Biomedicine and Its Cultural Authority


EXCERPT: Criticism of medicine as centered in molecular biology and technology, and prone to neglect the personal and social dimensions of health and illness, has a long history. Already in the 1880s, at the very moment in which medicine was being reconstituted by discoveries from laboratory science, there was pushback. Puck, the famous American magazine of humor and political satire, ran a panel of cartoons about medicine in 1886, one with the caption “No Time for Common Sick Folks.” The drawing shows a doctor in a lab coat leaving the bedside of a patient, hat in hand and rabbit in pocket, with the apology, “Excuse me, but I have an experiment to make.” A few years later, neurologist James J. Putnam, in an address to the Massachusetts Medical Society, observed that a concern to treat “not the disease only, but also the man” was a “familiar sentiment that often falls so solemnly from the lips of older members of the profession.”

Ever since, medicine has been hailed for its extraordinary explanatory and technical successes while at the same time generating considerable discontent. Against a narrow biologism and procedure-orientation, critics have argued for more socially oriented and humanistic approaches.

Why have these alternatives not gained more traction? Why have socially oriented and integrative approaches, despite their long appeal, remained marginal? Why, to turn the question around, does medicine continue on a course characterized by reductionism, mechanism-based explanations for clinical syndromes, and heavy reliance on technological solutions, despite arguments for change? No answer to these complicated questions can hope to be remotely complete, but I want to frame a general explanation by considering the powerful appeal of two enduring legacies, one from the seventeenth century and one from the nineteenth. Each is familiar enough. Philosophers and theologians have often reflected on the implications of seventeenth-century natural philosophy, particularly the works of Francis Bacon and René Descartes, to understand the commitments of modern science and medicine. Historians more commonly concentrate on the nineteenth-century changes that joined medicine with the physical and life sciences and gave birth to what we now call the “biomedical model” — a set of ideas that have structured thinking about disease and treatment ever since, often reducing medicine to a technical, scientific discipline. These two legacies together have given reductionist medicine a distinct cultural authority.

But this authority is also rooted in certain modern preoccupations: the valuation of health, which has increasingly become an end in itself; the “war against all suffering,” to use Ivan Illich’s phrase; and the project of self-determination. These preoccupations lay down powerful moral imperatives, which help to account for both the continued assertion of the biomedical model and for its extension over more and more areas of our lives, an extension held back only by the limits of our current technological powers....

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