Technology and Medicine

Technology and medicine are deeply interconnected fields that have evolved significantly over centuries, impacting healthcare practices and societal structures. The origins of this relationship can be traced back to ancient physicians like Hippocrates and Galen, whose ideas dominated medical knowledge until the eighteenth century. The establishment of research universities marked a turning point, combining education and innovation, particularly in anatomy and physiology. The emergence of modern science and industrialization in the nineteenth century further transformed medicine, introducing electrical technologies and pioneering discoveries such as antibiotics and DNA manipulation.

As technology advanced, the clinical perspective shifted towards a molecular understanding of health and disease, raising ethical concerns about biotechnological interventions at the genetic level. This shift has led to debates on whether medical research should primarily occur in clinics or laboratories, reflecting contrasting approaches to patient care and scientific experimentation. Recent developments, including telemedicine and robotic surgery, showcase how technology can enhance surgical precision and patient access. However, these advancements also highlight disparities in healthcare access, often influenced by socioeconomic factors. As pharmaceuticals increasingly focus on enhancing quality of life rather than curing diseases, ethical discussions in biopolitics, neuroethics, and medical ethics are more pressing than ever, underscoring the need for a thoughtful approach to the integration of technology in medicine.

Published in: 2023

By: Stingl, Alexander

Subject Terms

Technology and Medicine

Abstract

The development of technology, medicine, and social structures has been intertwined since the creation of the research university in the eighteenth century. One of the most significant changes has been the transformation of the clinical perspective to the molecular perspective. The challenge lies, therefore, in the ethical implications of the development of biotechnologies that can change the human organism on a genetic and molecular level.

Overview

It is not easy to decide where to begin a history of science, especially when speaking about the relations between medicine, society, and technology. One could begin with the first classical physicians, Hippocrates (ca. 460 BCE–379 BCE) and Galen (ca. 129 CE–216 CE). Indeed, into the mid-eighteenth century, the pendulum of medical wisdom swung between these two names since knowledge until that time had to be proven by reference to a classical text.

In the history of medicine, Galen is known not only as the first practitioner with vast anatomical knowledge but also for performing difficult operations requiring the use of sophisticated instruments. He is even reputed to have undertaken the first brain surgeries (Toledo-Pereyra, 1973). For centuries, his and Hippocrates's ideas were most often referred to as the defining criteria of all medical knowledge. Up to the mid-eighteenth century, much progress was made in the application of instruments, devices, and drugs that would, in many ways, have been readily available for scholars in line with Galen or Hippocrates.

However, another beginning could be made in the nineteenth century, when modern science was combined with industrialization, and technology came to the forefront with the emergence of electricity. Other accounts could focus on the discovery of penicillin or make the case that with the discovery of DNA, a new age dawned in which life could increasingly be directly manipulated, thus pinpointing the decisive moment in medical development to the twentieth century.

However, the incident that may have been most crucial for the development of medicine, and subsequently the use of technology in medicine, came in 1737, when the newly founded University of Goettingen persuaded the famous anatomist Albrecht von Haller to become one of the key figures of its faculty. While at the university, von Haller pioneered an important innovation in the education system by combining both research and education within his professorship (Lenoir, 1981a; Cunningham, 2002, 2003).

From that time forward, in ways they never had before, students lived and worked in close proximity to the creation of knowledge and the innovative application of instruments. For two elemental fields of medical knowledge—anatomy and physiology—this resulted in a spurt in knowledge creation, and by the end of the century, knowledge about physiology had exploded at such a rate that the scientific vocabulary could not keep up. Toward the end of the century, physiologists and anatomists—on the verge of creating the ultimate life science, biology—resorted to the language of the new critical philosophy of Immanuel Kant to find ways of expressing their findings (Lenoir, 1981; Stingl, 2008). It was this course that prepared the way for the breakthrough development of medicine.

Birth of the Clinic. After the emergence of anatomy and physiology, the next important step certainly was the "birth of the clinic" and the emergence of the clinical gaze, as it was called by Michel Foucault (1963). Following the French Revolution, two developments set in: the myth of a nationally organized medical profession and the myth that in an untroubled, and, therefore healthy society, disease would disappear. The effort to realize these two myths, Foucault claimed, rendered the medical doctor a politician. The doctor's gaze became a force; the doctor, considered all-wise, could see through the veil that covered the eyes of normal men and see the underlying reality. The effectual change from ancient to modern times thus lay not in a transformation of this idea of the doctor as wise but in the theory behind it.

As scientific research increased during this period, knowledge was increasingly perceived as fragile and dynamic. With the installation of the clinic, however, an abode was created for the accumulation of knowledge and its changes. The clinic was also storage for the technological devices employed in modernity. When the clinic was then turned into a facility for research and education as well, it became the prime force behind medical innovation.

Genetics & Biotechnology. This turn was amplified by the emergence of genetics and biotechnology, where the anonymous laboratory became a second stage for the creation of what can be called biopolitics, a political system in which populations' bodies are subject to government control.

Nikolas Rose has argued that as of the early twenty-first century, doctors, clinicians, and researchers have essentially changed their gaze (2007). While most people are still tied to the molar or somatic level, clinicians and experimenters view the human organism as a DNA-based bio-chemical system that needs to be optimized. They have, according to Rose, a molecular gaze rather than a clinical gaze (2007).

Applications

The Clinic versus the Laboratory. Whether the clinic or the laboratory is the main stage for the development of medical research and technology—and whether the two should be integrated into one site—has been disputed. In the history of physiology, anatomy, neurology, medicine, and psychology, the distinction between the practices of the clinic and the laboratory continued throughout the nineteenth century. Clinicians would not trust "artificial" lab results, while experimenters shunned the individualized experiences and ideas of clinical practitioners as lacking validity and universality. Pitted against each other by their own versions of objectivity and naturalism, clinicians and experimenters divided and reunited time and again.

This theme was repeated in the narrative structure of medical discourse and the technological development of medicine. In the early decades of the twentieth century, the discourse involved renowned scholars from related fields like Lawrence Henderson and Walter Cannon, whose experimental works in physiology became seminal. Henderson, an "occasional sociologist," is also credited with, at least in part, having introduced the idea that the patient-doctor relationship must be described in terms of "an equilibrating social system" (to apply the terminology of Vilfredo Pareto) in which the doctor helps the patient return to normal functioning within society. Whether Henderson or his younger Harvard colleague Talcott Parsons (who worked on the idea around the same time and had approached Henderson for advice on his project) was the actual author of this idea is not entirely clear, but both men used it in their lectures (Stingl, 2008). Parsons introduced the idea that a patient must be seen as occupying a social role, the sick role. Changes in technology, therefore, can be described in regard to the changes in the sick role as part of the social system in which it is embedded. This took a new turn in the 1960s in American medicine when critical scholars began arguing that progress in medical technology does not necessarily translate into better health care for everyone. Quite the contrary, it can lead to a widening of the gap between social classes, with only the wealthy able to afford expensive new treatments and the poor unable to receive other, less expensive treatments because medical progress has made them obsolete.

Certainly, surgical medical technology has already progressed to a stage that not long ago was considered science fiction. The classic idea of the surgeon's job being equitable to that of a "butcher with precision" has become outmoded due to the evolution of less invasive surgical instruments. Contemporary surgeons may employ micro-surgery and robots, as well as telemedicine, a technique in which the surgeon is not even in direct contact with the patient but controls a robot from some other location. These developments require more than just a steady hand and knowledge of human anatomy; they also necessitate that surgeons keep up with the fast-paced changes of computers and software tools. The latest developments in medical technology seem to realize the dream of nano-surgery, which allows the direct manipulation of single tissue cells or neurons. To keep pace with all of these developments, surgeons' education and training has had to change.

Medication & Drugs. One of the most major changes in the late twentieth and early twenty-first centuries is the industry around, and the application of, medication and drugs. The traditional model of campus-based academic research is long past. While governments still finance much research taking place at universities and state-run laboratory facilities, the bulk of research is done either at pharmaceutical companies or, at the very least, largely financed by these companies, even if the research does occur on college or university campuses. A major difference in this regard between Europe and the United States must be taken into account since, in many European countries, higher education is state-sponsored, while in the US, many facilities of higher education are private entities with their own economic interests at heart. This also means that researchers in European countries, such as Germany, cannot benefit in the same way from the profits garnered by their innovations.

The use of drugs and medication has also been subject to change. Pharmaceuticals are now often used not to cure or treat an illness but to improve conditions of life and livelihood. Whether used for enhancement (e.g., sexual or sports performance) or to overcome a cognitive disability, new drugs have enabled individuals to intentionally intervene in their own neuro-chemical processes, thus re-creating personhood in the image of neuro-chemical selves, as Nikolas Rose (2007) has argued.

Biopolitics. This recreation of the self is being increasingly addressed within the field of biopolitics, which, according to Michel Foucault, describes the technologies of power or style of government that regulate a population by disciplining its biological aspects. Beginning in the eighteenth century, these technologies began emerging in the form of dispositives of power/knowledge that account for the possibility of modifying and controlling the processes of life or the living being. In light of biopolitics and in the wake of Foucault, Giorgio Agamben has argued that one must therefore distinguish between bios (the biological/organic life) and zoe (which is life itself, purposeful and, to some degree, can be called the "spiritual life").

Developments in technology have also opened access to the "inner self" in another way, namely through devices such as Computed Axial Tomography (CAT), Positron Emission Tomography (PET), and (functional) Magnetic Resonance Imaging (fMRI). Having come a long way from the classic X-Ray, these technologies enable a wealth of insight into the body, even into the processes of the human brain. While some enthusiasts hope that it will one day be possible to even read minds by the use of these technologies, interpreting the images these technologies deliver is often as complicated as interpreting a literary classic, as Joseph Dumit has illustrated with PET scans (2004).

Viewpoints

Developments in medical technology spur dreams in other directions also. Members of the posthumanist or transhumanist movement believe that the salvation of the human race lies in the technological augmentation of the human body, whether it is through memory chips that transfer human consciousness into computers or through the creation of cybernetic organisms (cyborgs). Technological developments in the twenty-first century, at the very least, point to innovations that will replace lost limbs or equip blind people with nearly perfect artificial eyes.

At the same time, access to the genetic makeup of human beings has created a situation where certain physical or mental impairments can be discovered before birth through prenatal diagnosis and treated at a very early stage. In other cases, parents can choose not to have a child because of the likelihood of it having an impairment. These developments have incited heated debates in the field of bioethics in the past decades, as Fox and Swazey (2008) have recounted.

Social Effects of Medical Technology. The development of less- or non-invasive surgeries has had several social effects. First of all, it requires different kinds of training for doctors. Beyond medical training, an ever higher rate of "computer literacy" has to be considered a prerequisite for medical practice. This puts an older generation of surgeons at a disadvantage as well as prospective doctors and students from developing countries or of lower social classes.

But this question, which certainly falls into the realm of social justice, not only affects those who may be excluded from medical education but also, to an even larger degree, affects patients' access to medical care, including their choice of doctor. For example, the Internet has made it also possible for patients to consult with experts worldwide, and even surgery can be undertaken remotely from any location in the world by the application of robot arms, but these technologies are also available only to those who have the information and resources to access them.

Another important player in medical development is the advance of pharmaceutical companies. A multi-billion-dollar business, the pharmaceuticals market is one of the most profitable in the world. These corporations are the most important source of financing for medical research and have faced criticism for their influence on scientific studies on the effectiveness and side effects of medications and their political lobbying efforts. Critical voices such as David Healy have made a case against the new "medical oikumene" of researchers, government, and the pharmaceutical industry, with pharmaceutical companies often commissioning ghostwriters to write articles published under the names of renowned researchers (2004).

Increasingly, patients are turning toward alternative medicine. Though Asian healing traditions are often either overestimated or discounted, thorough scientific investigation reveals that they can have genuine benefits. Body disciplines such as yoga or Qi-gong can help attune the senses to the body, helping individuals locate pain or sub-optimal functioning long before the damage becomes permanent or life-threatening, thereby also making these practices cost-effective. In cases of children with ADHD or autism spectrum disorders (see Levenson), practicing Aikido has proven to be an effective technique for improving motor and social skills.

An important issue in medical ethics is the question of human test subjects. Since pharmaceuticals are a competitive business and, at the same time, safety regulations demand ever higher numbers of participants to increase reliability and validity, testing new drugs on human subjects has become more precarious for pharmaceutical companies. Many turn to developing countries, where they can find large numbers of willing subjects who will accept small financial compensations. These subjects are also "medication naïve," meaning that they have not previously been exposed to similar medication and are, therefore, better test subjects. Of course, this outsourcing of human testing is not without ethical concerns. Critics of pharmaceutical companies have questioned whether test subjects are apprised of what they are actually agreeing to participate in and whether experimental treatments undertaken in developing countries are unnecessarily dangerous to test subjects.

Terms & Concepts

Bioethics: Ethical concerns regarding human subjects.

Biopower: A term introduced by Michel Foucault to describe a technology of power that states apply in order to govern a population by subjugating the body itself to the discipline and regulative regime of biopolitics.

Functional Magnetic Resonance Imaging (fMRI): Technology that measures brain activity by recording changes in blood oxygenation and blood flow within the brain in response to certain stimuli. The images produced by fMRIs are subject to interpretation, however, and the technology is somewhat imperfect as there can be a temporal gap of up to a second between a stimulus and the observed reaction in the blood flow.

MRI: Magnetic Resonance Imaging (MRI) makes use of the magnetic specificity of elements in the human body to create images of the internal structures and functions of the body, offering an imaging technique similar to, but more clear than, Computer Tomography.

Neuroethics: The ethical questions raised by modern neurology and its capacities to not only provide an insight into the processes of thought, putting into question the idea of autonomy but also of manipulating mind and memory through enhancement drugs.

Positron Emission Tomography (PET): Like MRI and fMRI, PET is an imaging technique that makes visible certain processes occurring within the body. For this purpose, a slightly radioactive substance is introduced into the body to travel through the bloodstream. Given a certain stimulus, the bloodstream can then be mapped, producing an image of the region of activity.

Sick Role: In his 1940 lectures on medical sociology, Harvard sociologist Talcott Parsons (1902–79) introduced the concept of the sick role, which he later wrote about in The Social System (1951). Being sick, from this perspective, is for the patient, not simply a matter of fact, but rather comes with a set of social expectations that constitute an actual role in society. In this role, the sick person is exempted from other roles in society (e.g., their role at work or in the family) and considered to not be responsible for their condition. On the other hand, a sick person is expected to actively pursue treatment and seek out expert help.

Bibliography

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Technology and Medicine

On this Page

Subject Terms

Technology and Medicine

Abstract

Overview

Applications

Viewpoints

Terms & Concepts

Bibliography

Suggested Reading