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Biomedicine in museums

Representing biomedicine

For god ordens skyld lægger jeg vores papir til Museion-mødet tidligere i dag (tirsdag den 19. april) ud her på bloggen (dvs. til projektarkivet).

Kære alle, her er første version av det som vi har diskuteret i vinter — dvs. spørgsmålet om “representationer” som forudsætning for de følgende diskussioner av en indsamlngs- og udstillingsstrategi for dansk biomedicin. Vi har ikke lagt ind litteraturhenvisninger endnu … det er alt for tidligt. Vi har skrevet på engelsk fordi vi efterhånden vil i kontakt med andre som tænker i lignende baner. Vi ses tirsdag den 19. april kl. 14.

Hanne og Thomas

Representing biomedicine 1955-2005 first draft, 18 April 2005

Purpose of these notes
The purpose of these notes is to open up the discussion about the historiographical approach to the “Danish Biomedicine 1955-2005″-project.

Our point of departure is a historical phenomenon, called “biomedicine”. Our aim is to analyse different approaches to this phenomenon in order to select approaches appropriate for the creation of a Medical Museion devoted to the presentation of recent “biomedicine”. After internal discussion in the Museion-group we will continue to revise it with the aim of later publication (and much of it will probably have been weeded out by then :-).

What’s the problem?
This paper shall help solve the basic problem of the “Danish Biomedicine 1955-2005″-project, viz.: How shall we represent recent biomedicine in our own (Medical Museion) collections and exhibitions? This problem in turn is part of a more general problem, viz.: How can recent biomedicine be represented in (medical history) museums in the future? We will address the general problem in order to solve the local.

These notes begin with a number of definitions (what do we mean by “recent biomedicine”, by “Danish” and by “representation”). We then go on to identify a number of possible modes of representations of recent biomedicine in order to set the background for those that may be relevant for the Medical Museion project.

What is “recent biomedicine”?
A rich answer to this question can only be made after we have presented the many possible modes of representations below. Yet a tentative definition is:
• ‘Biomedicine’ means those parts of medicine (both medical science and clinical practice) that are based on the application of the natural sciences, especially the biological sciences (life sciences, biosciences).
• ‘Recent’ means the time period covered by the memory of historical actors who are still alive, i.e., approx. the last half century.
At the present moment therefore, ‘recent biomedicine’ equals medical and clinical sciences and practice that are informed by advances in sciences like molecular biology, molecular genetics, biochemistry, physiology, nuclear and quantum physics, electronics, computer science, etc., i.e., the intersection between the “life sciences” and “the health sciences”.

This definition of biomedicine includes for example pharmacology and much of pharmaceutical industry, odontology and much of its practice — but not nursing science, social medicine, classical epidemiology, social psychiatry, etc. It also includes many different practicies of the health care system like nursing, that depend on, and contribute to, biomedical-based clinical practice. In other words, we focus more on diagnostics and therapy, and less on general preventive medicine (but we include vaccination etc.). We focus more on advanced medical technology than on manual practice (e.g. chiropractic). We focus more on basic and clinical research than on personal care and nursing. We focus more on established medical science than on alternative medicine, etc. Our concept of biomedicin is thus narrower than the “health care system”. (These choices do not imply any evaluation of scientific medicine and biomedicine as more important or valuable than low-technological, humanistic and alternative medicine.)

Biomedicine is to a large extent a product of the emergence in the 19th century of a systematic human biology, in which nature for the first time was understood as constituted by a set of laws independent of culture and society. Thus, the body was seen as a universal entity, in which health and disease could be controlled independently of surrounding life circumstances.

This (historically and cross-culturally narrow) understanding of the nature of disease and the body seems to culminate in the recent promise of gene manipulation and of stem cell therapy as means of preventing and curing disease.

Interestingly, the priority and the apparent (funding and media) success of research into these new techniques, that partly emphasize treatment of the individual body ‘by itself’ (mediated by experts through a complex ‘amalgam’ of high-technology procedures) coincides with an increasingly individual-centered lifestyle and ideology in western/industrialized societies that has been evident during the period under study and in particular during the last twenty years. It also coincides with/echoes a claim made by alternative healers, that “self-treatment is the future”.

Another distinctive feature of biomedicine is its systematic focus on final cause explanations internal to the body — in contrast to medical systems that see, for example, cosmological imbalance, the wrath of God or the evil eye as final causes of illness. In this sense the concept of ‘biomedicine’ is more narrow than ‘medicine’. Whereas ‘medicine’ is a term for an academic discipline, ‘biomedicine’ is a different cut through this complex sphere that is concerned with understanding the nature of the human body.

Biomedicine depends on a vast ‘complex’ or ‘network’ of scientists, practicians and producers within related fields and within the pharmacological and medical device industries.

What is “Danish”?
Why “Danish” biomedicine? We don’t believe there is any specific “Danish” approach to biomedicine, or that biomedicine in Denmark is historically more significant than biomedicine in Singapore or Canada. “Danish biomedicine” shall primarily be understood as “global biomedicine” in its Danish variety. A spectrophotometer from Perkin-Elmer or a knockoutmus fra Singapore are as much parts of “Danish biomedicine” as an instrument from Radiometer, or a naked mouse from the Bartholin Institute. There are, of course, national variations in the biomedical pattern (as well as variations between individual institutions, or even laboratories), but otherwise biomedicine is basically a global phenomenon [*discuss Rabinows thesis about the local nature of PCR here].

The adjective “Danish” is therefore primarily added for pragmatic reasons. What happens (and has happened) in Denmark is in many ways “representative” of what goes on (and has gone on) in global biomedicine generally. “Danish biomedicine” is what we can pick it up (literally and metaphorically speaking) in Denmark (although ‘picking up biomedicine’ in Denmark is not tantamount to picking up ‘danishness’).

But if the limitation to “Danish” is made for pragmatic reasons only, why don’t we limit ourselves further to “Copenhagen biomedicine”, i.e., biomedicine as it occurs in the Copenhagen region — the Medical Faculty of Copenhagen University, Copenhagen University Hospital (KUH), regional farmaceutical and medicotechnical companies (Lundbeck, Novo Nordisk, Radiometer), regional general practitioners and dentists, etc. In other words “Copenhagen biomedicine” is probably as well-suited for understanding the global biomedical phenomenon as “Danish biomedicine”.

Question: do we have a special responsibility to collect instruments constructed by “Danish” companies (like Radiometer and Coloplast)? To collect the archives of major “Danish” scientists and medical doctors? To collect interviews with laboratory workers, doctors and patients in Danish hospitals and research institutions?

What does ‘representation’ mean?
What is representation? (And what is not a representation?). “Cultures are built out of representations”, writes the editor of the journal Representations: “Their making is, fundamentally, a communal activity. Even in the special realm we call art, representation is a communal activity, inseparable from collective motives, attitudes, and judgments”.

But the term is not unproblematic. As Wolfgang Iser points out, the term is loaded with naive ideas of the act of mirroring a given cultural reality: “It entails or at least suggests a given which the act of representation duplicates in one way or another”. In daily parlance the term representation has become interchangeable with “mimeses” whereby, says Iser, its “performative qualities” are concealed. In other words, the term ‘representation’ gives associations to language and knowledge as a mirror of reality rather than a construct. Iser suggests therefore that we always read the word ‘representation’ in the sense of ‘Darstellung’, i.e., “as not referring to any object given prior to the act of representation” (ibid.).

We agree both with the editors of Representations and with Iser. To us, ‘to represent’ means to bring forth, or construct, a more or less diffuse or unstructured social and cultural reality. Representation is closely linked to interpretation — any representation involves (presupposes) interpretation; furthermore, all representation is a product of more or less explicit and conscious selection and choice.

Here we list a number of possible alternative terms that more or less mean the same as ‘represent’:
‘account for’
‘construct an account of’
‘bring to life’
‘make a story out of’
‘put into words’
[‘italesætte’] ‘to model’

(Try to substitute ‘represent’ in the phrase “to represent Danish Biomedicine in collections and exhibitions” with each of these words to see which words work and which do not! Does the aim of the project change as these words substitute ‘represent’? Are there other words that better describe what we are intersted in doing?)

E.g. in what ways and by what means do scientists and practitioners of biomedicine show/manifest/display/express/describe/visualize/promote/signify/mediate (Da: vise/fremvise/fremstille/gengive/formidle/forestille/udstille/betegne/udtrykke/substituere/vikariere/ advokere for/være budbringer for/træde i stedet for) what they do?
Can all of these (and many more) ways of acting be subsumed under the heading ‘to represent’?

Representations come in many forms: linguistic, pictorial, material, etc. (and combinations of these forms), and in many different formats: scholarly books and research articles, popular media, material collections, documentary photos and films, paintings and drawings, etc. There are different styles and techniques of representation, e.g., interviewing, participant-observation, field-notes, photography, document collection, collection and display of tangible objects,

We believe that ‘genre’ is a useful concept in this context — i.e., we could speak of different “genres of representation”, like poems, fictional movies, documentary films, novels, and plays, tables, graphs, mathematical models, historical articles, sociological reports, economic theories and administrative reports.

Which of these genres are useful for representing recent biomedicine at the Medical Museion? Is a collection of material objects a genre of representation? Is a showcase in an exhibition a genre of representation?

Genres of representations of biomedicine
There are many actors who produce/create representations of “biomedicine”. Either because they are actors “within” who try to make sense of their own activities (actors’ collective understanding of themselves), or because they are “outside” actors who try to make sense of the Other’s activities (“science studies”).

Here we identify a number of possible attempts to make sense of biomedicine, i.e., to distingish between different genres of representation. Who are the representing actors? What are their aims? Which theoretical approaches do they take? Which facts about “biomedicine” do they produce? Whose interests and values are involved?

Our aim is to find out which of these genres of representations can aid us in representing biomedicine in museum collections and exhibitions. In doing so our methodological assumption is that all these genres of representations are equally important and powerful. No genre has priority over the others.

1) Media representations
The media (TV, radio, daily newspapers, weekly magazines, etc.) constitute a set of powerful genres of representations. How is biomedicine represented in television and films, in newspapers and magazines, in webpages and blogs? What does these media mythologies of biomedicine look like? How can they be used in exhibitions? (e.g., Dola Bonfils’ Novo-film (2003). Shall we collect them – or do we have access to other collections?

2) Representations in fiction
There are plenty of representations of biomedicine in novels, drama, poetry, science fiction and opera (cf. Philip Dick’s Do androids dream of electric sheep?). How can they be used in exhibitions? Shall we collect them in the library?

3) Representations in art
There are many varieties of representations in sculpture, painting, installations, concept art, video art, and photography. Jfr. blog-indlæg 21. og 24. februar. How can they contribute to exhibitions? Do we have any ambitions to collect this kind of art, as we have earlier collected, e.g. doctors portraits?

4) Representations in movies
How can they contribute to exhibitions? In teaching? (e.g., Spielberg’s “Minority report”, etc.)

5) Representations made by actors in biomedicine – scientists, doctors, nurses, lab workers etc.
We are talking here about representations made in actors’ categories (the mundane view of biomedicine) which are available in a variety of genres: scientific articles, textbooks, scientists’/doctor’s histories of medicine, annual reports, etc.

The representations made by biomedical actors are important, not because they are more “true” than other representations, but because they constitute a powerful source for media representations and representations in art and fiction, and not least for representations in terms of collections and exhibitions, as we can see in most medical history museums around the world (in other words, when medical doctors have represented medicine in medical history museums they have focused on instruments and historical facts). The represenations made by biomedical actors are also important because they originate close to biomedical practice, and because these actors are close to the centres of power that govern the Medical Museion (make friends!).

So how do scientists represent their own activity? What is scientists special “mundane” view of biomedicine? (The research article as a “strong” genre of representation.) What does scientists’ spontaneous history/sociology/anthropology of recent biomedicine look like? Do they prefer to represent science in thet format of biographical portraits of scientific superstars like James D. Watson or potential superstars like Milena Pinkowa, or in anecdotal form? Do they represent biomedicine represented as theories and facts? Do they prefer quantitative modes of representation (like number of published articles in peeer-reviewd journals = hits in PubMed). Or in mythological terms? If so, what does scientists’ mythological picture of science look like?

6) Patients’ representations
The patient’s perspective has been favoured amiong historians of medicine for more than two decades. What does biomedicine look like from the patients’ perspective? Are there as many patients’ perspectives as there are individual patients? Or patients with different diseases? Are we interessted in collections and exhibitions from the patients’ perspective? And what does it look like in an exhibition?

7) Administrative representations
Science/hospital administratos see biomedicine in terms of production units – as patients in/out, as number of bed-days, as number of clinical biochemical analyses. How does the health administrators’ view of biomedicine influence doctors’ views?

8) Political representations
What does biomedicine look like from the a political perspective? How does Anders Fogh Rasmussen and Helle Thorning-Schmidt view Danish biomedicine? How would they collect?

9) Representations by social scientists and law scholars
Health economists are usually interested in health care financing, health insurance, health policy, cost-benefit analyses for the health system, economic evaluation of the implementation of new technologies in the health system, etc. What would biomedicine look like from the perspective of an health economist / economic historian? Biomedicine as an economic system / industrial branch. How would a health economist make an exhibition of Danish biomedicine? What would an econnomic historian collect to make sense of Danish biomedicine?

Similarly, political scientists are usually interested in the health system as a political system (governance, conflict etc).

How would a geographer represent global biomedicine (time-space-distribution)?

What does an anthropological view of biomedicine look like?

How would a legal scholar collect and exhibit biomedicine?

There are many sociological narratives (a social constructivist perspective, ANT, etc.)

10) Theological perspectives
Are scientists playing God?

11) Scientometric representations
Scientiometrics goes back to the 1960s. The idea is to measure differnt scientific parameters quantitatively.

12) Biographical perspectives
Writing biographies of life scientists. Biomedical superstars. Websites with celebrity photos of Leroy Hood, Sidney Brenner, Francis Crick (cf. Janet’s thesis).

13) Ethical representations

14) Gender perspective
Women heroes in biomedicine (Dorothy Hodgkin, Rosalind Franklin)

15) Ethnic perspectives

16) The strange, the weird and the uncanny
The anecdotal, the mythological, the uncanny. Babies in pickles.

17) A science studies perspective
We recommend representation that focus on biomedicine as practice. i.e., we wish to do for “studies of biomedicine” in museology what “science studies” has tried to do for studies of science in the popular understanding of science.

Where do we go from here?
This review of different modes of representations of biomedicine (and there are many more; which have we forgotten?) is our point of departure for the second step of the analysis, which is to select modes of representation that we find most appropriate for our institutional purposes, viz. creating a Medical Museion that focuses on recent biomedicine.

In other words, we suggest that a “genre of representation” perspective guide the discussions about collection strategy and exhibition strategy that we shall undertake later this spring and in the summer of 2005.

Thomas Söderqvist

Author Thomas Söderqvist

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