- The Social World of Public Health Research
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Letting chance decide whether or not a patient should receive a promising treatment had already proved the thorniest issue in the debate among British and American physicians. As the hybridization between medicine, biology and, to a lesser extent perhaps, chemistry and physics, gathered momentum, statistics applied to experimental research quickly appeared as the third significant domain of activity in Unit 21's annual reports.
The group was soon able to establish working relationships with a growing number of biophysicists, biochemists, and geneticists.
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The strategic decision to insert Unit 21 firmly within the new world of medical research did not prevent the group from interacting with the DRMS. Up to the early s at least, Unit 21 contributed to various investigations launched by the different sections. Tellingly, however, their interventions focused almost exclusively on the most medicalized aspects of public health, which allowed them to carry out their research in a hospital setting, avoiding studies in the community or any other kind of investigation among the general population. For her part, Claude Rumeau-Rouquette, the first medical graduate to join Unit 21, went on to become the head of the Perinatal Health Section.
The Social World of Public Health Research
Her approach bore all the marks of Unit After all, Rumeau-Rouquette's analysis of risk factors for diseases or accidents incurred by the pregnant mother, the newborn, or both, were of immediate interest to clinicians. The disbanding of the Division put a halt to the long-lasting discussion that had taken place over the future of the public health sections. Furthermore, it appeared difficult to reduce the activities of bodies responsible for informing the Ministry of Health on an increasingly wide range of issues, particularly since the quality of their publications and reports was much praised.
Public health was far removed from their research interests, and in the view of laboratory scientists like Burg, who ran small, flexible research teams, the sections consumed too many resources, especially in terms of manpower. More irritatingly still, at a time when INSERM was increasingly encouraging researchers to submit their manuscripts exclusively to the most prestigious Anglo-American journals, their colleagues in the sections still favoured the book-length monograph in French as their medium of choice. None the less, many clinicians and laboratory scientists still believed that the production of information on the health of the population should remain within the province of the new research institute.
As late as December , the Scientific Council approved a resolution that reaffirmed this view. Not only had a decree, quite providentially, deprived the sections of the statutory protection they had enjoyed since , but the anticipated retirement of Lucie Laporte the DRMS's director since its foundation in June , allowed for a complete reorganization of the field. At that time, the Director General had extensive powers to choose the members of these commissions.
Burg's main concern lay in the high level of unionization among DRMS staff and the consequent risk of political turmoil. The mischievous strategy he developed to overcome this opposition consisted in tarnishing the scientific reputation of the Division to a point where even the most passionate call for its preservation would sound purely corporatist, politically biased, and ultimately illegitimate. In fact, while the public health credentials of the academics listed in the memorandum were rather limited, all were closely associated with Burg.
For this reason, perhaps, Burg felt able to anticipate, with utter confidence, the results of these future investigations:. There will inevitably ensue [ sic ]: a An all-encompassing critique of the DRMS's activities that would make the implementation of the reform project easier; b A suggestion to carry on establishing [relocating] the DRMS's sections within relevant specialized hospitals.
Burg therefore claimed that civil servants and public health physicians would be better off once the traditional, old-fashioned sections had been transformed into innovative and responsive research units. Ironically, Schwartz and his collaborators, with the notable exception of Rumeau-Rouquette, openly opposed a plan that should in principle have reinforced their position. Certainly, their loyalty towards their trade union, which resisted the demise of the public health sections, helps to explain their apparently paradoxical position. The second graduate of the Ecole Polytechnique to join Unit 21 in , Lazar had been based at Villejuif until , when he spent a sabbatical year at the Harvard School of Public Health.
There he discovered another approach to epidemiology, promoted by the likes of Brian MacMahon. He saw for himself how medical statisticians collaborated with public health scientists from various disciplines, and noted the stimulating effect it had on the whole field. Burg thought otherwise.
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When the DRMS was disbanded in , five sections were transformed into research units, and gradually relocated in various Parisian teaching hospitals. The need to appoint many more epidemiologists, as well as other public health scientists, had been clearly stressed in one of Burg's memoranda.
The demise of the public health sections, and their fall into oblivion over the thirty-five years that followed, had important long-term consequences. The population-based study of human health did not fit well with the reductionist approach favoured in biomedical laboratories. Moreover, the unstable mix of contributions to policy making and pursuit of an independent research agenda, which had characterized the work of the sections and helped to secure financial support for the INH in the previous period, was now viewed with aversion.
It was seen as a pollution of science, paradoxically, at a time when research units were increasingly urged to collaborate with the pharmaceutical industry and other private firms. On the one hand restrictions on finance and the size of the workforce, and on the other pressure to produce results within a limited timescale, also account for the extremely small number of cohort studies commissioned by INSERM until very recently. Many topics, including issues of burning interest to policy makers, were difficult to investigate by such means.
In turn, a succession of health scandals prompted the creation of public health agencies independent of the Department of Health, whose tasks included both the gathering of available data and the commissioning and practical organization of specific investigations—just as the DRMS had done. The similarities are becoming even more striking as the agencies, such as the Institut de Veille Sanitaire InVS , increasingly feel the need to expand this area of their research activities.
Meanwhile, the position of INSERM research units specializing in epidemiology and biostatistics, such as the twenty or so groups that came out of the successive partitions undergone by Schwartz's Unit 21, was not as auspicious as might have seemed. Being among the few remaining proponents of the huge research field of public health could certainly count as an asset; at the same time, the fact that these units were the last remaining exponents of a field situated on the lower rungs of the part implicit, part explicit scientific hierarchy that prevailed in the research Institute made them an easy target for criticism by more powerful disciplines.
A history of the genetic code , Stanford University Press, , have paved the way to a mushrooming literature. For an alternative approach to relational analysis of social action, see Andrew Delano Abbott, Chaos of disciplines , University of Chicago Press, INED's influence on the issue vanished after its leading demographer on the topic, Sully Ledermann, died suddenly in The Rockefeller was also instrumental in the contemporary establishment, along the same lines, of the London School of Hygiene and Tropical Medicine; Lise Wilkinson and Anne Hardy, Prevention and cure.
As late as —63, during negotiations between the INH and the Comission du Plan Planning Commission on the development of the Institute, he pledged the creation of fifty research units by the end of the decade, so as to equal the number already established by the British Medical Research Council. This unpublished report is reproduced on the CD-Rom mentioned in note 20 above. Until then, even the doctors and professors appointed to teaching hospitals had to make a living out of private practice.
Martin-Bouyer gained some notoriety in when he managed to trace the poisoning of over babies to the use of talcum powder contaminated by hexachlorophene an episode otherwise known as l'affaire du talc Morhange. The number of technicians was Ten years later, the number of researchers had more than doubled to 1,; meanwhile, the overall budget had jumped from 54 million francs in to million in That year, DRMS's resources reached , francs salaries, and other personnel expenses excluded.
Two successive heads of the Cancer Section, Pierre Denoix and Robert Flament, moved on to become professors of medicine, and later directors of the Institut Gustave Roussy, by far the most prominent French research and treatment centre in the field Denoix was eventually appointed Director General for Health.
I explored a much more complicated genealogy in my PhD dissertation, Berlivet, op. Many of the most motivated students would later swap places and start teaching in their turn; Berlivet, op. There were things that Daniel Schwartz, who was a mathematician, and very clever, did not understand. The Group played a most prominent part in the organization of multi-centre clinical trials in oncology. According to most public health researchers, the format imposed by medical journals did not allow them to reveal with precision either the technicalities of their investigations, or the mass of information gathered in the course of a research project that had taken years to complete.
Community Health , , 55 10 : —, on p. See Population 's special issue vol. National Center for Biotechnology Information , U. Journal List Med Hist v. Med Hist. Author information Copyright and License information Disclaimer. Open in a separate window. The End of an Era: the Demise of the DRMS The disbanding of the Division put a halt to the long-lasting discussion that had taken place over the future of the public health sections. For this reason, perhaps, Burg felt able to anticipate, with utter confidence, the results of these future investigations: There will inevitably ensue [ sic ]: a An all-encompassing critique of the DRMS's activities that would make the implementation of the reform project easier; b A suggestion to carry on establishing [relocating] the DRMS's sections within relevant specialized hospitals.
Conclusion The demise of the public health sections, and their fall into oblivion over the thirty-five years that followed, had important long-term consequences. Support Center Support Center. External link. In this context, the article of acquires a particular value. Published in Le nouvel observateur , the article I will focus on was written in tribute to the French edition of two essays by Panofsky.
The most important agent for the introduction of Panofsky's work in France was the sociologist Pierre Bourdieu, who translated the essay Gothic architecture and Scholasticism Panofsky, and directed the collection that contains the volume. The context of Panofsky's reception in France is particularly interesting in order to situate Foucault's reading, or rather, to mark its extreme discrepancy with the most common and resistant reactions. It is true that the attention given to Panofsky's studies, after the discussions between experts 3 about his works on the Gothic, came more from the side of philosophy, sociology and history of science that esteem and appreciate its theoretical constructs , rather than from art history.
In this sense we can also mention the success of the concept of Habitus for the historians linked with the revue Annales. So, while an important interest in Panofsky's writings came from a certain tradition of history and history of science at the precise moment at which they were calling into question their own epistemological tools, as demonstrated in Bourdieu's postscript, the situation is different for history of art.
The development of Panofsky's reception in this field seems to be dominated by what we can call a strong prejudice or a long misunderstanding. This interpretational grid, which is a side effect of the tendency to equate Panofsky's method with human sciences the context in which his works were published , far from being regarded as outdated, seems today still difficult to call into question 7. What they underlined was precisely how his works problematized or even surpassed the prevalent epistemological background of human sciences at the time.
The first, and probably the most important aspect of Panofsky's essays that strikes Foucault is that they bring hardship to the discourse's leading position. Foucault wrote clearly in this respect:. Discourse and figure each have their own way of being; but they maintain complex and entangled relations. These examples, besides showing the complexity of the mentioned phenomenon urge us to observe that concepts and methodological tools used by Panofsky are resulting from their specific operational field.
However, as we will soon see, in this work, which clarifies Foucault's conceptual instruments, methodology, and aims of the analysis, a particular place for painting is preserved. This point marks the impossibility of making the relation of painting's formal aspect with an object of representation as stable and referential.
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USC Digital Library, , public domain. In his famous introduction to S tudies in Iconology , Panofsky through the example of the acquaintance greeting by lifting his hat distinguishes three levels of meanings: The primary meaning, that is, in turn, separated in factual and expressive; the secondary or conventional subject, that is properly the first intelligible content; and the intrinsic meaning. The inquiry into those kinds of elements is presented as the aim of the method and has to be regulated by the history of styles and cultural symptoms.