The development of technology, medicine, and social structures has been intertwined since the creation of the research university in the eighteenth century. One of the most significant changes has been the transformation of the clinical perspective to the molecular perspective. The challenge lies, therefore, in the ethical implications of the development of biotechnologies that can change the human organism on a genetic and molecular level.
Keywords Bioethics; Biopower; Functional Magnetic Resonance Imaging (fMRI); MRI; Neuroethics; Positron Emission Topography (PET); Sick Role
It is not easy to decide where to begin a history of science, especially when speaking about the relations between medicine, society, and technology. One could begin with the first classical physicians, Hippocrates (ca. 460 BC– 379 BC) and Galen (ca. 129 AD–216 AD). Indeed, into the mid-eighteenth century, the pendulum of medical wisdom swung between these two names, since knowledge until that time had to be proven by reference to a classical text.
In the history of medicine, Galen is known not only as the first practitioner with a vast anatomical knowledge but also for performing difficult operations that required the use of sophisticated instruments. He is even reputed to have undertaken the first brain surgeries (Toledo-Pereyra, 1973). For centuries, his and Hippocrates's ideas were most often referred to as the defining criteria of all medical knowledge. Up to the mid-eighteenth century, much progress was made in the application of instruments, devices, and drugs that would, in many ways, have been readily available for scholars in line with Galen or Hippocrates.
However, another beginning could be made in the nineteenth century, when modern science was combined with industrialization and technology came to the forefront with the emergence of electricity. Other accounts could focus on the discovery of penicillin or make the case that with the discovery of DNA, a new age dawned in which life could increasingly be directly manipulated, thus pinpointing the decisive moment in medical development to the twentieth century.
However, the incident that may have been most crucial for the development of medicine, and subsequently the use of technology in medicine, came in 1737, when the newly founded University of Goettingen persuaded the famous anatomist Albrecht von Haller to become one of the key figures of its faculty. While at the university, von Haller pioneered an important innovation in the education system by combining both research and education within his professorship (Lenoir, 1981a; Cunningham, 2002, 2003).
From that time forward, in ways they never had before, students lived and worked in close proximity to the creation of knowledge and the innovative application of instruments. For two elemental fields of medical knowledge — anatomy and physiology — this resulted in a spurt in knowledge creation, and by the end of the century, knowledge about physiology had exploded at such a rate that the scientific vocabulary could not keep up. Toward the end of the century, physiologists and anatomists — on the verge of creating the ultimate life science, biology — resorted to the language of the new critical philosophy of Immanuel Kant to find ways of expressing their findings (Lenoir, 1981; Stingl, 2008). It was this course that prepared the way for the breakthrough development of medicine.
Birth of the Clinic
After the emergence of anatomy and physiology, the next important step certainly was the "birth of the clinic" and the emergence of the clinical gaze, as it was called by Michel Foucault (1963). Following the French revolution, two developments set in: the myth of a nationally organized medical profession and the myth that in an untroubled and therefore healthy society, disease would disappear. The effort to realize these two myths, Foucault claimed, rendered the medical doctor a politician. The doctor's gaze became a force; the doctor, considered as all-wise, could see through the veil that covered the eyes of normal men and see the underlying reality. The effectual change from ancient to modern times thus lay not in a transformation of this idea of the doctor as wise but in the theory behind it.
As scientific research increased during this period, knowledge was increasingly perceived as fragile and dynamic. With the installation of the clinic, however, an abode was created for the accumulation of knowledge and its changes. The clinic was also storage for the technological devices employed in modernity. When the clinic was then turned into a facility for research and education as well, it became the prime force behind medical innovation.
This turn was amplified by the emergence of genetics and biotechnology, where the anonymous laboratory became a second stage for the creation of what can be called biopolitics, a political system in which populations' bodies are subject to government control.
Nikolas Rose has argued that as of the early twenty-first century, doctors, clinicians, and researchers have essentially changed their gaze (2007). While most people are still tied to the molar or somatic level, clinicians and experimenters view the human organism as a DNA-based bio-chemical system that needs to be optimized. They have, according to Rose, a molecular gaze, rather than a clinical gaze (2007).
The Clinic Versus the Laboratory
Whether the clinic or the laboratory is the main stage for the development of medical research and technology — and whether the two should be integrated into one site — has been disputed. In the history of physiology, anatomy, neurology, medicine, and psychology, the distinction between the practices of the clinic and the laboratory continued throughout the nineteenth century. Clinicians would not trust "artificial" lab results, while experimenters shunned the individualized experiences and ideas of clinical practitioners as lacking validity and universality. Pitted against each other by their own versions of objectivity and naturalism, clinicians and experimenters divided and reunited time and again.
This theme was repeated in the narrative structure of medical discourse and the technological development of medicine. In the early decades of the twentieth century, the discourse involved renowned scholars from related fields like Lawrence Henderson and Walter Cannon, whose experimental works in physiology became seminal. Henderson, an "occasional sociologist," is also credited with, at least in part, having introduced the idea that the patient-doctor relationship must be described in terms of "an equilibrating social system" (to apply the terminology of Vilfredo Pareto) in which the doctor helps the patient return to normal functioning within society. Whether Henderson or his younger Harvard colleague Talcott Parsons (who worked on the idea around the same time and had approached Henderson for advice on his project) was the actual author of this idea is not entirely clear, but both men used it in their lectures (Stingl, 2008). Parsons introduced the idea that a patient must be seen as occupying a social role, the sick role. Changes in technology, therefore, can be described in regard to the changes in the sick role as part of the social system in which it is embedded. This took a new turn in the 1960s in American medicine, when critical scholars began arguing that progress in medical technology does not necessarily translate into better health care for everyone. Quite the contrary, it can lead to a widening of the gap between social classes with only the wealthy able to afford expensive new treatments and the poor unable to receive other, less expensive treatments because medical progress has made them obsolete.
Certainly, surgical medical technology has already progressed to a stage that not long ago was considered science fiction. The classic idea of the surgeon's job being equitable to that of a "butcher with precision" has become outmoded due to the evolution of less invasive surgical instruments. Contemporary surgeons may employ micro-surgery and robots, as well as telemedicine, a technique in which the surgeon is not even in direct contact with the patient but controls a robot from some other location. These developments...
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