Rise Of Biomedicine Research Articles

Emerging diseases, re‐emerging histories

The notion of “emerging infectious diseases” (EID) as a category of global health concerns was created in the 1990s to acknowledge that, although public health interventions, vaccines, and antibiotics since the late 19th century had given wealthier parts of the world control over most infectious diseases, the experience of Ebola and HIV/AIDS showed that new human diseases could still arise. “Emerging diseases” have clear histories, and the task the field of EID set itself has been to make those histories as short as possible—to catch emerging diseases as close to their origin as possible and snuff them out before they can become pandemics. In contrast, many of the known infectious diseases, those that were allegedly “conquered” by the rise of biomedicine in the late 19th and early 20th centuries and which (aside from smallpox) nonetheless still persist today, were assumed to have existed “since time immemorial.” Their histories had no specific time-depth, no documentable origins, and few discernible narrative arcs. The advent of a new field of research, palaeogenetics, has made possible an evolutionary perspective on pathogenic microorganisms, bringing hitherto unimaginable specificity to their documentable histories. Many origin stories, and nearly all globalization stories, fall within periods that historians and archaeologists study intensively. I argue that the diseases that have proved best suited to global expansion since the advent of the Holocene—those that became pandemics, like COVID-19—are those that have best exploited humans' global networks and behaviors in a given age. This recognition, in turn, gives the fields of both global health and history of medicine a new agenda.

Infusing bioethics into biology and microbiology courses and curricula: a vertical approach.

With the rise of biomedicine and biotechnology, there has been a corresponding growth in the need for better understanding of consequent ethical questions. Increasingly, biologists are being asked not only to offer technical clarifications but also to venture ethical opinions, for which most feel poorly equipped. This expectation puts pressure on biology instructors at the university level to provide biology majors the skills and experience to discuss with some confidence and competence bioethical issues which may arise in either the workplace or through public discourse in everyday contexts. Many fine curricular resources about bioethics are available for varied pedagogical purposes, but few target undergraduate biology or microbiology student audiences. When it occurs in the context of a course, bioethics instruction often is taught by non-biologists outside standard biology curricula. We propose that biologists should strive to “infuse” bioethical thinking into their courses and major curricula but not in such a way as merely to point at ethical problems, treating them at a surface level. We suggest what we call “vertical infusion”: taking one bioethical issue per course and integrating this issue within the context of a relevant biological topic, challenging students to push their thinking beyond their initial intuitions toward underlying scientific and ethical principles. While the vertical approach lacks widespread coverage of ethical issues throughout a single course, it has the advantage of taking the bioethical dimension seriously and in intimate relation to contemporary discoveries in biology and to the biological principles, processes, or procedures that occasioned the ethical quandaries in the first place.

Geneticizing Ethnicity: A Study on the “Taiwan Bio-Bank”

Taiwan as an island country is an immigrant society where interethnic marriages have been common. In the past centuries, it has not been unusual that people in Taiwan change their ethnic identities for various reasons. Its “four great ethnic groups” (sida zuqun)—the Hoklo, Hakka, Mainlanders, and aboriginal peoples—exist only as a social construction that arose in the 1990s in a specific political–cultural context. In 2005, a major government-sponsored research project, the Taiwan Biological Sample Bank—or Taiwan Bio-Bank (TBB)—was organized by a group of scientists and physicians. The purpose of the project is to collect genetic data from the “four great ethnic groups” of Taiwan in order to build a national database. This paper has three parts. First, I briefly review how the relationship between genetic attribution and the conceptualization of race/ethnicity has been addressed by social scientists and medical researchers since the mid twentieth century. Secondly, I analyze the history of biomedicine in Taiwan and the social and political context of the formation of the TBB project and its precursors. Thirdly, I examine the TBB's theoretical and methodological assumptions about race/ethnicity in Taiwan. I point out that the rise of biomedicine since the 1990s has contributed to the “ethnicization of biomedicine,” in the sense that scientists have used dubious ethnic/racial categories with increasing frequency in practicing biomedicine.

Geneticizing Ethnicity: A study on the “Taiwan Bio-Bank”

Taiwan as an island country is an immigrant society where interethnic marriages have been common. In the past centuries, it has not been unusual that people in Taiwan change their ethnic identities for various reasons. Its “four great ethnic groups” (sida zuqun)—the Hoklo, Hakka, Mainlanders, and aboriginal peoples—exist only as a social construction that arose in the 1990s in a specific political–cultural context. In 2005, a major government-sponsored research project, the Taiwan Biological Sample Bank—or Taiwan Bio-Bank (TBB)—was organized by a group of scientists and physicians. The purpose of the project is to collect genetic data from the “four great ethnic groups” of Taiwan in order to build a national database. This paper has three parts. First, I briefly review how the relationship between genetic attribution and the conceptualization of race/ethnicity has been addressed by social scientists and medical researchers since the mid twentieth century. Secondly, I analyze the history of biomedicine in Taiwan and the social and political context of the formation of the TBB project and its precursors. Thirdly, I examine the TBB’s theoretical and methodological assumptions about race/ethnicity in Taiwan. I point out that the rise of biomedicine since the 1990s has contributed to the “ethnicization of biomedicine,” in the sense that scientists have used dubious ethnic/racial categories with increasing frequency in practicing biomedicine.

Clinical Trials and the Reorganization of Medical Research in post-Second World War Britain

The rise of biomedicine is usually associated with the transformation of biological and medical research in the United States following the vast expansion of funding, both private and public, in the years after the Second World War.1 Along with the other authors in this issue, we are interested in describing this phenomenon in national contexts other than the United States. Our discussion of biomedicine in Britain draws upon many of the same themes as our fellow authors and the existing literature on the US—the new role of the state as scientific entrepreneur; the relationship between experimental medicine and clinical services; and the growing institutionalization of associations between laboratory and clinic—to emphasize the clinical trial as a privileged form of therapeutic evaluation in the post-war years. In particular we are keen to stress that the randomized clinical, or controlled, trial (RCT) in Britain developed within a period of increasing centralization of state policy and planning for health services and medical research. The epistemological success of the RCT in demonstrating the value of the anti-tuberculosis drug streptomycin elevated the technique to international prominence in the late 1940s. The 1948 trials of streptomycin conducted by the British Medical Research Council (MRC), along with similar trials in the United States, are usually recognized as the world's first randomized controlled trials. Indeed, the streptomycin trials, and the trials of PAS and isoniazid that followed in the early 1950s, did combine the statistical technique of randomization, with new organizational techniques, such as the division of specialist labour, and central review and data collection, across multiple sites of study. As Peter Keating and Alberto Cambrosio, Ilana Lowy, and Harry Marks have shown for the US, the success of the co-operative (that is, multi-centre) clinical trial was intimately related to the new role of the federal government, through the National Institutes of Health, in funding such organized biomedical research.2 Similarly, using treatment trials for tuberculosis and lung cancer as our case studies, we show for Britain that the promotion and organization of co-operative trials was fundamentally part of the MRC's new role within the state. We argue that the Council pursued the trials as a means of unifying a research landscape that was characterized by localism and suspicions about MRC plans to remodel clinical research to resemble the basic sciences. We argue further that a controlled trial must be understood both as a tool to produce knowledge persuasive enough to direct best clinical practice, and as a powerful means to discipline research workers in disparate settings.3 Neither process was particularly straightforward. It took years of clinical trials of anti-tuberculosis chemotherapies before sanatorium treatment and bed-rest were entirely given up by British physicians. The MRC's 1955 trials carried out in the Indian city of Madras (Chennai) are generally regarded as conclusively showing domiciliary care to be redundant in the presence of chemotherapeutic intervention; however, we argue that trials influenced but did not change practice overnight. Similarly, the lung cancer trials initiated by the MRC following a conference in 1957 as part of a broader programme of therapy trials for various types of cancer, proved difficult to run. Furthermore, they did not resolve the controversy as intended, not least because procedures and treatment pathways were well established before the trials. Serious historical attention to the organizational details, reception of such RCTs, and resulting changes in practice, is needed if we are not to be blinded by hindsight. Before we turn to the trials, however, we need to discuss the role of the MRC in the history of biomedicine in Britain and the place of the Council within the post-war socialized National Health Service (NHS).