted in Dichotomous Portrayals of Physicians in Films of the Era”
• “Re-Emerging Fear: The 1991 Outbreak of Multi-Drug Resistant Tuberculosis in the New York Prison System”
• “Germs of Progress: Schistosomiasis, Health Research and Dam Development in Senegal, West Africa, at the End of the 20th Century”
• “Portrayals of Selective Serotonin Reuptake Inhibitors, Personality, and Self-Concept, 1987 to 1994”
• “Strong Work: The Forces that Shape a Medical Student into an Intern”
• “Perception and Poverty: A Historical Look at the Persistence of Sexually Transmitted Diseases in the African-American Community”
• “Pregnancy and Childbirth Practices and Popular Literature in Twentieth-Century America: Historical and Social Perspectives”

Pursuing an MD Thesis

Students who wish to explore the possibility of pursuing an MD thesis in the Section of the History of Medicine should meet with the Director of Medical Studies for History of Medicine or with any member of the Section of the History of Medicine. The DMS will also provide more specific instructions for preparing the MD thesis in History of Medicine, including some of the ways that such historical work differs from scientific papers in the basic and clinical sciences. Funding to support research is available from the Office of Student Research .

Director of Medical Studies

Professor in the History of Medicine and of History

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Meaning of thesis in English

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• I wrote my thesis on literacy strategies for boys .
• Her main thesis is that children need a lot of verbal stimulation .
• boilerplate
• composition
• dissertation
• essay question
• peer review

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thesis | American Dictionary

Examples of thesis, collocations with thesis.

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a large amount of ice, snow, and rock falling quickly down the side of a mountain

Keeping up appearances (Talking about how things seem)

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• v.92(5); May 2002

The McKeown Thesis: A Historical Controversy and Its Enduring Influence

James colgrove.

James Colgrove is with the Program in the History and Ethics of Public Health and Medicine, Division of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY.

The historical analyses of Thomas McKeown attributed the modern rise in the world population from the 1700s to the present to broad economic and social changes rather than to targeted public health or medical interventions. His work generated considerable controversy in the 1970s and 1980s, and it continues to stimulate support, criticism, and commentary to the present day, in spite of his conclusions' having been largely discredited by subsequent research. The ongoing resonance of his work is due primarily to the importance of the question that underlay it: Are public health ends better served by targeted interventions or by broad-based efforts to redistribute the social, political, and economic resources that determine the health of populations?

IN A BODY OF RESEARCH published from the 1950s to the 1980s, the physician and demographic historian Thomas McKeown put forth the view that the growth in population in the industrialized world from the late 1700s to the present was due not to life-saving advancements in the field of medicine or public health, but instead to improvements in overall standards of living, especially diet and nutritional status, resulting from better economic conditions. His historical analysis called into question the effectiveness of some of the most basic and widely applied techniques in the public health armamentarium, including sanitary reforms, vaccination, and quarantine. The “McKeown thesis” sparked the inquiries and shaped the research hypotheses of many scholars and became the subject of an extended controversy.

McKeown's work may be seen in the context of the debate over the relationship between food supply, economic development, and population growth that has engaged the natural and social sciences since the days of Thomas Malthus. McKeown's research also came to play a prominent role in the debate that emerged in the United States and Great Britain following World War II, and that intensified in the 1970s, over the appropriate focus and allocation of medical resources.

Sophisticated analyses in the field of historical demography effectively overturned the McKeown thesis in the early 1980s. Yet it has shown remarkable staying power, continuing to draw support and commentary throughout the 1990s. The purpose of this article is to examine the controversy over Thomas McKeown's work and its ongoing influence on public health research and policy. Even though its empirical foundation and conclusions are now considered flawed, the questions at the heart of the McKeown thesis—What are the most important determinants of a society's patterns of morbidity and mortality? and How should public health practitioners most effectively focus their efforts?—remain as relevant today as when they were first proposed.

HUMAN AGENCY VS ECONOMIC GROWTH

The McKeown thesis attempted to construct a unifying theoretical explanation for the so-called demographic transition, the dramatic growth in the population of the industrialized world from around 1770 to the present. The thesis can be summarized as follows: Population growth was due primarily to a decline in mortality from infectious disease. This decline was driven by improved economic conditions that attended the Industrial Revolution, which provided the basis for rising standards of living and, most important, enhanced nutritional status that bolstered resistance to disease. Other variables that may have been operating concurrently—the development of curative medical interventions, institution of sanitary reforms and other public health measures, and a decline in the virulence of infectious organisms—played at most a marginal role in population change. Put another way, the rise in population was due less to human agency in the form of health-enhancing measures than to largely invisible economic forces that changed broad social conditions.

McKeown came to demographic studies by way of an interest in the historical role of medicine. He had a strong interest in the ways that social factors such as class, income level, and living environment influence health and a passionate belief that the medical profession should move beyond a strict biological paradigm to address these factors. At the time McKeown began investigating past trends in population change, historical demography was a relatively new discipline. 1

McKeown advanced the core tenets of his thesis in 4 seminal articles published between 1955 and 1972 in the journal Population Studies . 2– 5 Each treated various aspects of the demographic transition, weighing the relative effects of various potential contributors to the decline in mortality. Medical treatments were ruled out, because most were introduced long after a downward mortality trend had already begun. Public health advances, McKeown determined, played only a small role, because they influenced water-borne illnesses such as cholera, which were responsible for just a small portion of the mortality decline, but not airborne ones such as tuberculosis, which made up the majority. Declining virulence of infectious agents was rejected as biologically implausible. In a 1962 article, McKeown concluded that “the rise of population was due primarily to the decline of mortality and the most important reason for the decline was an improvement in economic and social conditions.” 3 (p121) Among these conditions, the most significant was improved diet.

In 1976, McKeown published 2 books that summarized and synthesized the arguments he had advanced during the previous 20 years. In The Modern Rise of Population , 6 McKeown once again put forth his view about the primary role of social melioration, led by nutrition, in population growth. The structure of his argument unfolded in successive chapters as he discussed the potential alternative causes for the rise in population. The book was mostly derived from his Population Studies articles and contained little new material.

Published the same year, The Role of Medicine: Dream, Mirage, or Nemesis? 7 was McKeown's most explicitly polemical use of historical data. The book contained a further recapitulation of his now-familiar arguments about the relative contributions of medicine and economic progress to the health of society. It was less a research monograph, however, than a philosophical treatise on the nature of well-being and illness and what he saw as the appropriate role of medical providers. Medicine, McKeown stated, placed far too much emphasis on “cure” and not enough on “care,” in part because of a misunderstanding of history: “[M]isinterpretation of the major influences, particularly personal medical care, on past and future improvements in health has led to misuse of resources and distortion of the role of medicine.” 7 (pxiv) He concluded with a plea for a more humanistic, less technocratic role for the medical profession.

HISTORY AND IDEOLOGY

Elements of the McKeown thesis came under scrutiny in the 1960s and the early 1970s, mostly in academic journals of demographic or economic history. Various historians took issue with McKeown's summary dismissal of the importance of medical intervention and made the case for the importance of, among other measures, smallpox inoculation and the development of hospitals. 8– 10 Nevertheless, the thesis could hardly be described as controversial around that time, either in terms of its influence on other scholars or the criticism it attracted.

It was during the late 1970s and the 1980s, following the publication of The Modern Rise of Population and The Role of Medicine , that the McKeown thesis stimulated a highly visible and often contentious debate, focusing primarily on the contribution of medicine to society's well-being, which spread from the world of demographic and economic history to the realm of medicine and public health. The impact of the 2 works was significant, with many articles of the time describing them as establishing a “new orthodoxy” in historical interpretation. Since neither work contained substantially new material, it is somewhat surprising that the thesis achieved such sudden prominence. Part of the reason is simply that McKeown's opus had much greater impact once it was collected between the covers of 2 books and reached a wider audience than the readership of a specialized academic journal. Part of the answer also lies in the social and political climate of the late 1970s, a time of tension and transition in the field of medicine in which McKeown's diminution of the role of curative technologies struck an especially resonant chord.

The medical profession underwent a profound crisis of confidence in the 1970s, as advanced nations of the world, especially the United States and Great Britain, began to question large expenditures on sophisticated medical techniques that seemed to produce diminishing returns in quality of life. In contrast to the optimism and faith in medicine that had characterized the 1950s, the prevailing attitude toward the profession became one of cynicism, mistrust, and therapeutic nihilism. 11, 12 A spate of books and journal articles in both the popular and academic press questioned the ethics, values, and priorities of the institution of medicine; some of these attacks came from economists, while others were made by left-wing social historians who critically examined the cultural and political status of the profession. 13– 17 One of the most prominent works was Archibald Cochrane's Effectiveness and Efficiency: Random Reflections on Health Services , 13 which claimed that the benefits of many sophisticated and expensive procedures had not been adequately evaluated. Another was Ivan Illich's Medical Nemesis: The Expropriation of Health , 14 a harsh polemic that described medicine as a malign influence that does more harm than good through misguided and often dangerous “treatments.”

McKeown's 2 books were frequently cited alongside these works as part of the same social critique. Although the subtitle of The Role of Medicine: Dream, Mirage, or Nemesis? was an explicit reference to Medical Nemesis , McKeown distanced himself from Illich's ideology; in the introduction to The Role of Medicine , he wrote that it had little in common with Medical Nemesis “except perhaps in the sense that the Bible and the Koran could be said to be identified by the fact that both are concerned with religious matters.” 7 Yet both men shared the view that the increasing emphasis in the second half of the 20th century on hightechnology, curative medical efforts was a misguided diversion of resources away from more environmentally focused health programs. Many like-minded commentators saw McKeown's interpretation of the past as an object lesson about the failings of the present and a guideline for the future.

McKeown's critique of the medical establishment also dovetailed with a newly prominent discourse that was emerging in the United States, Canada, and Great Britain that emphasized the role of individual responsibility for health. In 1974, the Canadian health minister, Marc Lalonde, issued an influential report in which he called for citizens to examine their behavioral and lifestyle choices as the root of illness in society. 18 In an essay in the journal Daedalus , John Knowles, a physician and president of the Rockefeller Foundation, laid the blame for an unhealthy society on the personal habits of individuals and argued that people should stop looking to organized medicine or the government for improvements in health. 19 Both documents, which received wide attention in the popular and academic press, cited McKeown's work—selectively—to buttress claims that government-supported medical services had but a limited role in health. This environment helps explain the prominence that the McKeown thesis achieved. The Role of Medicine alone was cited in more than 130 articles in the decade following its release, primarily in journals of medicine, public health, and health services administration. 20 At least 2 journals, the Milbank Memorial Fund Quarterly and the Journal of Interdisciplinary History , devoted special issues responding to McKeown's claims.

While many scholars found McKeown's ideas persuasive, others took a more skeptical stance, and from his book's publication in the mid-1970s through the end of the 1980s, the 2 volumes were the targets of often scathing criticism focusing on both the substance of his conclusions and the methods by which he reached them. Several distinct though related elements of the thesis were targets of attack: the propositions that the growth of population was due to a decline in mortality rather than a rise in the birth rate, that active human intervention in the form of medical and public health measures had little to do with the fall in the death rate, and that increasing food supplies led to enhanced nutritional status at the population level. The methodological shortcomings for which McKeown was condemned included vaguely and imprecisely defining and categorizing the historical phenomena he was analyzing (such as “medical measures,” “standards of living,” and “food distribution”), failing to subject a hypothesis to rigorous analysis for plausibility, allowing ideological biases to color interpretation of data, and selectively overlooking other relevant scholarship.

A THEORY IS DISCREDITED

It was ultimately on empirical grounds that the McKeown thesis was overturned. The quantitative techniques used by historical demographers grew in sophistication from the 1950s to the 1980s. 21 A group of French scholars at the Institute National d'Etudes Démographiques in Paris developed a technique known as family reconstruction with which they were able to study the period predating the institution of death registration in France in 1792. In England, the Cambridge Group for the History of Population and Social Structure began in the early 1960s to generate a considerable body of influential work on population trends in Britain. 22 The Cambridge Group mined a rich source of data: parish registers dating from 1538 that recorded baptisms, burials, and marriages for the period before the first census in Britain. The group's groundbreaking research gave rise to numerous articles that presented a more complete and nuanced view of population change than McKeown's work had offered. 23, 24 One of the criticisms of McKeown's later work was that he failed to acknowledge and incorporate these more recent findings. He countered that the parish data being used by the Cambridge Group were problematic because of their fragmentary and ambiguous nature; answering his critics in a 1978 Population Studies article, he declared that “few would claim that they [parish records] provide a reliable picture of national fertility and mortality trends before the nineteenth century.” 25

The research of the Cambridge Group culminated in the publication in 1981 of The Population History of England 1541–1871 by E. A. Wrigley and Roger Schofield, which represented perhaps the most significant challenge yet to the credibility of the McKeown thesis. 26 Applying a variety of sophisticated new statistical and analytic techniques to the parish registers to overcome problems of accuracy and interpretation, Wrigley and Schofield produced a comprehensive and authoritative volume that conclusively demonstrated the invalidity of a central feature of McKeown's reasoning—that the growth in population was due to a decline in mortality, not a rise in fertility. Indeed, the book treated the McKeown thesis dismissively, consigning it to mentions in a few footnotes.

Probably the most detailed and thorough critique of McKeown's research came from Simon Szreter in a 1988 article. 27 Szreter claimed that the thesis suffered from conceptual inaccuracy, especially with respect to the catchall term “rising standards of living,” which conflated a heterogeneous group of phenomena, some of them related to economic changes and others to social reforms. More damning, Szreter conducted a new analysis of McKeown's own data on mortality trends in the 19th century and found that McKeown had misinterpreted the death records, confusing tuberculosis, bronchitis, and pneumonia. This misreading led to, among other errors, an incorrect description of the timing of the decline in tuberculosis mortality and an underestimation of deaths from bronchitis and pneumonia, which Szreter asserted played a more prominent role in overall mortality than McKeown had allowed. In Szreter's new interpretation of the data, public health measures such as clean water and milk supplies assumed greater importance, while changing social conditions, to which McKeown had attributed beneficial effects such as improvements in nutrition, were in fact a detrimental influence, resulting in, for example, overcrowded and poorly constructed housing resulting from rapid urbanization.

Finally, Szreter turned his attention to what he viewed as a crucial weakness that underlay McKeown's research: that McKeown had allowed his a priori assumptions about the limited value of medical intervention and the need for social reform to predetermine his analytic categories, thus biasing his interpretation of evidence. Szreter concluded his critique with a biographical sketch of McKeown, examining the ideology that influenced the research.

McKeown's professional and political battle was primarily directed against those who argued for ever greater diversion of the new National Health Service resources into curative technical medicine—invasive surgery and biochemical “treatments”—at the expense of preventive, humanistic medicine—efforts to understand and modify the health implications of the environment in its widest sense. . . . McKeown's exploration of the historical record was fantastically effective in these professional, political terms, thoroughly puncturing the inflated claims to importance, on the grounds of a supposed long history of life-saving achievements, of the medical “technocrats.” 27 (p33)

Szreter was not alone in pointing out the way that this political bias had influenced McKeown's writing. In a scathing critique of the thesis, S. Ryan Johansson accused McKeown of dissembling by presenting The Modern Rise of Population as a detached scholarly investigation when instead it was a piece of advocacy for a current policy. 28 “It is clearly an abuse of persuasive methods for any scholarly text to present itself as detached, when it is in fact an applied text presenting a skewed interpretation of the past designed to recruit support for a present policy,” Johansson wrote. 28 (p125)

As Johansson's essay implies, the policy implications of the McKeown thesis were controversial. Two courses (at least) may follow from the claim that targeted health interventions had not produced gains for populations: either refocus efforts on programs designed to change broad social conditions, or eliminate government involvement in health altogether, since a rising economic tide will lead, however indirectly, to improved health at the population level. As Johansson noted, the McKeown thesis could be (and was) interpreted as a model that “subverted the germ theory/public health orthodoxy and marginalized the role of the state as the key agent of reform in modern mortality history.” 28 (p106)

Commenting on the work of McKeown and Archibald Cochrane, one historian noted, “it is thus a sad irony that McKeown's historical work and Cochrane's advocacy . . . gained popularity during a period of growing concern over the costs of health services in the United States, Great Britain and other Western societies, for both these bodies of work have been used as a way of containing costs and providing a rationale for doing so, without at the same time sharing the concern of the authors for humane and equitable care.” 12 (p262)

THE CONTINUING RESONANCE OF THE MCKEOWN THESIS

The consensus among most historians about the McKeown thesis a quarter century after it first stirred controversy is that one narrow aspect of it was correct—that curative medical measures played little role in mortality decline prior to the mid-20th century—but that most of its other claims, such as the assessment of the relative contributions of birth rates and of public health and sanitation measures to population growth, were flawed. A new historical orthodoxy, however, has not taken its place. The complex interrelationships between economic changes, social trends, and professional medical and public health activities remain refractory to simple or sweeping explanations. Much of the problem in arriving at unifying theories of change, as Gretchen Condran has noted, is that “competing explanatory variables were changing simultaneously.” 29 (p119)

Inquiries into all of the variables continues, stimulated in large measure by McKeown's iconoclastic interpretation. 30– 32 In particular, many historians of public health and medicine have used McKeown's ideas as a starting point to reexamine and reassert the value of various sanitary reforms, which he had discredited. For example, Gretchen Condran, acknowledging the McKeown thesis, examined the influence in Philadelphia of public health and sanitary measures such as improvements in the milk and water supplies and in child care practices and concluded that “intervention as against economic growth was a major source of the decline in mortality in American cities.” 29 (p121) A 1991 volume of essays included several that explicitly and implicitly responded to the McKeown thesis, examining topics such as the declines of cholera and tuberculosis and the effects of social and sanitary factors such as improved housing conditions and pasteurization. 33 More recently, Amy Fairchild and Gerald Oppenheimer made the case that McKeown had insufficiently explored the effect on tuberculosis rates of 2 public health interventions, quarantine of infected people and eradication of the bovine form of the illness (responsible for transmission through contaminated milk). 34

The ongoing interest in McKeown's ideas, not only among historians but also among policymakers addressing contemporary issues, is striking. What accounts for his work's remarkable durability? Why has the influence of the McKeown thesis persisted even after its conclusions were discredited? In part, his writing continues to generate responses because many scholars believe that although McKeown's analysis was flawed, his underlying ideas regarding the effects of poverty and economic well-being on health were essentially correct. More broadly, McKeown's influence has continued to be felt because his research posed a fundamental question that has lost none of its relevance in the decades since he began writing in the post–World War II era: Are public health ends better served by narrow interventions focused at the level of the individual or the community, or by broad measures to redistribute the social, political, and economic resources that exert such a profound influence on health status at the population level?

Although McKeown's formulation of this question achieved unusually wide visibility, for the reasons discussed above, he was not the first to raise it. His work represented a reframing of a much older debate, dating to the latter part of the 19th century, between sanitary reformers devoted to improving social conditions in the broadest sense and germ theorists dedicated to controlling disease through the sophisticated tools of bacteriology. Far from fading in prominence, the questions he raised have assumed new salience at the beginning of the 21st century, especially in debates about how best to confront health threats such as AIDS, tuberculosis, and malaria in the developing world. For example, commenting on the recent initiative to provide AIDS drugs in poor nations, a health activist based in Nepal summed up the 2 sides of this debate when he noted, “There has been an overemphasis . . . [on] drugs. The lack of drinking water is a much bigger priority in most countries than anti-retroviral treatments.” 35

A large and growing body of research suggesting that broad social conditions must be addressed in order to effect meaningful and long-term improvements in the health of populations has validated the underlying premise of McKeown's inquiries. 36– 39 This research challenges public health professionals to view targeted interventions and social change, not as dichotomous or opposing choices, but rather as essential complements to each other, and to find ways to integrate technical preventive and curative measures with more broad-based efforts to improve all of the conditions in which people live. These concepts, which lie at the heart of the McKeown thesis, account in large measure for its continuing resonance in the field of public health. McKeown's work, empirically flawed though it may have been, placed before a wide audience a set of practical and ethical challenges with which policymakers in the United States and internationally will continue to grapple in the coming decades.

Acknowledgments

The author thanks Ronald Bayer and Amy Fairchild for their comments on an earlier version of this paper.

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