Biomedicine

Biomedicine is the name given to a form of western professional medicine that asserts that illness is largely caused by deviations from universal biological norms. For most of the past century, this approach to medicine has been the standard for evaluation of all other approaches, whether popular or professional. Biomedicine assumes that illness and medical theory, science and practice, are acultural and have universal validity.

Research in the latter quarter of the 20th century has led to a reformulation of biomedicine within anthropology and, to a lesser extent, within sociology. Our recognition of the cultural bases of biomedical theory and practice has led to an understanding of biomedicine as a professional ethnomedicine, not an objective medical standard against which all other systems are measured. Medical knowledge can present problems,“facts” given by research or nature.

Before the 1980s, anthropologists considered western medicine to be of an entirely different order than medicines of other cultures. They applied the term ethnomedicine to other, nonwestern medical systems, and they referred to biomedicine as scientific, modern, cosmopolitan, or simply medicine. While the term western medicine differentiated biomedicine, the other terms clearly indicated anthropologists' negative assumptions about nonwestern medicines.

Attendant upon the use of a dichotomy differentiating ethnomedicine and (bio)medicine was another, implicit contrast: the distinction between ineffective and ephemeral “beliefs” found in nonwestern medicines and the perceived “knowledge” of western medicine. In the late 1970s and early 1980s, researchers such as Good,DelVecchio, and Kleinman shattered the perception of biomedicine as acultural, rational, and scientific. They found that extra-medical domains of culture were intimately bound up with the theory and practice of medicine. These domains include systems of social classification (ethnicity, race, gender, age, religion, class, rurality, and so on),self-concepts, prestige, competition, kinship and friendship, personal advancement, ritual, and magic.

Biomedicine is heterogeneous, in contrast to the scientific ideal. It is locally construed, constructed, and practiced, that is, “many medicines” and not a single enterprise.

Although science is basic to medicine, researchers have demonstrated that science itself is a cultural endeavor, thus joining colleagues in the philosophy and history of medicine and science with critical studies of the sciences that medicine applies. These studies often come from cultural, often interpretive, perspectives and are appropriately labeledcultural studies of science.

The term biomedicine eliminates the implicit hierarchy of earlier terms and highlights the equally professional nature of many nonwestern medical systems and their schools, licensing, pharmacopoeia, texts, divisions of labor, domains, forms of practice, specialties, hierarchies, and technologies. Each ethnomedical system exhibits a culturally specific formulation of human biology, that is alocal biology rather than a universal one. This concept of local biology addresses the very different conceptualizations of human physiology encountered in professional medicine and makes sensible divergences in diagnoses and therapies as well as illness. Racialized and gendered local biologies figure prominently in this research.

Today, studies of biomedicine emphasize interpretation, discourse, experience, suffering, and meaning, although some adhere to materialist perspectives. In the contemporary interpretive view, the “bio” in biomedicine is a form of materialism that constitutes its greatest failing in the face of human suffering. [Page 371]Anthropologists with this view see illness in categorical, transpersonal, and decontextualized terms. Ironically, most physicians hold that the biological focus is biomedicine's strength.

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