RESEARCH IN PROGRESS
A New Methodology for Evaluating Intellectual Collaboration in Translational Brain Tumor Research
The Politics of Positivist Epistemology in Post-Modernity
Health Citizenship and the Politics of Anti-corporate Capitalism in Post-modern and Globalized Worlds : From Behavioral Individualism to Environmental and Structural Etiology of Chronic Disease
Medicine, Social Science and the Management of Social Democracy: Social Medicine and Scientific Humanism in Britain in the Twentieth Century
Medical Humanism & Social Medicine in the United States
A New Methodology for Evaluating Intellectual Collaboration in Translational Brain Tumor Research
For over a decade, academic and commercial biomedicine has advocated the re-generation of clinical science through the development of a Translational Research paradigm that will speed up and reduce the costs of the discovery, development and delivery of novel therapeutic and preventive interventions. Within this context, effective multi, inter and transdisciplinary collaboration has been a central concern of governmental and foundational funding bodies and commercial producers. However, amongst the current literature discussing avenues and obstacles to TR none has focused specifically on the interaction of separate conceptual systems and disciplinary cultures that characterize basic science, clinical research and population research. The integration of concepts, methods and values is critical to the operation of intellectual disciplines and the formation of conceptual paradigms. My current research project aims to dissect these complex relationships by developing a new method of evaluation within the “Science of Team Science” that integrates qualitative and quantitative analytical social scientific methods from sociology, history and anthropology.
The Politics of Positivist Epistemology in Post-Modernity
What does the conflict ridden history between science, scientism and political change have to offer an understanding of the role of scientific and secular rationalism in the future of a globalized world in the twenty first century? Are the latest faith wars simple conflicts between alternative forms of authoritarianism and is the possibility of linking emancipatory knowledge to the democratization of social power a futile illusion?
This project analyses the critique of Enlightenment rationalism pursued by intellectuals from a wide range of humanistic disciplines from the Interwar years. This critique expanded a cultural expression of anxiety about the authoritarian potential of the effects of what Max Weber had first problematized as the impact of scientific rationality in producing professionalized, Taylorized, one-dimensional bureaucratic social orders. A debate subsequently ensued surrounding ‘science as social relations’ which was exemplified within the post WWII ideological struggles within Western Marxism. In this debate Bernal-inspired visions of ‘scientific socialism’ became characterized, from the 1960s, by Hegelian Marxists as an Orwellian nightmare of technological totalitarianism leading Toward a Rational Society inhabited by One Dimensional Man. The archeologist of knowledge Michel Foucault extended this critique beyond an internal debate within Marxism to an investigation of a universalizing legacy of the Enlightenment in the creation of disciplinary knowledges that facilitated ideological systems of panoptican surveillance through heuristics such as ‘bio-power’.
In the last quarter of the twentieth century and the early years of the twenty first, the politics of science and society have moved beyond politicized intellectual discourses to the theatres of power in a globalized world characterized by a forceful contest for colonial cultural monopoly. In this historical moment, science as a logic of domination continues to be dissected within post-colonial analyses of the determinants of subaltern oppression and diasporic disenfranchisement. In a separate context, but at the same time, science has been represented as a demonic influence in a divinely ordered universe within the articulations of faith enthusiasms that are nevertheless at war with each other.
The project investigates the question of what possibilities remain for positivism politicized by humanitarian social democratic values and their realization, in Jurgen Habermas terms, in a relationship between knowledge and vested human interests and values which are discursively redeemable.
Health Citizenship and the Politics of Anti-corporate Capitalism in Post-modern and Globalized Worlds : From Behavioral Individualism to Environmental and Structural Etiology of Chronic Disease
Social medicine in the Anglo-American context remained closely bound to the bio-psycho-socio-model of chronic disease that underpinned lifestyle, behavioral models of prevention after the Second World War. However, recent political developments regarding chronic disease prevention, specifically with respect to obesity, has been promoting a paradigmatic shift that re-links Anglo-American social medicine with its roots in structural analysis of disease etiology and with the continued structural analytical focus of Latin American Social Medicine.
This project has examined the way in which obesity in the Anglo-American context has figured prominently in the development of a behavioral etiological framework for analyzing chronic diseases and in a behavioral conceptualization of prevention through individual lifestyle changes since the Second World War . This conceptual framework has, however, been challenged since the 1990s by radical health reformers who have focused on the role of corporate capitalism in the production of diseases that have been identified within a neo-liberal model of prevention as an individual responsibility. For a much longer period, the role of corporate industrial organizations in the production of chronic disease has been highlighted by historians of occupational diseases and by historians of smoking together with reformers’ and government agencies’ battles with the tobacco industry from the 1980s. More recently a radical health reform war on ‘Big Food’ has mimicked many of the strategic arguments and actions of the earlier wars on ‘Big Tobacco’ and ‘Big Pharma’. In their war against ‘Big Food’ radical health reformers have depended on the substitution of an environmental for a behavioral etiological explanation obesity. This substitution originated, ironically, in the work of a distinguished behavioral scientist, Dr Kelly Brownell, who identified the cause of obesity and overweight to be a toxic environment of addictive food production, which includes the mass marketing and advertising technics of the corporate food industry. Brownell and his co-founders of a health reform group, Center for Science in the Public Interest, have argued for government intervention to control and prevent obesity morbidity through taxation of high calorie low nutritious foods, the banning of junk food sales from schools and compulsory public disclosure of calorific and chemical components of nutritional products including restaurant menus.
The future goal of the project is to examine how a new heuristic for understanding chronic diseases is emerging within radical health activism that integrates understanding the complex interaction of biology with the political, economic, social and cultural relations of the twenty first century. It seeks to understand how such an intellectual reconfiguration integrates the future evolution of social medicine in the Anglo-American with the Latin American holistic structural model of social medicine.
Medicine, Social Science and the Management of Social Democracy: Social Medicine and Scientific Humanism in Britain in the Twentieth Century
How has social theory influenced medical knowledge and practice in the twentieth century? From the time of their initial academic institutionalization in British universities in the late nineteenth century, the social sciences were perceived as Durkheimian conceptual and practical tools for the management of social harmony and integration. As medicine embraced these new knowledge tools in the twentieth century did they facilitate a new role for medicine in the management of modern society? Has the interdisciplinary relationship between medicine and sociology made possible what the last Chief Medical Officer to the British Local Government Board, Arthur Newsholme, foresaw as ‘the medical management of corporate life’?
This project examines the complex relationship between medicine and social science within the context of the transfer of health care and medical services to a from tax funded delivery system in the twentieth century. It explores the vision that early enthusiasts amongst medical academics in the 1930s had of the possibilities for a new discipline of social medicine. The study compares this vision with the actual development of social medicine within medical academia and research following the Second World War. It focuses especially upon the transfiguration of social medicine into a new socio-behavioral epidemiological paradigm which facilitated the development of ‘life-style medicine’. The study explores the changing construction of the of the ‘healthy life-style’ and its influence upon public health and medical education, popular beliefs and its role in creating a worried well, or health anxious, society in the late twentieth century.
Medical Humanism & Social Medicine in the United States
When in 1957 Case Western Reserve became the first medical school in the United States to attempt to revise the Flexner Model of the medical curriculum they were driven by the primary goal of improving the acquisition of clinical competency by student physicians. The historical story behind the impetus for curriculum revision is complex including a broader debate between powerful professional subgroups within the US medical profession as a whole. A prominent pedagogical consideration which featured in the curriculum reform movement, however, was the desire to include training in the social sciences and the humanities for student physicians to enhance their clinical skills.
Controversy continues to rage, however, surrounding the role of the humanities and social sciences as they are represented in the medical curriculum in the United States. Opinions are highly divided and contrasting about the purpose and boundaries of such programs of instruction. Opinions about the role of the humanities and social sciences range from stressing the need to instruct students in ‘cultural competency’ to concern to introduce students to a much broader conceptualization of the complex social and cultural role of medical practice and the power of bio-medical knowledge in contemporary US society and beyond in a globalized world. Though such points of view are not mutually exclusive, the emphasis that different schools place on the wide range of disciplines and goals offered by the humanities in medicine have a marked effect on the nature of the programs offered, on their content and on their form. These differences are exacerbated by a certain vagueness in defining exactly what the humanities and the social sciences are in their relationship to medicine.
This project will examine the development of the medical humanities and the social sciences in medical education in the US from the 1950s to the present day by examining their institutionalization in major academic medical centers. At the same time the project will investigate attempts made at institutionalizing a definitive conceptualization of medical humanism as a discipline and its relationship to ‘scientific humanism’ as an ideological/social movement. This will involve an exploration of the foundation of relevant scholarly societies and academic journals in these fields and public intellectual discourses on these subjects.
Most important recent publications
2007 Dorothy Porter, Review: ‘Matters of Exchange: Commerce, Medicine and Science in the Dutch Golden Age'JAMA 298: 1339-1340. Go to the article.
2007 Dorothy Porter,‘The Social Contract of Health in the Twentieth and Twenty First Centuries’, in Susan Gross Solomon (University of Toronto), Patrick Zylberman (CERMES, Paris), Lion Murard (CERMES, Paris) (Editors), On Shifting Ground:” Health and Space in the Twentieth Century (in press - Johns Hopkins University Press, 2007)
2007 Dorothy Porter,‘The Decline of Science: Babbage Revisited’, in John Pickstone, Roberta Bivins (eds), Di Omni (London, Palgrave Macmillan, 2007).
2007 Dorothy Porter,‘Public Health in Industrial and Post-Industrial Societies’, in Marie Nelson (ed.), Occupational Health and Public Health. Lessons from the Past, Challenges for the Future (Stockholm, Sweden, Arbetslivsinstitutet. 2007), 12-22.
2006 Dorothy Porter,‘How Did Social Medicine Evolve, and Where Is It Heading?’, PLoS Medicine, October 24th, 2006, 1667-1672.
2002 Dorothy Porter,‘From Social Structure From Social Structure to Social Behaviour: Social Medicine and Class Culture in Britain after the Second World War’, Contemporary British History ,Vol 16 (2002), 58-80.
2002 Dorothy Porter,‘Health Care and the Construction of Citizenship in Civil Societies in the Era of the Enlightenment and Industrialisation’, in A. Cunningham, O. Grell and R. Jutte (eds), Health Care and Poor Relief in 18th and 19th Century Northern Europe (London, Ashgate, 2002), 15-31.
2001 Dorothy Porter,’Sick, Sick, Sick’, The Paradox of Medicine and Health in England Since 1945’, Filipe Fernandez-Armesto (ed.) with an ‘Introduction’ by Roy Jenkins, A History of England. England 1945-2000 (London, The Folio Society, 2001), 411-428.
2000 Dorothy Porter,‘Biological Determinism, Evolutionary Fundamentalism and the Rise of the Genoist Society’, Critical Quarterly, 42 (2000), 67-84.
2000 Dorothy Porter,‘The Healthy Body in the Twentieth Century’, in Roger Cooter and John Pickstone (eds), Medicine in the Twentieth Century, (Amsterdam, Harwood Academic Publications, 2000), 201-206.
2005/
1999 Dorothy Porter, Health, Civilisation and the State: a History of Public Health from Antiquity to Modernity (London, Routledge, 1999; 2005)
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