What is Biomedicine?
Recent dictionary entries define biomedicine as a branch of medicine that is combined with research in biology or, in other words, as the application of the natural sciences, especially the biological and physiological sciences, to clinical medicine.
While, indeed, in present-day discourse the term ‘biomedicine’ (and its adjectival form ‘biomedical’) generally refers to modern, scientific Western medicine, casual use of the term disguises two important facts, namely that the term itself is of recent origin (its widespread use postdates World War Two) and, more important, that the relation between biology and the clinic is, even in the twenty-first century, far from being as seamless and as unproblematic as the term would lead one to suppose.
The term first surfaced, rather idiosyncratically, in the 12th edition (1923) of Dorland’s medical dictionary, but its career took off in the 1950s, when users gave it two related, yet distinct meanings. On the one hand, there was the epistemological idea of a crossing over of medicine with biology, with all its institutional consequences. On the other hand, the term referred to a substantive area, namely the study of environmental stresses on the human body—a normal body in a pathological environment—as in the case of space travel (NASA, with its manned space program, was established in 1958) and radioactive fallout from nuclear experiments. Both meanings are, of course, linked, insofar as they are mirror images of the attempt to relate biology to pathology.
To speak of biomedicine is to take for granted the claim that the relationship between biology and pathology, rather than a matter of quality, is simply one of quantity, i.e., of bodily mechanisms gone awry by reaching beyond the upper or lower limits of the normal spectrum. As forcefully argued by Canguilhem (1966), such a claim is highly questionable. This is not to say that such a thing as ‘biomedicine’ is an epistemological monster and thus a practical impossibility. Rather, it is to point to the fact that the relationship between biology and pathology is not a simple one, and that, instead of taking their relationship for granted, one should analyze their practical, ongoing articulation.
But is the biomedical project really that novel? Did not pathology already attempt to model itself on biology since Thomas Sydenham’s seventeenth century proposal that diseases be treated as autonomous entities, like plants and animals, and be subjected to similar schemes of description and classification? Is it not the case that contemporary ‘biomedicine’ goes back to the bacteriological and laboratory revolution of the second half of the nineteenth century, or to Rudolf Virchow’s contemporary program of a cellular pathology applying cell biology to pathological processes (Vogel and Rosenberg 1979, Cunningham and Williams 1992)? While the idea that the pathological can be reduced to the normal is indeed a common theme in nineteenth century medicine, at the practical level, the normal and the pathological remained the products of distinct experimental and institutional practices. From this point of view, modern biomedicine constitutes a novel institutional and scientific activity that is incommensurable with the biology and medicine of, say, a Louis Pasteur or a Robert Koch. Biology and medicine are now tightly intertwined research enterprises. Practitioners of the activity known as biomedicine can no longer say beforehand whether a particular research project, clinical investigation or even clinical intervention will result in biological or medical facts. Somewhat like the distance between pure and applied research, that between biology and medicine has collapsed without, of course, erasing the distinction between the two activities.
