Abstract：
Jerome Wakefield criticizes my biostatistical analysis of the pathological-as statistically subnormal biological part-functional ability relative to species, sex, and age-for its lack of a harm clause. He first charges me with ignoring two general distinctions: biological versus medical pathology, and disease of a part versus disease of a whole organism. He then offers 10 counterexamples that, he says, are harmless dysfunctions but not medical disorders. Wakefield ends by arguing that we need a harm clause to explain American psychiatry\'s 1973 decision to declassify homosexuality. I reply, first, that his two distinctions are philosophic fantasies alien to medical usage, invented only to save his own harmful-dysfunction analysis (HDA) from a host of obvious counterexamples. In any case, they do not coincide with the harmless/harmful distinction. In reality, medicine admits countless chronic diseases that are, contrary to Wakefield, subclinical for most of their course, as well as many kinds of typically harmless skin pathology. As for his 10 counterexamples, no medical source he cites describes them as he does. I argue that none of his examples contradicts the biostatistical analysis: all either are not part-dysfunctions (situs inversus, incompetent sperm, normal-flora infection) or are indeed classified as medical disorders (donated kidney, Typhoid Mary\'s carrier status, latent tuberculosis or HIV, cherry angiomas). And if Wakefield\'s HDA fits psychiatry, the fact that it does not fit medicine casts doubt on psychiatry\'s status as a medical specialty.
摘要：
杰罗姆·韦克菲尔德批评了我对病理学的生物统计学分析，认为相对于物种，在统计学上低于正常的生物部分功能能力，性别,和年龄——因为它没有伤害条款。他首先指控我忽略了两个普遍的区别：生物学和医学病理学，一部分的疾病与整个有机体的疾病。然后他提供了10个反例，他说,是无害的功能障碍，但不是医学障碍。韦克菲尔德最后辩称，我们需要一个伤害条款来解释美国精神病学1973年解密同性恋的决定。我回答，首先,他的两个区别是与医疗用途不同的哲学幻想，发明只是为了从一系列明显的反例中拯救他自己的有害功能障碍分析(HDA)。无论如何,它们与无害/有害的区别不一致。在现实中,医学承认无数的慢性疾病，与韦克菲尔德相反,他们的大部分课程都是亚临床的，以及多种典型无害的皮肤病理。至于他的10个反例，他引用的医学来源没有像他那样描述他们。我认为他的例子都没有与生物统计分析相矛盾：两者都不是部分功能障碍（situsinversus，无能的精子,正常菌群感染)或确实被归类为医学疾病(捐赠的肾脏，伤寒玛丽的携带者身份，潜伏性结核病或艾滋病毒，樱桃血管瘤）。如果韦克菲尔德的HDA符合精神病学，它不适合医学的事实令人怀疑精神病学作为医学专业的地位。
