Canguilhem criticized the concept of “public health”: health and disease are concepts that only apply to individuals, taken as organic totalities. Their extension to a different level of organization is purely metaphorical. The importance assumed by epidemiology in the construction of our knowledge of the normal and the pathological does, however, call for reflection on the role and the status of the population level of organization in our approach to health phenomena. The entanglement of the biological and the social in (...) human life and in contemporary societies justifies this level of analysis for better understanding the complexity and the interaction of health determinants both at the level of individuals and their interactions and at that of the population. But is this population level just a useful level of analysis that makes it possible to bring to light the social determinants of health at the individual level, or does it rest instead on characteristics of the population that are irreducible to individual characteristics, but which are nevertheless important for understanding and taking action with respect to both population and individual health? Defending this second alternative, I show how the epidemiological point of view, and in particular that of social epidemiology, leads us to rethink the possibility of a concept of “population health” that is not reducible to the sum of individual instances of health. (shrink)

ArgumentThis article addresses the doctrinal controversy over the various characterizations of irritability and sensibility. In the middle of the eighteenth century, this scientific debate involved some encyclopaedist physicians, Albrecht von Haller (1709–1777), Jean-Jacques Ménuret de Chambaud (1733–1815), and Théophile de Bordeu (1722–1776). The doctor from Bern described irritability as an experimental property of the muscle fibers and made it the basis of a neo-mechanism in which organic reactions are related to the degree of irritation of the fibers. The practitioners from (...) Montpellier considered sensibility, a property of living matter, to be a spontaneous activity of the organ and developed around this notion an original conception of the organism as the sum of the specific lives of each part. Beyond conceptual divergences, two ways of thinking whose philosophical presuppositions (conception of living matter, mechanism, and organicism), were in opposition, while their epistemological principles (experience versus observation) and their medical practices (active medicine and expectant medicine) went on to evolve in different directions. The privileged place granted to experimentation and assessment enabled physiology to be articulated as an autonomous scientific discipline; the pre-eminence of observation and attention to the radical specificity of the living being constituted the bases of clinical medicine. (shrink)

The idiotypic network theory (INT) was conceived by the Danish immunologist Niels Kaj Jerne in 1973/1974. It proposes an overall view of the immune system as a network of lymphocytes and antibodies. The paper tries to offer a reconstruction of the genesis of the theory, now generally discarded and of mostly historical interest, first of all, by taking into account the context in which Jerne’s theoretical proposal was advanced. It is argued the theory challenged, in a sense, the supremacy of (...) the clonal selection theory (CST), this being regarded as the predominant paradigm in the immunological scenario. As CST found shortcomings in explaining certain phenomena, anomalies, one could view INT as a competing paradigm claiming to be able to make sense of such phenomena in its own conceptual framework. After a summary outline of the historical background and some relevant terminological elucidations, a narrative of the various phases of elaboration of the theory is proposed, up to its official public presentation. (shrink)

Positron emission tomography is a frontiermedical technology that, in contrast to the othercomputer-assisted technologies providing anatomicalpictures, produces functional images. I argue that PETalso opens up an avenue for shifting from images back toanalysis of measurements. Admittedly, quantification of functionrequires structural constraints. I coined the emerginginterpretational framework quantitative anatomyin an attempt to conceptualize the PET merger betweenmeasuring and imaging, the two competing meansmedicine uses to examine the human body. Anatomyjustifies interpretations that fit the existingknowledge of a larger clinical audience, whilestatistical data (...) possess an unexplored potential tointroduce mathematical rigor in the evaluation offunction, but are still a black box for the majorityof clinicians. This epistemological change is beingcarried out by PET users in action as well as indiscourse. (shrink)