The Stance of Practice

While all Biomedicines generate clinical practices, they differ significantly in their stances vis-à-vis disease and the patient. The foundational studies of Biomedicine in the 1980s showed that it is not unitary but rather consists of "many medicines" (Gaines & Hahn, 1985). Within and across medical specialties, as well as across cultures, we find a variety of views all called Biomedicine (Hahn & Gaines, 1985; Lock & Gordon, 1988; Luhrman, 2000; Wright & Treacher, 1982).

Nevertheless, as DelVecchio Good (1995) and Davis-Floyd (2001) suggest, key characteristics of Biomedicine (such as its separation of mind and body, its mechanistic metaphors, its distancing style) tend to remain constant across cultures. Equally salient among these characteristics is aggressive intervention, most particularly in the United States but also in many other countries. For example, throughout their history, U.S. biomedical practitioners have aggressively treated many disorders without a trace of scientific basis, often to the detriment of the patient. The mercury and bloodletting of earlier times nowadays are replaced by massive over-prescription of drugs (one of the leading causes of death in the contemporary United States) and the overuse of invasive tests and surgical interventions. The surgical maxim "when in doubt, cut it out" aptly expresses American Biomedicine's aggressive focus. Here gender once again becomes salient: cesarean sections, hysterectomies, and (until recently) radical mastectomies have been among the most commonly performed of unnecessary surgeries in the United States (see Katz, 1985, 1998).

In contrast, French Biomedicine has long been characterized by its non-interventive strategies; for example, it has minimized radical surgery, seeing it as too aggressive and too destructive of the body esthetic (Payer, 1989). Likewise, within American Biomedicine the "culture of medicine" (a term physicians use to refer to internal medicine), often conflicts with the "culture of surgery": internists tend to prefer a more patient, "wait and see" approach (Hahn, 1985; Helman, 1985).

Biomedicine's traditional aggressiveness has carried with it the promise of dramatic cures. This promise has become its Achilles' heel as lawsuits proliferate when this promise is not fulfilled. The baby is not perfect, the surgery results in infection, the dialysis fails—it must have been someone's fault, as Biomedicine seemed to have promised all would be well. In general, biomedical practitioners justify their frequent use of aggressive interventions in historical terms, citing the drastic reductions in mortality that have resulted from early 20th-century understandings of the etiology of infectious diseases and the discovery of antibiotic drugs. Their critics, however, can show that disease rates were already dropping in the industrialized world because of cleaner water and improvements in sewage treatment and nutrition. In the developing world, this argument continues (McKeown, 1979).

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