Hello, this week we’re going to talk about biomedicine, the topics of your readings, and some
Modern western medicine is based on what we call the biomedical model.
This model has been dominant in medicine since the end of the 18th century.
It is based on 6 basic assumptions.
The first assumption is the mind-body dualism, that the body can be treated separately from the
The second assumption is a mechanical metaphor; the body can be repaired like a machine.
Third assumption, technological imperative, that biomedicine values technological interventions.
It is also reductionist, the fourth assumption, with a focus on biomedical changes, rather than
other changes that could happen in a person.
Fifth assumption is the doctrine of specific ideology, which means that every disease is caused
by 1 specific, identifiable disease agent, or the so-called germ theory.
The last assumption is that medicine is based on objective science, empirical observations that
lead to findings.
The reasoning here in biomedicine is that disease is a distinct entity.
Disease can be revealed through signs and symptoms.
Disease ((on the patient is a passive side, off-disease manifestation.))
A disease is a departure from normality, so being normal is healthy, being abnormal is being
It is easy to see that there is some limitations and problems with biomedicine.
The body in biomedicine is isolated from the other aspects of personhood.
Social and material causes of disease are neglected.
And subjective ((interpretation meanings of illness also irrelevant also what counts for signs and
Yet medicine is typically understood as the only valid understanding of illness.
Medicine is typically seen as progress, progress from the speculations about health and illness
in prior times.
But medicine of course has also accomplished a lot of things that then led to the understanding
that medicine is considered progress.
We have more accurate knowledge about our bodies.
We have been able to eradicate some diseases.
And we have been able to eliminate some erroneous ideas and some pretty harsh practices like
bloodletting that were done in earlier times.
And we are able today to control some diseases.
How did biomedicine get established?
Foucault argues that the real change in medicine happened in the mid-18th century.
This is when science was applied to medicine, when science and medicine were fused.
The real main point here is Foucault argues, the clinical gaze, the act of seeing, observing, the
pathological, the abnormal, the body.
What had to be seen was what was below the skin, what was not there before, and in the mid-
18th century, people started looking beyond the skin.And this look, this clinical gaze led to essential changes in our knowledge and the
reorganization of old concepts and theories about health and disease into a new medical-
What is new about this discourse?
This new discourse now views or knows elements of the body that we haven’t known before,
tissues, organs, et cetera.
Developed new elements of pointing to pathology, so now pathology is a symptom that is then
translated into a sign.
We now understand linear processes of morbid events leading up to a disease.
And disease is now linked to certain organisms, so if somebody is sick, we know where that
disease started, which organism it affects.
All this, what I just named, is going back to this idea that we can look, this clinical gaze that
Foucault argues that the clinic, the clinical gaze and clinic with medical practice, was pivotal for
that change, for empirical looking, systematic looking, and looking at the body and that bodily
With this new way of looking at the body, what practitioners asked patients also changed.
Today, or back then in the mid-18th century, we don’t ask anymore “what is the matter with
What medical practitioners ask patients is “where does it hurt?”
Because again, we need to find the organ, we need to try and establish linear processes, so the
questions have become different.
The new focus also now is finding the disease, not finding out what is the matter with the
The gaze identifies symptoms, visible symptoms, indications of disease.
These symptoms are then turned into signs of a disease; they signify a certain disease.
And all the plurality of observations are then turned into cases of disease.
In the US, biomedicine took its first baby steps in the late 1800’s and grew into the profession
that we know today, up to around 1945.
After 1945, up till about 1980 it was the glory days of biomedicine, as many people have
referred it to, or the golden days of biomedicine with a vast expansion of knowledge and
interventions, the development of technologies, and big investments in public health based on
After 1980 though, we see an erosion of the professional dominance, a decrease in the public
confidence in biomedicine, and a persistent use in alternative medicines, despite the progress
and successes of biomedicine.
Because at the same time we also became aware of the limits of biomedicine and these limits
For example, chronic diseases, biomedicine still does not have an answer for many, many
And the rising costs in healthcare, with all the technological interventions, with all the
developments we saw in biomedicine, this has been very expensive, so costs in healthcare
have been rising because of biomedical interventions.We also see in the 1980’s a change in consumer behavior, patients actually became
They wanted to have choices, they wanted to have input, they wanted to be part of and take
charge of their own health and their own biomedical treatment.
We also became more critical of the side effects of biomedicine, because biomedicine it’s been
quite harsh and has a lot of brutal interventions like surgery.
And patients have ordered medications that have a lot of side effects.
So patients have become more and more aware of the effects of biomedicine and the
detrimental effects of biomedicine.
Additional critique came from philosophers, thinkers, even within the biomedical community.
Questions about decontextualization of biomedicine, with the focus of just biomedical changes,
the link between material circumstances, the environment and illness has been neglected in
The whole person has often been neglected in biomedicine, because what we’re looking at is
the disease, specific organs, and people very often were dealt with as passive objects.
People also criticized that the disease categories that we have established are not accurate
descriptions of pathologies, but many of them are socially constructed.
Reasoning behind those disease categories come from authorities, structures, power plays,
incidents, accidents, things happen, certain groups determine certain things.
So there was some social elements in how disease categories were fabricated, and of course
then that is not an accurate description of actually diseases or pathologies that exist.
People have also started to question the superiority of biomedicine over alternative medical
The idea here is since the 1980’s the question is, “It biomedicine really that much better than
other medicines, do they do that much more than other medicine?”
Especially for example if we look at Chinese medicine that seems to be very successful with
treating patients, including chronic diseases.
The question comes up, why are we clinging on to biomedicine if it doesn’t do what other
medicines actually can do?
All these changes of course, in the view of modern biomedicine are or have been imbedded in
larger social structures and changes.
We have lost overall, a little bit of confidence in science as the answer to everything.
We have also… the place where we are has decreased in importance.
We are now a global village, which also means that we are looking at other approaches and
then we might not take our approach as the only valid and right approach.
The economic wellbeing of people has decreased in some places, and over time, and of course
circular events also happen.
But the point is here with decreasing economic wellbeing, questions came up about the price
and the costs of biomedicine.
The breakdown of social contracts.
For example, nuclear families, more and more people live alone, biomedical intervention often
require longer taking care of people after they left the hospital.
What do we do with these people who live alone?Again, the social contract, larger families, or even nuclear families are getting smaller, breaking
up, and that impacts the possibility of attaining biomedical treatments to some degree.
In sum, a lot of social structures have impacted how we see biomedicine today, and these
changes of course are ongoing.
But what has happened is the fundamental issue here is that today biomedicine is not seen as
the only possible answer to health and treating illness and treating disease.
And there are some questions and some critiques that have become more and more valid.
As I talked in last lecture, early in the 1960’s 70’s, people have started to critique biomedicine.
Today this seems to be a more general approach that a lot of people have questions about the
validity of modern biomedicine.
We do not want to forget all the good things that biomedicine can do and has done.
But again, there is some critique imbedded in larger social and cultural changes in our world.
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