Systems medicine, which is based on computational modelling of biological systems, is emerging as an increasingly prominent part of the personalized medicine movement. It is often promoted as ‘P4 medicine’. In this article, we test promises made by some of its proponents that systems medicine will be able to develop a scientific, quantitative metric for wellness that will eliminate the purported vagueness, ambiguity, and incompleteness—that is, normativity—of previous health definitions. We do so by examining the most concrete and relevant evidence (...) for such a metric available: a patent that describes a systems medicine method for assessing health and disease. We find that although systems medicine is promoted as heralding an era of transformative scientific objectivity, its definition of health seems at present still normatively based. As such, we argue that it will be open to influence from various stakeholders and that its purported objectivity may conceal important scientific, philosophical, and political issues. We also argue that this is an example of a general trend within biomedicine to create overly hopeful visions and expectations for the future. (shrink)

Although it is now generally acknowledged that new biomedical technologies often produce new definitions and sometimes even new concepts of disease, this observation is rarely used in research that anticipates potential ethical issues in emerging technologies. This article argues that it is useful to start with an analysis of implied concepts of disease when anticipating ethical issues of biomedical technologies. It shows, moreover, that it is possible to do so at an early stage, i.e. when a technology is only just (...) emerging. The specific case analysed here is that of ‘molecular medicine’. This group of emerging technologies combines a ‘cascade model’ of disease processes with a ‘personal pattern’ model of bodily functioning. Whereas the ethical implications of the first are partly familiar from earlier—albeit controversial—forms of preventive and predictive medicine, those of the second are quite novel and potentially far-reaching. (shrink)

The predominant model of the body in modern western medicine is the machine. Practitioners of the biomechanical model reduce the patient to separate, individual body parts in order to diagnose and treat disease. Utilization of this model has led, in part, to a quality of care crisis in medicine, in which patients perceive physicians as not sufficiently compassionate or empathic towards their suffering. Alternative models of the body, such as the phenomenological model, have been proposed to address this crisis. According (...) to the phenomenological model, the patient is viewed as an embodied person within a lived context and through this view the physician comes to understand the disruption illness causes in the patient’s everyday world of meaning. In this paper, I explore the impact these two models of the patient’s body have had on modern medical practice. To that end I first examine briefly the historical origins of the biomechanical and phenomenological models, providing a historical context for the discussion of each model’s main features in terms of machine-world and life-world. Next, I discuss the impact each model has had on the patient–physician relationship, and then I examine briefly the future development of each model. The meaning of illness vis-à-vis each model of the patient’s body is finally examined, especially in terms of how these two models affect the patient’s interpretation of illness. The paper concludes with a discussion of the biomechanical and phenomenological models, in terms of the quality of care crisis in modern western medicine. (shrink)

The objective of this article is to analyse the value-ladenness of technology in the context of medicine. To address this issue several characteristics of technology are investigated: i) its interventive capacity, ii) its expansiveness and iii) its influence on the concept of disease, iv) its generalising character, v) its independence of the subjective experience of the patient. By this analysis I hope to unveil the double face of technology: Technology has a Janus-face in modern medicine, and the opposite of its (...) factual face is evaluative. (shrink)

Though ubiquitous across the medical social sciences literature, the term “biomedicine” as an analytical concept remains remarkably slippery. It is argued here that this imprecision is due in part to the fact that biomedicine is comprised of three interrelated ontological spheres, each of which frames biomedicine as a distinct subject of investigation. This suggests that, depending upon one’s ontological commitment, the meaning of biomedicine will shift. From an empirical perspective, biomedicine takes on the appearance of a scientific enterprise and is (...) defined as a derivative category of Western science more generally. From an interpretive perspective, biomedicine represents a symbolic-cultural expression whose adherence to the principles of scientific objectivity conceals an ideological agenda. From a conceptual perspective, biomedicine represents an expression of social power that reflects structures of power and privilege within capitalist society. No one perspective exists in isolation and so the image of biomedicine from any one presents an incomplete understanding. It is the mutually-conditioning interrelations between these ontological spheres that account for biomedicine’s ongoing development. Thus, the ontological dissection of biomedicine that follows, with particular emphasis on the period of its formal crystallization in the latter nineteenth and early twentieth century, is intended to deepen our understanding of biomedicine as an analytical concept across the medical social sciences literature. (shrink)

This article proposes that the French performance artist Orlan, has, by undertaking a series of surgical interventions on her face and body, radically challenged current standards of beauty. By engaging with Judeo-Christian iconography, Greek mythology and French literature in her operations/performances, she has established an oeuvre that aligns her not only with corporeality and the abject body through images of the sacrificial, but also with aberrant body forms associated with the carnival. Although seduced by the rhetoric that surrounds the body (...) in technology, she has turned to excess as a strategy against the benign and controlled nature of the screen, and the media's homogenization of body images. Her new identity, although not extreme, is a site of resistance in a society bent on eliminating forms that threaten the status quo. (shrink)

The objective of this article is to investigate ethical aspects of technology through the moral term “paternalism”. The field of investigation is medicine. The reason for this is twofold. Firstly, “paternalism” has gained moral relevance through modern medicine, where physicians have been accused of behaving paternalistic and threatening patients’ autonomy. Secondly, medicine is a brilliant area to scrutinise the evaluative aspects of technology. It is argued that paternalism is a morally relevant term for the ethics of technology, but that its (...) traditional conception is not adequate to address the challenges of modern technology. A modification towards a “technological paternalism” is necessary. That is, “technological paternalism” is a fruitful term in the ethics of technology. Moreover, it is suited to point out the deficiencies of the traditional concept of paternalism and to reform and vitalise the conception of paternalism in ethics in order to handle the challenges of technology. (shrink)

Technology is believed to have liberated health care from dogmas, myths and speculations of earlier times. However, we are accused of using technology in an excessive, futile and even detrimental way, as if technology is compelling our actions. It appears to be like the monster threatening Dr. Frankenstein or like the socerer’s broom in the hand of the apprentice. That is, the same technology that should liberate us from myths, appears to be mythical. The objective of this article is to (...) investigate the background for the re-entrance of the myth: How we encounter it and how we can explain it. The main point is that a myth of technology is normative: it relates ‘is’ and ‘ought’ and directs our actions. This becomes particularly clear in health care. Hence, if there is a myth of technology, it is an ethical issue, and should be taken seriously. (shrink)

For historians of medicine, the professor Theodor Billroth of the University of Vienna was the leading European surgeon of the late nineteenth century and the personification of intervention by organ or body part removal. For social and political historians, he was a German nationalist whose book on medical education heralded the rise of anti-Semitism in the Austrian public sphere. This article brings together and critically reassesses these two hitherto separate accounts to show how, in a period of dramatic social and (...) political change, Viennese surgery split into two camps. One, headed by Billroth, was characterized by an alliance with the German educational model, German nationalism leading to racial anti-Semitism and an experimental approach to the construction of surgical procedure, which heavily relied on the methods of pathological physiology. The other, which followed a long Austrian tradition, stood for a clinically oriented and strictly organized medical education that catered to an ethnically and socially diverse population and, simultaneously, for an anatomically oriented surgery, largely of the locomotor apparatus. This study shows how, in a major centre of medical education and capital of a multiethnic empire, surgical and national identities were forged together. (shrink)

Many physicians assert that new cost-control mechanisms inappropriately interfere with clinical decision-making. They claim that high costs arise from poorly practiced medicine, and argue that effective utilization of resources is best promoted by advancing the scientific and ethical ideals of medicine. However, the claim is not warranted by empirical evidence. In this essay, I show how it rests upon aesthetic considerations associated with diagnostic elegance. I first consider scientific rationality generally. After a review of analytical empiricist and socio-historical approaches in (...) the philosophy of science, a form of Kant's aesthetic is used to explain how scientific discovery and justification are linked, and to show how meta-theoretical considerations associated with the goals and method of science work together with exemplars of practice. This analysis enables us to understand how the ideals of medicine as a science guide the initial patient history and physical exam in such a way that a parsimonious use of tests is indicated. Aesthetic considerations unite the basic scientific and ethical commitments of the modern medical paradigm and are central for rightly understanding clinical judgment. (shrink)

This paper outlines the background and significance of philosophy of technology as a focus of inquiry emerging within nursing scholarship and research. The thesis of the paper is that philosophy of technology and nursing is fundamental to discipline development and our role in enhancing health care. It is argued that we must further our responsibility and interest in critiquing current and future health care systems through philosophical inquiry into the experience, meaning and implications of technology. This paper locates nurses as (...) important contributors to the use and integration of health care technology and identifies nursing as a discipline that can provide specific insights into the health experience of individuals, cultures and societies. Nurses are encouraged to undertake further examination of epistemological, ontological and ethical challenges to arise from technology as a focus of philosophical inquiry. The advancement of philosophy of technology and nursing will make a profound contribution to inquiry into the experience of technology, the needs of humanity and the development of appropriate health care. (shrink)

Germund Hesslow has argued that concepts of health and disease serve no important scientific, clinical, or ethical function. However, this conclusion depends upon the particular concept of disease he espouses; namely, on Boorse's functional notion. The fact/value split embodied in the functional notion of disease leads to a sharp split between the science of medicine and bioethics, making the philosophy of medicine irrelevant for both. By placing this disease concept in the broader context of medical history, I shall show that (...) it does capture an essential part of modern medical ideology. However, it is also a self-contradictory notion. By making explicit the value desiderata of medical nosologies, a reconfiguration of the relation between medicine, bioethics, and the philosophy of medicine is initiated. This, in turn, will involve a recovery of the caring dimensions of medicine, and thus a more humane practice. (shrink)

This paper begins by examining the claim that the practice of medicine is essentially a moral endeavor. According to this view, all clinical practice has moral content, and each clinical situation has a moral dimension. I suggest that in order to recognize this moral dimension, clinicians must engage in an interpretive process, and that they must be able to interpret clinical data in ethical terms. However, clinicians often lack the ‘moral perception’ required to appreciate this moral dimension. I will argue (...) that physicians lack moral perception when the clinical data they are given do not offer sufficient opportunity for interpretation. This paper draws on the work of Merleau-Ponty to suggest that this loss of interpretation is, paradoxically, the result of the way that patients experience illness. This thesis may be productive, first, because it suggests opportunities to explore the process of moral perception. This thesis also suggests ways for ethicists and educators to enhance clinicians' perception of the ethical dimensions of clinical practice. Finally, the concept of moral perception, when grounded in the patient's experience of illness, creates a fruitful area of inquiry that warrants inclusion in what may someday be the philosophy of medicine's canon. (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)

After describing the disorder of psychopathy, I examine the theories and the evidence concerning the psychopaths’ deficient moral capacities. I first examine whether or not psychopaths can pass tests of moral knowledge. Most of the evidence suggests that they can. If there is a lack of moral understanding, then it has to be due to an incapacity that affects not their declarative knowledge of moral norms, but their deeper understanding of them. I then examine two suggestions: it is their deficient (...) practical reason or their stunted emotions that are at fault. The evidence supports both explanations. I conclude with an overview of the debate concerning whether they are morally or legally responsible for their actions. (shrink)

This paper explores the reasons why women who are themselves fertile might consent to undergo in vitro fertilization (IVF) with an infertile male partner. The reasons often given are desire to have that particular man's child, or altruism, giving a gift to the partner. Although ethically, the decision should be completely woman's prerogative, because IVF programs usually treat the couple as a unit, she may be offered few other options by the medical staff. In social terms, whether the woman is (...) or is not infertile may be immaterial because in either situation, if she wants to try to have a biological child and maintain the relationship, she may have to make a patriarchal bargain and undergo in vitro fertilization. (shrink)

Sigmund Freud’s five long case histories have been the focus of seemingly endless fascination and criticism. This article examines how the long case-history genre developed and its impact on the professionalization of psychoanalysis. It argues that the long case histories, using a distinctive form that highlighted the peculiarities of psychoanalytic theory, served as exemplars in the discipline. In doing so, the article extends John Forrester’s work on ‘thinking in cases’ to show the practical implications of that style of reasoning. The (...) article illustrates how the form disappeared once the theoretical basis of the movement was set. The genre never became institutionalized, although the content of the five long case histories did, because of Freud’s accepted role as theoretician of psychoanalysis. (shrink)

The use of artificial intelligence in healthcare has led to debates about the role of human clinicians in the increasingly technological contexts of medicine. Some researchers have argued that AI will augment the capacities of physicians and increase their availability to provide empathy and other uniquely human forms of care to their patients. The human vulnerabilities experienced in the healthcare context raise the stakes of new technologies such as AI, and the human dimensions of AI in healthcare have particular significance (...) for research in the humanities. This article explains four key areas of concern relating to AI and the role that medical/health humanities research can play in addressing them: definition and regulation of “medical” versus “health” data and apps; social determinants of health; narrative medicine; and technological mediation of care. Issues include data privacy and trust, flawed datasets and algorithmic bias, racial discrimination, and the rhetoric of humanism and disability. Through a discussion of potential humanities contributions to these emerging intersections with AI, this article will suggest future scholarly directions for the field. (shrink)

During the nineteenth century physiologists and clinicians developed several graphical recording systems for the mechanical registration of heart sounds. However, none of these replaced traditional methods of auscultation. The paper describes criticism of the aural sense as one of the driving forces behind the development of phonocardiography and analyses its variants from a technological and clinical perspective. Against the background of the physiological “method of curves,” the parameters that prevented the implementation of phonocardiography against overwhelming odds are highlighted. Contemporaries denied (...) specific evidence beyond auscultation. Many clinicians also feared that the art of auscultation was being undermined by the new, reproducible mechanical methods. The paper argues that phonocardiography was on the one hand regarded as impractical in clinical settings; on the other hand—and even more important—implicit practices, tacit knowledge and cultural models fostered skepticism against the new method. The argument of “self-evidence”—often connected to medical images, curves, graphs or tables—was not valid for the visualization of cardiac sounds in the opinion of the promoters of acoustic heart sound registration and its individual interpretation. Rather, the acts of subjective hearing and objectively reporting what was heard seemed “self-evident” for pathophysiological characteristics and the development of a diagnosis. Therefore, auscultation and phonocardiography coexisted with different emphases. While auscultation remained the method of choice for a bedside diagnosis, phonocardiography played its role in differential diagnostics or research settings. (shrink)

These three books illustrate some key themes in the history of science and the history of microscopy. First is a new enthusiasm among some historians and philosophers of science to embrace the history of microscopy as an area worthy of study, a recognized area of investigation for the historian and philosopher of science. In so doing these historians have redefined the subject area from the more traditional and much researched history of microscopes, with its emphasis on the technical, to a (...) consideration of the community of practitioners of microscopy and the theoretical contexts in which they carried out their studies. They have attempted to view the practice of microscopy and its practitioners within a conceptual, philosophical, and social context. They have by no means excluded technical considerations, but have argued that those alone can explain neither the rise, flourishing, and apparent decline of microscopy in the seventeenth and eighteenth centuries, nor its resurgence in the nineteenth century. Rather, they have argued that an analysis of microscopy must include social and conceptual considerations in addition to the technical. With these three books we have moved at last from the history of microscopes to the history of microscopy, within the context of the history and philosophy of science. The history of microscopy can now take its place within the larger inter-disciplines of HPS and STS. (shrink)

This article explores the relationship between medicine’s history and its digital present through the lens of the physician-patient relationship. Today the rhetoric surrounding the introduction of new technologies into medicine tends to emphasize that technologies are disturbing relationships, and that the doctor-patient bond reflects a more ‘human’ era of medicine that should be preserved. Using historical studies of pre-modern and modern Western European medicine, this article shows that patient-physician relationships have always been shaped by material cultures. We discuss three activities (...) – recording, examining, and treating – in the light of their historical antecedents, and suggest that the notion of ‘human medicine’ is ever-changing: it consists of social attributions of skills to physicians that played out very differently over the course of history. (shrink)

This article presents a case study of a recent controversy over the use of computed tomography as a diagnostic technology in South Korean hospitals. The controversy occurred in the wake of a series of conflicts in the late twentieth century over the legitimate placement of healing practices, medicinal substances, and medical technologies within Korea’s separate “Western Medicine” and “Korean Medicine” systems of health care and pharmaceutical distribution. The controversy concerned an attempt to use hi-tech imaging technology—the epitome of modern medicine—in (...) a clinic that maintains a strong ideological attachment to Korean healing traditions. A close study of this dispute, based on interviews, participant observation, and documentary analysis, showed that discursive positions taken about the translatability of medical technologies changed with the context of dispute, and did not reflect a stable epistemic boundary between rival medical paradigms. (shrink)

This article discusses the emergence of the modern body, as portrayed by Foucault, in early 20th-century medical practice. Specifically, this article argues how the coming of the patient-centered record in the United States was a pivotal event in this emergence. We argue how the shape and functions that the record acquired during this period was fundamentally intertwined with the new shape that both the patient’s body and medical institutions acquired. We zoom in on two specific examples: the re-historizing and subjectifying (...) of the body, both afforded by new record-keeping practices. The topic addressed here is the embodying of the patient: the production of a patient with a body whose characteristics are the effect of the interrelation of the patient with a growing number of professionals and investigative instruments, and with a medical record which becomes more and more significant in these interrelations. (shrink)

Is technology value-free or is it value-laden? How does technology affect human autonomy? These questions, viewed within the context of medicine, are the focus of attention in this article. The central argument is that we need neither to subscribe to the value-neutrality dictum nor to the all-encompassing value-ladenness thesis to explain the pertinent position of technology in medicine. Technology is constitutive of and strongly implicated in difficult questions of value. This, however, does not mean that technology is identical to (or (...) neutral to) these value-laden questions. Technology poses issues of value, but only some of these relate to technology qua technology. Hence, it makes a difference whether we discuss general questions of value posed by technology or whether we discuss the value-ladenness of technology. Admitting technological value-ladenness does not imply that we are subject to a technological imperative that reduces our autonomy, on the contrary, it explains how technology increases our responsibility. This is particularly prominent in medicine. (shrink)

The practice of mediate auscultation—listening to the body through a stethoscope—was at the center of new articulations of medical thought and practice in the 19th century. During that period, the stethoscope became the hallmark of medical modernity. This article offers a detailed examination of the work of RTH Laennec and other important writings on the stethoscope in order to argue for the centrality of a distinctive orientation toward listening in modern medicine. The development of mediate auscultation applied medical and scientific (...) reason to listening, just as a particular practice of hearing the body became integral to everyday functioning of medicine. Mediate auscultation was thus an artifact of a new approach to reason and the senses, one based in a scientific mindset and a logic of mediation. (shrink)

This essay argues that Berger and Mohr’s A Fortunate Man (1967) – comprising social observation and photographs of the rural practitioner, Dr. Sassall and his patients – enacts an embodied, intersubjective empathy called “pain-work.” The book enacts “pain-work” through two strategies. Firstly, by conflating three ways of seeing – Berger’s observation, Mohr’s photography, and Sassall’s medical gaze – it shows that the clinical encounter embodies objective vision through intersubjective pain. Secondly, it employs the concepts of recognition and witnessing to show (...) how the subjectivity of the physician is distributed in his community. Thus, Berger and Mohr witness Sassall’s witnessing of his patients; even as Sassall and his patients are constituted intersubjectively, so too are Berger, Mohr, and Sassall. (shrink)

ArgumentIn the winter of 1849–1850 in Königsberg, German physiologist Hermann von Helmholtz (1821–1894) conducted pioneering measurements concerning the propagation speed of stimulations in the living nerve. While recent historians of science have paid considerable attention to Helmholtz's uses of the graphic method, in particular his construction of an instrument called “myographion,” this paper draws attention to theinscription surfacesthat he used in effective ways for capturing and transmitting his findings. Against the background of recent archival findings, I show that Helmholtz used (...) isinglass copies of his graphical recordings in order to communicate the basic principle of previous measurements to the academic public. As the correspondence with his Berlin-based friend and colleague Emil du Bois-Reymond (1818–1896) and the subsequent development of the myographion make clear, these curves were not meant as measurements but functioned as demonstrations. In other words, Helmholtz's curves did provide “images of precision” (Olesko and Holmes 1993) – but they were not precise images. (shrink)

This thesis is about the content and concerns of each of four disciplines pertaining to the field of bioethics: medicine, philosophy, religion and law. Emphasis is put on the human values each reflects in patients' lives. A last chapter is dedicated to patients' narrative in order to bring a practical perspective to the discussions of the previous chapters. The four essential human values interconnecting among the four disciplines are: the patients' need for authority, the need for protection, the existential questioning (...) about the meaning of life, and the fear of death. (shrink)

Science and technology have vastly expanded the realm of medicine. The numbers of and knowledge about diseases has greatly increased, and we can help more people in many more ways than ever before. At the same time, the extensive expansion has also augmented harms, professional responsibility, and ethical concerns. While these challenges have been studied from a wide range of perspectives, the problems prevail. This article adds value to previous analyses by identifying how the moral imperative of medicine has expanded (...) in three ways: (1) from targeting experienced phenomena, such as pain and suffering, to non-experienced phenomena (paraclinical signs and indicators); (2) from addressing present pain to potential future suffering; and (3) from reducing negative wellbeing (pain and suffering) to promoting positive wellbeing. These expansions create and aggravate problems in medicine: medicalization, overdiagnosis, overtreatment, risk aversion, stigmatization, and healthism. Moreover, they threaten to infringe ethical principles, to distract attention and responsibility from other competent agents and institutions, to enhance the power and responsibility of professionals, and to change the professional-beneficiary relationship. In order to find ways to manage the moral expansion of medicine, four traditional ways of setting limits are analyzed and dismissed. However, basic asymmetries in ethics suggest that it is more justified to address people’s negative wellbeing (pain and suffering) than their positive wellbeing. Moreover, differences in epistemology, indicate that it is less uncertain to address present pain and suffering than future wellbeing and happiness. Based on these insights the article concludes that the moral imperative of medicine has a gradient from pain and suffering to wellbeing and happiness, and from the present to the future. Hence, in general present pain and suffering have normative priority over future positive wellbeing. (shrink)

In 1947, the Cornell psychiatrist Keeve Brodman and a handful of colleagues began developing what would become one of the most widely used health questionnaires of its time—the Cornell Medical Index (CMI). A rigidly standardized form, the CMI presented 195 yes-no questions designed to capture the health status of “the total patient.” Over the following decades, Brodman’s project of standardizing medical history taking gradually evolved into a project of mathematizing and computerizing diagnosis: out of the CMI grew the Medical Data (...) Screen (MDS), one of the first computerized methods of deriving diagnoses from patient data. This essay follows the life course of these tools through the second half of the twentieth century. It argues for a genealogy of biomedical computing and computerized diagnosis that takes more seriously the continuities between computer-based digital practices and paper-based analog ones. The computerized MDS evolved from, and rested upon, paper data practices associated with questionnaires and surveys. The interlocking histories of the CMI and the MDS prompt a reconsideration of the material and temporal parameters within which the history of computerized medicine has conventionally been understood. (shrink)

Western culture has a few traditions of representing the human body – among them mortuary art (gisants), the freak show, the culture of the relics, renaissance art and pre-modern and modern anatomy. A historical analysis in the spirit of Norbert Elias is offered with regard to body – person relationship in anatomy. Modern anatomy is characterized by separating the story of the person from the story of the body, a strategy that is incompatible with the bio-psycho-social paradigm of clinical medicine. (...) The paper discusses different aspects of the above traditions and how they might bear on this conflict and on contemporary bioethics and bedside practice. (shrink)

What clinicians, biomedical scientists, and other health care professionals know as individuals or as groups and how they come to know and use knowledge are central concerns of medical epistemology. Activities associated with knowledge production and use are called epistemic practices. Such practices are considered in biomedical and clinical literatures, social sciences of medicine, philosophy of science and philosophy of medicine, and also in other nonmedical literatures. A host of different kinds of knowledge claims have been identified, each with different (...) uses and logics of justification. A general framework is needed to situate these diverse contributions in medical epistemology, so we can see how they fit together. But developing such a framework turns out to be quite tricky. In this survey, three possible frameworks are considered along with the difficulties associated with each of them. The essay concludes with a fourth framework, which considers any epistemology as part of a practice that is oriented toward overcoming errors that emerge in antecedently given practices where knowledge is developed and used. As medicine indirectly advances health by directly mitigating disease, so epistemology indirectly advances knowledge by directly mitigating error. (shrink)

Using conversation analysis and a collection of naturally occurring US primary care consultations, this article explores the search for pain during primary care physical exams. Inhabiting this activity is a ‘collision’ of expertise between physicians’ clinical knowledge about bodies and patients’ knowledge about their bodies. I show how patients responding to questions like does that hurt? tacitly guide physicians to their pain using pain displays, glottal cutoffs and response delays to observably react to the physician’s touch, delineating painful from non- (...) or less-painful areas. Physicians respond to these practices by altering the trajectory of their touch in coordination with the patient’s embodied behavior. In this local context, physicians’ touch not only constrains patients to affirm pain in a particular location, but it is also a unique affordance for patients to guide physicians while nonetheless preserving the physician’s authority over where to test for pain, thereby maintaining the physical examination activity framework. (shrink)

Increasingly privatized auditory spaces resulting from the mutual engendering of auditory cultural practices and sound technologies that separated the sense of hearing and segmented acoustic spaces have had a muting effect on our experience of Others that has intensified since the advent of mobile listening devices. In Section 1 of the article, I outline features of the social realm of the nineteenth to twentieth centuries that made modern sound technologies possible and then features of the technological realm that have shaped (...) today’s social realm – all with an eye toward our experience of other people. Then, in Section 2, I reach for a few phenomenological tools from the work of Jean-Paul Sartre, Emmanuel Levinas, and Don Ihde to draw out the phenomenological vectors that have taken shape within the enmeshed sociotechnological context described in Section 1. Specifically, I show how technologically mediated auditory experience has been individualized and how the use of sound technologies on the go – whether wearing earphones or in a car – has had a muting effect on our experience of others. (shrink)

Medical expertise plays a major role in large-scale welfare arrangements, for example, in private insurance companies. It symbolizes the objectivity and reliability of the procedures of risk selection and legitimates the acceptance and rejection of clients. To understand "reliability" in this context, this article discusses the introduction of chemical urine analysis for life insurance examination between 1880 and 1920. The article argues that reliability of urine analysis is not an intrinsic characteristic of the technology and thus cannot serve as the (...) explanation for the relevance of this technology as a means of risk selection. The construction of a "reliable technology" went hand in hand with the development of a standardized, uniform, and predictable performance of the test and an emergence of specific network—namely, a large-scale, bureaucratic insurance practice in which examination rooms of physicians became connected to the head offices of insurance companies by administrative means. During this process, the balance of power between medical examiners and insurance companies was reversed. Insurance compa nies depended on medicine for risk selection, but physicians increasingly had to act according to the rules set by life insurance companies. (shrink)

To set medicine within the context of a good or faithful life requires virtues that give physicians and patients the skills to understand and practice the kind of care medicine is capable of giving. We begin with a prayer that names some of these virtues. We then show how the language of medicine impedes these virtues by fostering the illusion that medicine will free us from illness and mortality. While Aristotle’s account of virtue and happiness seems capable of telling us (...) how to live with finitude, Jonathan Lear shows how it involves another fantasy of escape from it. We then show how Karl Barth’s account of health offers physicians and patients a language by which both the capabilities and the limitations of medicine may serve rather than undermine a good life. 1. (shrink)

Prevention of age-related disorders is increasingly in focus of health policies, and it is hoped that early intervention on processes of deterioration can promote healthier and longer lives. New opportunities to slow down the aging process are emerging with new fields such as personalized nutrition. Data-intensive research has the potential to improve the precision of existing risk factors, e.g., to replace coarse-grained markers such as blood cholesterol with more detailed multivariate biomarkers. In this paper, we follow an attempt to develop (...) a new aging biomarker. The vision among the project consortium, comprising both research and industrial partners, is that the new biomarker will be predictive of a range of age-related conditions, which may be preventable through personalized nutrition. We combine philosophical analysis and ethnographic fieldwork to explore the possibilities and challenges of managing aging through bodily signs that are not straightforwardly linked to symptomatic disease. We document how the improvement of measurement brings about new conceptual challenges of demarcating healthy and unhealthy states. Moreover, we highlight that the reframing of aging as risk has social and ethical implications, as it is generative of normative notions of what constitutes successful aging and good citizenship. (shrink)

In this article, consultation via the Internet and the use of the Internet as a source of medical information is examined from an ethical point of view. It is argued that important ethical aspects of the clinical interaction, such as dialogue and trust will be difficult to realise in an Internet-consultation. Further, it is doubtful whether an Internet doctor will accept responsibility. However, medical information via the Internet can be a valuable resource for patients wanting to know more about their (...) disease and, thus, it is a means to enhancing their autonomy. (shrink)

The ArgumentIn this article I argue that brain images constructed with computerized tomography (CT) and positron emission tomography (PET) are part of a category of “expert images” and are both visually persuasive and also particularly difficult to interpret and understand by non-experts. Following the innovative judicial analogy of “demonstrative evidence” traced by Jennifer Mnookin (1998), I show how brain images are more than mere illustrations when they enter popular culture and courtrooms. Attending to the role of experts in producing data (...) in the form of images, in selecting extreme images for publication, and in testifying as to their relevance, I argue that there is an undue risk in courtrooms that brain images will not be seen as prejudiced, stylized representations of correlation, but rather as straightforward, objective photographs of, for example, madness. (shrink)

ABSTRACT This article explores the history of the bedwetting alarm, invented in 1938 by two psychologists to cure enuresis, or bedwetting, using the principles of classical conditioning. Infused with the optimism of behaviorism, the bedwetting alarm unexpectedly proved difficult to implement in practice, bearing a multitude of unanticipated complications that hindered its widespread acceptance. Introduced as a medical and psychological technology, in practice the alarm was also a child‐rearing device, encouraging the kind of behavioristic attitudes that had prompted its initial (...) development, while simultaneously promoting the child‐centered approach that would become dominant in the early 1950s. The life story of the bedwetting alarm muddies the traditional account of how child‐rearing theories progressed in tidy succession, suggesting both that behavioristic approaches did not die out in the 1930s and that elements of permissive child‐rearing were being considered earlier than we traditionally assume. (shrink)