An Introduction to the Medical Epistemology of Georges Canguilhem: Moving Beyond Michel Foucault

Spicker, Stuart F.

doi:10.1093/jmp/12.4.397

Cited by 19 publications

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“…The epistemology of medicine-in-particular has been explored by George Canguilhem in his treatise “On the normal and pathological”. Canguilhem argues that disease is not a quantitative degree in the spectrum of health, instead health and disease are evaluative terms that signal qualitative distinctness [ 4 , 28 ] 1 , 2 , 3 Canguilhem’s views are radically holistic. He shares with Bernard the preoccupation of using statistics to understand individual phenomena, but he resolves the question by denying the possibility of reducing health and diseases beyond the concrete human beings as independent total wholes.…”

Section: Resultsmentioning

confidence: 99%

“…He shares with Bernard the preoccupation of using statistics to understand individual phenomena, but he resolves the question by denying the possibility of reducing health and diseases beyond the concrete human beings as independent total wholes. He rejects that organs or cells can be diseased, except in the most metaphorical senses [ 28 ]. This notion may appear obsolete or counterintuitive in an era where molecular defects causing diseases are constantly being discovered and cell and organ transplantation can cure diseases.…”

Section: Resultsmentioning

confidence: 99%

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Reconciling art and science in the era of personalised medicine: the legacy of Georges Canguilhem

Contino

2023

Philos Ethics Humanit Med

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Background Biomedicine, i.e. the application of basic sciences to medicine, has become the cornerstone for the study of etiopathogenesis and treatment of diseases. Biomedicine has enormously contributed to the progress of medicine and healthcare and has become the preferred approach to medical problems in the West. The developments in statistical inference and machine learning techniques have provided the foundation for personalised medicine where clinical management can be fully informed by biomedicine. The deployment of precision medicine may impact the autonomy and self-normativity of the patients. Understanding the relationship between biomedicine and medical practice can help navigate the benefits and challenges offered by precision medicine. Methods Conventional content analysis was applied to “Le Normal and le Pathologique” (Canguilhem G. The Normal and the Pathological. Princeton: Princeton University Press; 1991) and further investigated with respect to its relationship with techne and precision medicine using PubMed and Google Scholar and the Standford Encyclopedia of Philosophy to search for the following keywords singularly or in combination: “Canguilhem”, “techne”, “episteme”, “precision medicine”, “machine learning AND medicine”. Results The Hippocratic concept of techne accounts for many characteristics of medical knowledge and practice. The advances of biomedicine, experimental medicine and, more recently, machine learning offer, in contrast, the model of a medicine based purely on episteme. I argue that Canguilhem medical epistemology establishes a framework where episteme and data-driven medicine is compatible with the promotion of patient’s autonomy and self-normativity. Conclusions Canguilhem’s medical epistemology orders the relationship of applied medicine with experimental sciences, ethics and social sciences. It provides guidance to define the scope of medicine and the boundaries of medicalization of healthy life. Finally, it sets an agenda for a safe implementation of machine learning in medicine.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Reconciling art and science in the era of personalised medicine: the legacy of Georges Canguilhem

Contino

2023

Philos Ethics Humanit Med

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“…Hence, the law of large numbers never teaches us anything about any particular case!&dquo; Moreover, he asserts that &dquo;statistics teach absolutely nothing about the mode of action of medicine nor the mechanics of cure in those whom the remedy may have taken effect.' 4 For better or worse, statistical techniques that are based on subjective or logical probability have evolved to what is known as Bayesian or neo-Bayesian analysis. Pharmacokinetics has adapted Bayesian principles of conditional probabilities for its methodologies.…”

Section: The Patient As a Statisticmentioning

confidence: 99%

Critical Reflections on Therapeutic Drug Monitoring

Morley

Strand

1989

Journal of Pharmacy Practice

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THERAPEUTIC DRUG monitoring is fre-.i-quently identified as applied pharmacokinetics. However, this narrow conception is misleading and confines clinical practice to a technical/mechanistic level of intervention rather than to a broader patient-specific focus. Recognizing the need to expand our clinical focus has fueled the clinician's enthusiasm for the application of pharmacodynamics to patient care. However, therapeutic decisions based entirely, or in large part, on serum concentration data are questionable. Posey' observes, &dquo;it appears that at least initially, on a research level, many clinical pharmacists will be turning increasingly to pharmacodynamics instead of serum concentration data to analyze drug regimens.&dquo;Benetl asserts that a correlation between pharmacokinetics and pharmacodynamics will provide more data to our understanding of drugdrug and drug-disease interactions in human populations. However, Benet acknowledges that a correlational data base may not be useful for the treatment of individual patients. For the clinical pharmacist who treats individuals rather than aggregate populations, this is an important consideration.This article describes two major issues that, in spite of the influence of pharmacokinetics and pharmacodynamics, may threaten the responsible practice of patient-specific therapeutic drug monitoring. The two issues are (1) the limitations of the use of aggregate data that are generated from experimental or statistical models and extrapolated by clinicians in order to make individual patient-focused decisions concerning drug therapy, and (2) the dangers inherent in the fragmentation of the patient into technical data values, organ systems, and receptors for drug compounds.- THE PATIENT AS A STATISTICThe most important observation to be made regarding pharmacokinetics, or broader epidemiological data, is that the data are abstract and aggregate and are not individual facts.Thomasma2 observes that, &dquo;[T]he problem of applying general or abstract knowledge to individuals is a central problem in making clinical judgments.&dquo;Thomasma2 describes research and practice as &dquo;logically distinct activities.&dquo; Research attempts have had varying degrees of success in producing generalizable knowledge, but in practice &dquo;therapeutics&dquo; refers to &dquo;a class of activities meant to benefit individual patients or a distinct group of patients.&dquo; In either case, the clinician's ethical mandate is to treat the patient as an individual and not as a member of a group or cohort.Clinicians should keep this research/practice distinction in mind when making clinical decisions, particularly when using pharmacokinetic data that were derived from research results, since these data are often &dquo;applied to individuals who were not part of the original set.&dquo;It is wise to make careful inferences in therapeutics. The more abstract the concept, the less appropriate its application to individual patients. 2The conformity between aggregate data and the individual patien...

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“…In this study, we critique the boundaries between normal and abnormal ageing by considering how these boundaries have been established and maintained as natural and clearly demarcated within present‐day Western contexts, drawing on the seminal ideas of Georges Canguilhem and Michel Foucault, both influential twentieth‐century French philosophers (Spicker 1987). Canguilhem was a physician and philosopher concerned with normality, the pathological, and the implications that common understandings of the normal and pathological have for the development of medical knowledge and the practice of medicine (Horton 1995).…”

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confidence: 99%

Reexamining the boundaries of the ‘normal’ in ageing

OʼRourke¹,

Ceci²

2011

Nursing Inquiry

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Textbooks and policy documents tend to present the boundary between normal and abnormal ageing as natural and clearly demarcated. In this study, we trouble the notion of natural and clearly demarcated boundaries between normal and abnormal ageing by considering how these boundaries have been established and maintained in present-day Western contexts. We draw on both Canguilhem's discussion of the normal and the abnormal and Foucault's emphasis on the role of the sociohistorical context in the social practice of boundary generation. In doing so, we critically examine common conceptualizations of normal and abnormal ageing, including those found in antiageing science, successful ageing and healthy ageing policy discourses and in health education textbooks. We argue that the growing emphasis on 'healthy' ageing both reflects and shapes the societal views of those individuals who are not able to remain disease-free and represents a kind of mystification of ageing where ageing without functional or cognitive decline is instituted as the norm. Awareness of the role that the social context plays in shaping definitions of normal and abnormal ageing encourages critical consideration of the effects that Western conceptualizations of normal ageing may have for older adults who continue to age with cognitive or functional decline.

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An Introduction to the Medical Epistemology of Georges Canguilhem: Moving Beyond Michel Foucault

Cited by 19 publications

References 0 publications

Reconciling art and science in the era of personalised medicine: the legacy of Georges Canguilhem

Reconciling art and science in the era of personalised medicine: the legacy of Georges Canguilhem

Critical Reflections on Therapeutic Drug Monitoring

Reexamining the boundaries of the ‘normal’ in ageing

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