Author Archives: Michael Cournoyea

Michael Cournoyea

About Michael Cournoyea

Michael Cournoyea is a doctoral student at the IHPST at the University of Toronto. He received his BSc at McGill University in Biology and Philosophy and has worked at the intersection of these disciplines for the last five years. He currently works as a don at Victoria College and is active in student life on campus. His work examines the pluralism and politics of causal explanations in medicine -- whether biomedical, evolutionary, phenomenological, or sociological. The implications of his work are pragmatic, engaging issues in racialized medicine, the sovereignty of patient health, and how we should live the healthy life.

Is this the era of personalizable medicine?

Physicians are trained in a science of particulars. Your bodily experiences might be unique, your preferences deserving of personal care, and your history worthy of a docudrama… but the medical evidence at your bedside was gathered in a freeze-framed panorama: randomized, controlled, and blinded. This is the science of particulars: big-picture studies that have to be individualized for you. And me. This is evidence-based medicine.

But how does this landscape represent you — person and patient?

Lets begin with semantics. What’s the difference between patient-centered, person-centered, and personalized medicine?

Patient-centered medicine revitalizes a patient’s values, preferences, and autonomy. It brings respect for patient decisions back into the clinical equation.

Person-centered medicine treats patients as… persons. Persons can suffer, worry, and hope unlike their objectified and medicalized counterparts: diseased patients.

Personalized medicine aims to truly be that science of particulars: customizing diagnoses, treatments, and prognoses based on your unique biological (i.e. genetic) architecture. Your SNPs have so much to say.

Do any of these epistemic stances make medicine more than just personalized, but personalizable? I’m not so sure. Lets leave that up for debate.

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Weekly Roundup

McGill Office for Science and Society, developed and run by some of the most engaging chemistry professors, hosts a collection of news bulletins and informative content on the value of chemical knowledge in everyday life.

A Toronto statistician has cracked some kinds of Ontario scratch lottery tickets — statistics wins again.

Matthew Nisbet at Age of Engagement discusses embedding climate change education in TV programs. You know, like how every kids show would have an anti-smoking episode? Wow.

NASA’s Kepler observatory has been discovering new planets at a furious rate. Can we stop worrying about the environment yet Curtis?

No, then how about if we terraform Mars?

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Weekly Roundup

As reported by The Onion Radio News, the National Science Foundation has concluded that science is hard; the consensus comes nearly a decade after the Science is Hard Theorem was first published.

Sharpen your pencils and critical reading skills by tagging along with Matthew Nisbet in his course entitled ‘Science, Environment and Media’ offered at American University and online via Age of Engagement. So far only the syllabus and first assignment has been posted so it’s just the right time to join in! Or perhaps you would be more interested in Culture, Mental Health and Psychiatry.

According to Scientific American, Obama attempted to gather momentum in scientific innovation during his State of the Union address this week. The most demanding scientific quandaries need a Sputnik-like rallying-cry, whatever that might mean.

Interested in figuring out exactly where you are… without your handy Global Positioning System? Check out a recent post on The Renaissance Mathematicus and longitude will never be the same.

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Review: The Scientific Life by Steven Shapin: A Moral History of a Late Modern Vocation

In  The  Scientific  Life,  Steven  Shapin  argues  that  people  and  their virtues matter in late modern science. While scientists struggle to remain objective and impersonal, it is the personal, familiar, and charismatic–the traits once swept aside as vices by the scientifically virtuous–that have come to embody the “truth-speakers” of late modernity. With an enormous and  sometimes  daunting  wealth  of  primary  sources  (from  technical commentaries to his own sociological fieldwork), Steven Shapin breathes life  back  into  these  quotidian  virtues.  The  Scientific  Life  is  as  much a disjointed genealogy of scientific virtue as a reminder that trust still matters at the cutting-edge of scientific “future-making.” Shapin’s mastery of historical narrative is clear; anyone interested in the American scientific persona and how it has transformed in the twentieth century would do well to wade patiently through this thick and rewarding text. But hang up your expectations of historical linearity (and, sometimes, thematic coherence) as you weave through motley professionals, theorists, and critics drawn from over a century of science commentators. Perhaps this work is best described as textured: rich in detail, woven intricately, but hardly smooth to the touch.

Shapin begins by detailing the  transformation from science as calling to science as job in the late nineteenth and early twentieth century (chapters 1-3). During this period, the idea of science as vocation lost its impetus as the fruits of discovery became politically and economically valuable. Robert K. Merton’s sociology exemplified this shift, asserting that neither constitutional nor motivational differences existed between scientists and non-scientists.  The  Mertonian  “moral  equivalence”  of  the  scientist  (i.e. scientists  are  just  ordinary  folk)  eventually  displaced  Weber’s  “man  of science,”  in  whom  moral  authority  once  stemmed  from  a  merging  of curiosity and morality. The “spirited” scientist became the disinterested scientist, in personal convictions and professional identities. Despite the unclear origins of this “moral equivalence” (as Shapin prudently admits), a commitment to the idea persisted in the post-World War II era of “Big Science” and the military-industrial-academic complex.

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Does science hide in narrative?

Michael Cournoyea

Are our most emotive and personal forms of description — the story, confession, history, narrative — neglected by scientific thought? Or does science hide in narrative? We don’t expect scientists to tell us a tale in the meticulous detail of their publications; narrative is reserved for the scandals of memoirs, the courtroom appeal, and the patient’s history. Narrative may even be powerful in science education, but that doesn’t mean it’s essential to the scientific process. In last week’s debatable, Boaz Miller asked whether scientific knowledge is anything special. This week, I want to dig deeper to ask if narrative is essential to all forms of knowledge, including scientific knowledge. Tell me why, within or without a story…

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Can medicine revive the dying patient-as-subject?

Michael Cournoyea

Evidence-based medicine (EBM) has come to dominate medical epistemology. Whether you are designing a clinical trial, prescribing medication, or Googling an unusual symptom you will most likely encounter EBM: the new standard of medical knowledge. EBM aims to improve patient care by systematizing medical research in a hierarchy of ‘best evidence’. This hierarchy helps to streamline clinical guidelines in the face of an ever-growing literature and the subjective ambiguities of the clinical encounter. But ambiguities remain, and the most notable source of ambiguity is the patient. Since the early EBM movement in the 1990s – when EBM identified itself as a paradigm shift – the movement has struggled to incorporate patient subjectivities into its objective standards of evidence. 1

In its most recent incarnations, EBM seeks to balance a systematic approach with a patient-centered ethic. Patient preferences, values, narratives, and lived experience are ostensibly integrated into the clinical expertise and patients’ choice of the clinical encounter. At first glance, this integrative approach may seem inclusive and progressive, revitalizing the patient’s role and expertise in the management of her own health. Respect for autonomy and consent, it seems, is enough to prevent ‘slavish, cookbook approaches’ in dealing with individual needs and experiences.

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  1. In defining EBM, the Centre for Evidence Based Medicine currently emphasizes the need for both conscientious clinical expertise and current best evidence:

    Evidence-based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. … Good doctors and health professionals use both individual clinical expertise and the best available external evidence, and neither alone is enough. Without clinical expertise, practice risks becoming tyrannised by evidence, for even excellent external evidence may be inapplicable to or inappropriate for an individual patient. Without current best evidence, practice risks becoming rapidly out of date, to the detriment of patients. Evidence-based medicine is not restricted to randomised trials and meta-analyses. (http://www.cebm.net)

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Can science inform our use of animals?

Gary L. Francione, featured in the interview below, runs the blog "Animal Rights: The Abolitionist Approach"

This week’s debatable falls on Canadian Thanksgiving, when a large helping of friends, family, and pets gather to enjoy the autumnal colours, mild weather, and symbolically buttered turkey. For the vegans among us (baking the kale in the corner), Thanksgiving is not only a time for family and friends, but a time for awkward questions and strategic mealtime maneuvers.

For the scientifically-minded vegan, this is also a time to be quizzed on the nutritional science of plant protein, the evolution of human omnivory, and the carnal instincts of end-of-the-world culinary scenarios (would we eat a turkey to survive the apocalypse?). Around the dinner table, Science faces-off against Morality in a fight where most of the punches miss. Arguments invoke scientific facts and folklore between moral imperatives and utilitarian calculi. And Science has a strong left hook: global climate change, human nature, and agribusiness are almost always drawn into the ring. But lets leave those fights for another time.

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