Juliette Ferry-Danini

Since George L. Engel’s famous description of, and attack on, “the biomedical model,” there has been considerable interest in developing alternative ways of thinking about and doing medicine that address some of its ills. Engel proposed a “biopsychosocial model,” which seeks to combine psychological and social facts with the biological facts already prominent in medicine to understand disease and its treatment. The model has become more or less commonplace, although subjected to its own criticisms. Defining biomedicine as a model to criticize and improve from has in fact a long tradition prior to Engel’s work—a tradition that is often forgotten. This chapter explores past and potential future criticisms of biomedicine, notably the biopsychosocial model, but also the recent revival of medical humanism that has followed. Much like the biopsychosocial model, a “humanistic” model may sound attractive, but it could also prove to have drawbacks.

This paper sets to explain how one of the most prescribed and sold pharmaceutical drugs in France – Spasfon (phloroglucinol), introduced on the French market in the 1960s, became and remained so successful in the absence of solid scientific evidence. Integrating the epistemology of ignorance and a feminist approach to the history of medicine, my goal is to understand how this case of ignorance was initially constructed and how it has maintained itself to this day. I argue that sexism is one key factor explaining how ignorance was constructed around this very popular – and incidentally pink – pharmaceutical drug.

Vous en avez probablement au fond de votre trousse à pharmacie. Le Spasfon est l’un des médicaments les plus prescrits et vendus en France, en majorité aux femmes. Une pilule rose familière lorsque l’on souffre de règles douloureuses. Et pourtant, aucun essai clinique ne soutient son efficacité pour cette indication. Juliette Ferry-Danini retourne aux origines du médicament, dans les années 1960. L’histoire du Spasfon n’est pas toute rose : des malades empoisonnés à dessein, des données scientifiques défaillantes et le sexisme ont marqué son développement, construisant une situation d’ignorance scientifique qui perdure aujourd’hui. Dans cet essai de philosophie féministe, l’autrice analyse les conséquences de cette ignorance en médecine et propose des outils essentiels pour redonner du pouvoir et de l’autonomie aux patientes et patients.

Une médecine plus humaniste serait une médecine où les professionnels de santé feraient preuve de plus d’empathie envers leurs patients. Or s’il est difficile d’attester un déclin de l’empathie en médecine en l’attribuant au modèle biomédical, l’empathie n’est pas sans défaut. Cela ne signifie pas la mort de l’humanisme médical. Il est possible de le faire reposer sur un concept minimal de compassion et de lui intégrer une approche basée sur les systèmes de santé. L’humanisme ainsi défendu n’est plus empathique, mais il est aussi plus convaincant.

This paper describes the scientific practices of the anatomists from the Société Anatomique de Paris (1803–1873) who were collecting anatomical and pathological specimens in Nineteenth-Century Paris and which led to the building of the anatomy and pathology Musée Dupuytren (1835–2016). The framework introduced by Robert Kohler to describe collecting sciences (2007) is useful as a tool to identify the set of diverse practices within pathological anatomy in nineteenth-century Paris. However, I will argue that anatomy and pathology collecting had specific features compared to most collecting sciences. Two main collecting practices could be distinguished: first, “finding” anatomical specimens and second, keeping these specimens. The first kind of practices were at least rhetorically and explicitly motivated by Auguste Comte’s positive philosophy. But “finding” an anatomy or pathology specimen could not be completely compared to finding an object or making a simple observation, as dissecting as well as some experimental practices were also involved. Heterogeneous practices thus coexisted within collecting in anatomy and pathology. Epistemological as well as pragmatic tensions arose. On top of Kohler’s framework, I introduce Sabina Leonelli’s concept of “data journey” to offer a narrative of the diversity of collecting practices involved in the Société Anatomique de Paris and the Musée Dupuytren. I use the concept to analyse how this diversity of practices impacted knowledge production.

Aujourd’hui délaissées, parfois devenues gênantes, les collections médicales furent pourtant à l’avant-garde du renouveau de la médecine au début du XIXe siècle, avant que celle-ci ne devienne la médecine telle que nous la connaissons aujourd’hui. Selon une vision courante de l’histoire de la médecine, les collections médicales auraient perdu de leur utilité lorsque la médecine a accédé au statut de science expérimentale, les musées d’anatomie faisant alors place aux laboratoires. Les collections d’anatomie-pathologie comme le musée Dupuytren ne seraient que le reliquat de cette histoire, le témoignage d’un échec méthodologique à opposer aux succès de la physiologie expérimentale. Cette narration de l’histoire de la médecine est-elle cependant correcte ? Dans quels buts épistémologiques les médecins ont-ils créé ces collections ? Quelles connaissances cherchaient-ils à obtenir par ce biais ? Plus généralement, pourquoi collecter en médecine – et en science – et pourquoi collectionner ? Pour répondre à ces questions, je m’intéressai principalement dans cette contribution aux pratiques de collecte et de collection chez les médecins de la Société Anatomique de Paris au XIXe siècle et au rôle joué par ces pratiques dans la construction de la collection Dupuytren.

Selon l’une des thèses les plus répétées de la médecine narrative, la théorie littéraire, ou plus largement, la narration, permettrait aux membres du personnel médical d’appréhender les récits des patients et par là, de prendre en considération leurs expériences dans leur singularité absolue. Dans ma contribution, je soulignerai quelques limites de cette thèse. J’appuierai mon analyse sur un exemple de récit dominant de maladie, les récits portant sur le cancer du sein aux États-Unis au XXe siècle, à partir des analyses féministes qui en ont été faites. Ainsi je montrerai d’une part qu’il est peu plausible que les récits des patients soient absolument singuliers et uniques, en un sens pertinent, et d’autre part que certains récits peuvent devenir dominants et marginaliser des récits qui voudraient s’en démarquer.

Empathy is often described as a virtue which that could help in making medicine more humanistic. This paper argues that there are two limits to this thesis. First, it is unclear whether a lack of empathy can be attributed to the biomedical education. Second, empathy itself is not without issues, and another concept, compassion, can be put forward instead. Humanism based on compassion is more minimalist, but integrated with an approach focused on health systems, it makes humanism more tangible and radical.

In some quarters within philosophy of medicine, more particularly in the phenomenological approaches, naturalism is looked upon with suspicion. This paper argues, first, that it is necessary to distinguish between two expressions of this attitude towards naturalism: phenomenological approaches to illness disagree with naturalism regarding various theoretical claims and they disapprove of naturalism on an ethical level. Second, this paper argues that both the disagreement with and the disapproval of naturalism are to a large extent confused. It then offers some proposals to set up an agenda for future collaboration.

According to recent approaches in the philosophy of medicine, biomedicine should be replaced or complemented by a humanistic medical model. Two humanistic approaches, narrative medicine and the phenomenology of medicine, have grown particularly popular in recent decades. This paper first suggests that these humanistic criticisms of biomedicine are insufficient. A central problem is that both approaches seem to offer a straw man definition of biomedicine. It then argues that the subsequent definition of humanism found in these approaches is problematically reduced to a compassionate or psychological understanding. My main claims are that humanism cannot be sought in the patient–physician relationship alone and that a broad definition of medicine should help to revisit humanism. With this end in view, I defend what I call an outcomes-oriented approach to humanistic medicine, where humanism is set upon the capacity for a health system to produce good health outcomes.