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ABSTRACT
The idea of reducing pathology to biology has an extensive history, and the initial forms of the enterprise were unsuccessful. This article discusses the philosophical literature surrounding the notion of reduction in the sciences in general and of biology in particular; reviews several 19th-century programs that promoted the reduction of medicine to other biological disciplines; and examines the post-war origins of the notion of biomedicine. It shows how biology and medicine tend to interact in the constitution of new biomedical knowledge and how the notion of a pathological process resulting in a lesion remains central to the understanding of disease. The article proposes that while strict reduction has yet to be realized, one can speak of a continuing and successful realignment of biology and pathology since the Second World War.
IN A RECENT BOOK, Inventing Biomedicine, Jean-Paul Gaudillière (2002) defines biomedidne as the conjunction of three post-war tendencies: the molecularization of the life sciences, the rise of modeling, and the experimentalization of the clinic. Taken together, according to Gaudillière, these tendencies have transformed the biology laboratory into "the site for the discovery, manipulation and control of the causes of pathological processes" (369). If we accept Gaudillière's implied suggestion that the biology laboratory has supplanted the pathology laboratory as the focal point of medicine, then we might reasonably conclude that the 19th-century program of reducing medicine to a form of biology has finally been realized.
Gaudillière is not alone in expressing such an opinion. A more radical expression of this view can be found in a recent commentary in Nature, in which the president of the U.S. Biophysical Society, Ken Dill (1999), defines biomedicine as a tendency that has emerged in the last half-century to successfully "reduce the problems of disease to problems of molecular science: to identify the relevant molecules, to purify them, to determine their three-dimensional structures at atomic resolution, and then to create drugs to bind to them, atom by atom" (309). Dills definition of biomedicine was immediately challenged by Alan Schechter (1999), a clinical researcher at the NIH, who criticized Dill for naïve rcductionism and accused him of having conflated "biology and medicine into an ill-defined hybrid 'biomedicine.'" Schechter did not deny the existence of this hybrid; rather, he objected...