: Individualized Medicine from Antiquity to the Genome Age Instructors: Nathaniel Comfort Gianna Pomata

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1 : Individualized Medicine from Antiquity to the Genome Age Instructors: Nathaniel Comfort Gianna Pomata Course description In this course, we will examine the history of individualized diagnosis and treatment, as well as different concepts of the individual and their impact on medical practice and healthcare, from the ancient Greeks to the present day. While the concept of individuality spans the entire Western medical tradition, some aspects of it have remained remarkably constant; others have evolved, taking on new meanings in different social, intellectual, and technological settings. This course will explore the various meanings of individuality in medicine and health policy through the centuries, with particular attention to the following issues: the tension between concepts of disease centered on the individual patient and concepts of disease based on population, as well as the tension between environmental and hereditary views of illness; the longevity, persistence, and reinvention of key concepts such as individual constitution or diathesis ; the tension between a scientific view of medicine and a focus on individuality; the significance of thinking with cases in medical theory and practice, and the changing role of the case history as a fundamental site of attention to the individual patient; the repeated redefinitions of individuality by different biomedical specialties, including immunology, genetics, and reproductive physiology; the impact of biomedicine on related concepts such as personhood, the self, and identity; genetic individuality as a principle of medical care and pedagogy, and as a branding tool in the expanding global medical marketplace. The course will be organized as a seminar, with a mix of lectures, class discussion and class presentations of selected readings. Students are encouraged to develop a research project to present as a final paper. Guidelines for the final paper will be distributed in class. Evaluation will be based on class participation, including short written assignments (40%), and on the final paper (60%).

2 2 Syllabus Week Date Title Readings 1 1/25 Framing the issue: individualized medicine in historical perspective 2 2/1 Concepts of disease: specific entity or individual sickness? 3 2/8 Individualized medicine in the Hippocratic and Galenic tradition Comfort, Putting the Person in Personalized Medicine at 29/putting-the-person-in-personalized-medicine/ Marcel Mauss, A category of the human mind: the notion of person, the notion of self in The Category of the Person: Anthropology, Philosophy, History, ed. M. Carrithers, S. Collins, S. Lukes, Cambridge 1985 (first pub. 1935), pp N. J. Allen, The category of the person: a reading of Maussʼ last essay, in The Category of the Person: Anthropology, Philosophy, History, ed. M. Carrithers, S. Collins, S. Lukes, Cambridge 1985, pp O. Temkin, The Scientific Approach to Disease: Specific Entity and Individual Sickness, in Temkin, The Double Face of Janus and Other Essays in the History of Medicine, Baltimore, 1977 (first pub. 1963), pp SOURCE: Rufus of Ephesus, Medical Questions, (a 1st/2nd century AD text on how to interrogate the patient to reconstruct what weʼd now call anamnesis ), excerpts from Arthur J. Brock, Greek Medicine, New York 1929, pp Erwin Ackerknecht, "Diathesis: The Word and the Concept in Medical History", Bulletin of the History of Medicine 56 (1982), pp G. R. Burgio, "Diathesis and Predisposition: The Evolution of a Concept." European Journal of Pediatrics, 155, no. 3 (1996), pp Robert C. Olby, Constitutional and Hereditary Disorders, in Companion Encyclopedia to the History of Medicine, ed. W. F. Bynum and R. Porter, London, 1993, vol. 1, pp SUPPLEMENTARY (optional): Danielle Jacquard, De crasis à complexio: note sur le vocabulaire du temperament en latin medieval, in D. Jacquard, La science médicale occidentale entre deux renaissances, Ashgate,

3 3 4 2/15 The philosophical problem: is a science of individuality possible? 5 2/22 A revival of individualized medicine in early modern Europe. 6 2/29 Individualized medicine in crosscultural perspective: a comparison of early modern Europe and China. 7 3/7 An individualized science of the soul? Individuality in the history of psychology and psychiatry. 1997, pp st assignment: preliminary proposal due John Forrester, if p, then what? Thinking in cases, in History of the Human Sciences, 9/3 (1996), pp Rachel Ankeny, Using cases to establish novel diagnoses: creating generic facts by making particular facts travel together in Peter Howlett and Mary S. Morgan, eds., How well do facts travel? The dissemination of reliable knowledge, Cambridge (2011), pp W. L. Straus Jr. and O. Temkin, Vesalius and the Problem of Variability, in Bulletin of the History of Medicine, 14 (1943), pp Nancy G. Siraisi, Vesalius on Human Diversity, Journal of the Warburg and Courtauld Institutes, 57 (1994) pp Gianna Pomata, Sharing Cases: the Observationes in Early Modern Medicine, in Early Science and Medicine, 15/3 (2010) pp nd assignment: preliminary bibliography due Charlotte Furth, Producing Medical Knowledge through Cases: History, Evidence, and Action in Thinking with Cases: Specialist Knowledge in Chinese Cultural History, ed. Charlotte Furth, Judith T. Zeitlin, and Ping-chen Hsiung, Honolulu: Univ. of HawaiʼI Press, 2007, pp Ping-Chen Hsiung, Facts in the Tale. Case Records and Pediatric Medicine in Late Imperial China in Thinking with cases, pp Andreas Gailus, A Case of Individuality: Karl Philipp Moritz and the Magazine for Empirical Psichology, in New German Critique, 79 (2000), pp Ruth Leys, Adolf Meyerʼs Life Chart and the Representation of Individuality, in Representations, (1991), pp Ian Hacking, Rewriting the Soul. Multiple Personality and the Sciences of Memory, Princeton, 1995, pp

4 4 8 3/14 Chemical individuality: inborn errors 9 3/21 Immunological individuality: self/non-self 10 3/28 The individual and the population 11 4/4 Easter SUPPLEMENTARY (optional): Andrew M. Fearnley, Primitive Madness: Rewriting the History of Mental Illness and Race, in J. Hist. Med. and Allied Sci., 2, 2008, pp Garrod, Archibald Edward. "The Huxley Lecture on Diathesis." British medical journal 2, no (Nov ): Garrod, Archibald Edward. "Chemical Basis of Individuality." Chap. 2 In The Inborn Factors in Disease; an Essay Oxford: The Clarendon Press, Haldane, J. B. S. "Biochemistry of the Individual." In Perspectives in Biochemistry Cambridge: Cambridge Univ. Press, Scriver, C. R. "Inborn Errors of Amino-Acid Metabolism." British Medical Bulletin 25, no. 1 (1969): rd assignment: revised proposal due Tauber, A. I., and S. H. Podolsky. "Frank Macfarlane Burnet and the Immune Self." Journal of the history of biology 27, no. 3 (1994): Burgio, G. R. "Commentary on the Biological Self: Toward a ʻBiological Ego.ʼ From Garrod's ʻChemical Individualityʼ to Burnet's ʻSelfʼ." Thymus 16, no. 2 (Sep 1990): Tauber, A. I. "Moving Beyond the Immune Self?". Seminars in immunology 12, no. 3 (Jun 2000): doi: /smim Galton, Francis. Natural Inheritance. London: MacMillan, 1889, chap. 10, pp Childs, Barton. "Garrod, Galton, and Clinical Medicine." Yale Journal of Biology and Medicine 46, no. 4 (1973): Mendelsohn, J. Andrew. "Medicine and the Making of Bodily Inequality in Twentieth-Century Europe." In Heredity and Infection: The History of Disease Transmission, New York: Routledge, 2001, pp th assignment: revised bibliography due

5 5 12 4/11 Personhood and the new reproductive technologies 13 4/18 Personalized genomic medicine 14 4/25 The individual stakeholder: genes to society 15 5/2 Synthesis Discussion Amer, M. S. "Breaking the Mold: Human Embryo Cloning and Its Implications for a Right to Individuality." UCLA law review. University of California, Los Angeles. School of Law 43, no. 5 (Jun 1996): Hoyer, K. "Conflicting Notions of Personhood in Genetic Research." Anthropology today 18, no. 5 (Oct 2002): Brock, D. W. "Human Cloning and Our Sense of Self." Science 296, no (Apr ): doi: /science McKusick, Victor A. "The Anatomy of the Human Genome: A Neo-Vesalian Basis for Medicine in the 21st Century." JAMA 286, no. 18 (2001): Snyderman, R., and R. S. Williams. "Prospective Medicine: The Next Health Care Transformation." Acad Med 78, no. 11 (2003): Shastry, B. S. "Pharmacogenetics and the Concept of Individualized Medicine." The pharmacogenomics journal 6, no. 1 (Jan-Feb 2006): doi: /sj.tpj Auffray, C., D. Charron, and Leroy Hood. "Predictive, Preventive, Personalized and Participatory Medicine: Back to the Future." Genome medicine 2, no. 8 (2010): 57. Childs, Barton. Genetic Medicine: A Logic of Disease. Baltimore: Johns Hopkins University Press, 1999, chaps Davis, J. C., P. Ma, and S. Sutaria. "The Microeconomics of Personalized Medicine." McKinsey Quarterly 2010 (Feb 2010): doi: /nrd2825. Unpublished documents from curriculum reform committee, Genes to Society course, JHUSOM. Final paper due

HISTORY 249 HEALTH AND THE HEALER IN WESTERN HISTORY. Prof. F. Wallis/Prof. T. Schlich Fall term 2012 Tuesday/Thursday 11:35 AM-12:55 PM Leacock 26

HISTORY 249 HEALTH AND THE HEALER IN WESTERN HISTORY Prof. F. Wallis/Prof. T. Schlich Fall term 2012 Tuesday/Thursday 11:35 AM-12:55 PM Leacock 26 CONTACT INFORMATION Office hours: (1) Prof. Schlich, Tuesday