Precision Medicine has become a common label for data-intensive and patient-driven biomedical research. Its intended future is reflected in endeavours such as the Precision Medicine Initiative in the USA. This article addresses the question whether it is possible to discern a new ‘medical cosmology’ in Precision Medicine, a concept that was developed by Nicholas Jewson to describe comprehensive transformations involving various dimensions of biomedical knowledge and practice, such as vocabularies, the roles of patients and physicians and the conceptualisation of disease. (...) Subsequently, I will elaborate my assessment of the features of Precision Medicine with the help of Michel Foucault, by exploring how precision medicine involves a transformation along three axes: the axis of biomedical knowledge, of biomedical power and of the patient as a self. Patients are encouraged to become the managers of their own health status, while the medical domain is reframed as a data-sharing community, characterised by changing power relationships between providers and patients, producers and consumers. While the emerging Precision Medicine cosmology may surpass existing knowledge frameworks; it obscures previous traditions and reduces research-subjects to mere data. This in turn, means that the individual is both subjected to the neoliberal demand to share personal information, and at the same time has acquired the positive ‘right’ to become a member of the data-sharing community. The subject has to constantly negotiate the meaning of his or her data, which can either enable self-expression, or function as a commanding Superego. (shrink)

This article discusses various ethical and philosophical aspects of heroin addiction. It arose as a result of the plan by the Amsterdam city council to supply free heroin to drug addicts. The objective of treatment of heroin addicts is ambivalent because what is in fact a socio-cultural problem is transformed into a medical problem. The characteristics of this treatment are made explicit through a philosophical analysis which sees the medical intervention as part of a strategy aimed at achieving social normalisation. (...) The reason why such a social control function is practised by physicians is discussed, as well as the reason why heroin users in particular are the object of such a process. In this paper, heroin addiction is considered primarily as a cultural problem. The consequences of this for treatment and ethics form the conclusion. (shrink)

In order to understand the lived experiences of physicians in clinical practice, we interviewed eleven expert, respected clinicians using a phenomenological interpretative methodology. We identified the essence of clinical practice as engagement. Engagement accounts for the daily routine of clinical work, as well as the necessity for the clinician to sometimes trespass common boundaries or limits. Personally engaged in the clinical situation, the clinician is able to create a space/time bubble within which the clinical encounter can unfold. Engagement provides an (...) account of clinical practice as a unitary lived experience. This stands in stark contrast to the prevailing notion, referred to as a dual discourse, that describes medicine as the addition of humanism to science. Drawing on Aristotle’s notion of phronesis and Sartre’s definition of the situation, we illustrate how this novel perspective entwines clinical practice, the person of the clinician, and the clinician’s situation. (shrink)

The varieties of meaning in which we use the terms illness and health requires that we develope a conceptualization allowing us to maintain a unity between the differences. In fact, the experiences of health and illness are complex ones and they need to be understood in their different levels so that the need for help of patients and their desire for health is adequately faced. At its roots, the experience of illness is that of a threat posed to the unreflective (...) credit given to life in good health. This threat has not only a biopsychosocial dimension, but a moral and sybolic one as well, and it is mainly at this level that illness represents a moral challenge. Contemporary culture seems to be at pains in suggesting a shared set of meanings enabling the patient to give an intersubjectively valid sense of illness, since the only kind of answer offered is a technical one. The symbolic dimension of the notions of health and illness call for a deeper cultural enterprise of looking for a credible sense of illness for our times. (shrink)

Ian Hacking has defined himself as a philosopher in the analytic tradition. However, he has also recognized the profound influence that Michel Foucault had on much of his work. In this article I analyse the specific imprint of certain works by Foucault—in particular Les mots et les choses—in two of Hacking’s early works: Why Does Language Matter to Philosophy? and The Emergence of Probability. I propose that these texts not only share a debt of Foucauldian thought, but also are part (...) of what I believe is Hacking’s central project: the analysis of the historical and situated conditions of possibility for the emergence of concepts and of objects, inspired also by the French philosopher’s thought. (shrink)

On several occasions Michel Foucault advocated a methodological turn towards what he called a ‘happy positivism’. Foucault’s emphasis on the surface does not deny the importance of structures of hiding, but understands it as a game in which the structures of hiding are viewed as contingently given. In this paper, I will analyse the conflict between the hacker movement and the field of corporate interests. I argue that the introduction of graphical user interfaces and the maintaining of copyright interests are (...) the contingent background of the ongoing conflict. By bracketing the analyses of hidden intentional structures, the happy positivist is thus able to facilitate deeper understandings of the prevailing structures of hiding. (shrink)

Michel Foucault’s famous book on madness first appeared in 1961 as Folie et Déraison. When it was reissued in 1972, ‘Déraison’ had dropped from the title, but it remained dense in the text, often capitalized or italicized. No two texts, abridgements, or translations of the madness book are identical with respect to the word. It is translated as ‘unreason’, but what does it mean? How did Foucault use it? Why did he come to downplay it? The relationships between déraison and (...) painting and writing are explored. It is noted that the idea of ‘archaeology of knowledge’ is introduced in connection with a discussion of folie and déraison as displayed in Racine’s Andromaque. (shrink)

In this contribution, I wish to explore the potential of health technology assessment and ethics for increasing our capacity to pre-empt the shortcomings and undesired consequences of modern health care while maintaining its benefits. Central is the presumption that in case of some health problems this cannot be done unless we explicitly reconsider some features of the modern health care system, especially those related to its strong reliance on scientific rationality and the strong role played by medical professionals.So as to (...) both maintain the benefits of advanced health care and ensure that it produces less reason for concern, we need to reconsider our approach to rationality—and maybe even the way in which we build our health care system around that rationality. That is, we need to introduce an element of reflexivity. Two types of circumstances are being explored in which such reflexivity may prove worthwhile: controversies on side effects, and persistent problems encountered in optimising health care. Drawing on brief discussions of typical cases, we explore the potential of reflexive HTA and its methodical prerequisites.We conclude that ethicists may contribute to reflexive HTA, if they combine a hermeneutic—and often also participative—methodology with a solid understanding of the relation between the health problem under scrutiny and more general critique of the health care system. Insights from the areas of science and technology studies, as well as from social philosophy may be critical items in their tool kit. (shrink)

El pluralismo cultural y la diversidad social atraviesan diferentes contextos sociales en el mundo contemporaneo, ejerciendo diferentes impactos sobre las instituciones oficiales. En el contexto de los servicios de salud de una ciudad cosmopolita como Montreal, la realización de nuevos proyectos de investigación y de intervención se hace necesaria, con el fin de evaluar la manera como los diversos grupos poblacionales entran en relación con dichos servicios. A nivel investigativo, se hace indispensable la creación de colaboraciones interdisciplinarias con las cuales (...) poder examinar las situaciones clínicas, a la luz de los diferentes elementos que la componen: sociales, culturales y étnicos. En este artículo, expongo algunas reflexiones que se derivan de una investigación interdiscip-linaria entre antropólogos y médicos, cuyo tema central giro en torno de los desórdenes funcionales del intestino dentro de la población infantil. Este trabajo en antropología médica permitió documentar y analizar los discursos de las familias y de los niños alrededor de la percepción de dicho problema de salud, así como de las prácticas y soluciones que estos ponen en marcha y con las cuales buscan aliviar el dolor y lograr un estado de bienestar. Las reflexiones que comparto en este artículo tienen como centro de interés los principales referentes teóricos y metodológicos utilizados desde la disciplina antropológica, los cuales seran ilustrados con la ayuda de algunos extractos de entrevistas realizadas. Mas allá de simplemente enumerar los resultados de la investigación, muestro un ejemplo de colabora-ción fructífera entre la antropología y la pediatría, la cual abre perspectivas de investigación y de aplicación futuras en lo que atañe a las relaciones entre las familias, las comunidades y los servicios institucionales. (shrink)

This article provides a reading and analysis of Foucault’s 1973-4 lecture course Le pouvoir psychiatrique. It begins by situating the course within the wider context of Foucault’s work, notably in relation to Histoire de la folie and the move of the early 1970s to the conceptual tools of power and genealogy. It is argued that Le pouvoir psychiatrique is a rewriting of the last part of Histoire de la folie from the perspective of these new conceptual tools. Analysis then moves (...) to more thematic concerns, showing how this course enriches our understanding of Foucault’s work on the sources of power, the individual and the family, and the spaces of the disciplinary society. Particular focus is given to the role of the army, public health, the hospital, children, women and hospital architecture. The article concludes by showing how the themes of this course, while not worked up for publication themselves, point the way to concerns in Foucault’s later work, notably The History of Sexuality and collaborative work on urban medicine and habitat. (shrink)

Philosophy of immunology is a subfield of philosophy of biology dealing with ontological and epistemological issues related to the studies of the immune system. While speculative investigations and abstract analyses have always been part of immune theorizing, until recently philosophers have largely ignored immunology. Yet the implications for understanding the philosophical basis of organismal functions framed by immunity offer new perspectives on fundamental questions of biology and medicine. Developed in the context of history of medicine, theoretical biology, and medical anthropology, (...) philosophy of immunology differs from these related branches of study in its focus on traditional philosophical questions concerning identity, individuality, ecology, cognition, scientific methodology and theory construction. This broad agenda derives from immunology’s multifaceted research program that has developed from its initial clinical challenges of host defense, transplantation, autoimmunity, tumor immunology, and allergy. In addition to these well-established research areas, immunity is now understood to play a central role in other physiological functions, development, ecology, and evolutionary mechanics. Holding together these diverse domains of inquiry lie philosophical commitments oriented by organismal identity. In this regard, pertinent issues are raised concerning cognition (organization of immune perception and information processing), the character of individuality (framed by the ecological context of immune-mediated assimilation and rejection), and the dynamics of complex systems (understood as holistic systems biology). Indeed, immunology, in the context of cognitive science, evolutionary biology, environmental sciences, and development provides multi-focal perspectives for philosophy of science. (shrink)

The author of the present paper argues that while trying to explain the institutional success of the science and its broad social impact, it is worth throwing aside the arguments concerning the universal traits of human nature, changes in the human mentality, or transformation of the culture and civilization, such as the development of capitalism or bureaucratic power. In the 16th century no new man emerged, and no mutants with overgrown brains work in modern laboratories. So one must also reject (...) the Great Divide between the cultures of the scientific and pre-scientific and replace it with multiple, uncertain and unexpected ‘not-so-great divides’, which can be described in meticulous anthropological studies. Although the achievements of science are certainly spectacular, and the gap between scientific practice and other areas of activity is so obvious, this does not mean that one must look for the \"great\" reasons behind this situation. One should rather focus on quite down-to-earth practices and tools used by scientists. A significant part of their activities can be described by referring to the craft of writing, reading and transforming of various types of inscriptions (records), and broadly understood visualization – their combining, performing, interpreting, confronting, comparing, shifting, shuffling etc. The important role of these tools and methods is especially visible in situations of scientific controversy. It is so because scientific controversies are won by the one able to muster on the spot the largest number of well aligned and faithful allies, and the technology of writing, printing and visualizing play a special role in mobilizing them. These are necessary to ensure that certain factors can be mobile – easy to move from place to place, and yet, immutable – not undergoing deformation as a result of the movement. This way, scientists are able to not only diffuse different types of factors relevant to the dispute and the process of constituting science, but also concentrate them in the centers of calculation, where, through accumulation, one can take actions not available elsewhere. (shrink)

In various writings Michel Foucault has shown how, in the beginning of the 19th century, in settings such as army barracks, psychiatric hospitals and penitentiary institutions, the modern human sciences were ‹born› as an ensemble of disciplines (medical biology, psychiatry, psychology, criminology, and the like) From the beginning, the nature-nurture de- bate has been one of its key disputes. Are human individuals malleable by environmental factors (such as psychiatric treatments or disciplinary regimes), or do they rather display inborn predispositions for (...) delin- quency and other forms of antisocial behaviour? In the current era of genetic testing, in behavioural genomics and neuroscience, this issue is as controversial and topical as ever. Büchner’s unfinished drama Woyzeck (written in 1836) is a remarkable anticipation of this debate, staging the birth of the human individual as a research subject. It is the story of a destitute soldier who, according to his superiors, displays er- rant behaviour and is therefore recruited to serve as a research subject in an experiment. His army physician turns him into a ‹case›, which can be meticulously monitored and studied so as to record the genesis of a crime. In this paper, Büchner’s unsettling play is analysed in detail as one of the great anticipatory literary documents of the 19th century, ex- ploring the idea of predictive psychiatry and the quest for genetic pre- dispositions: a primal scene as it were of the nature-nurture debate as it unfolds from predictive criminology up to behavioural genomics. (shrink)