[Diabetes and developments in data-intensive care: self-regulation turns patients into professionals]. / Gaat data-intensieve zorg onze omgang met ziekte veranderen?

In addition to progress, medical-technological innovations often involve transformations, for example in the conceptualization and experience of disease(s). A historical example is the rise of self-regulation by diabetes patients in the 1970s and 1980s. Textual analysis of Diabc, the monthly magazine of the Diabetes Vereniging Nederland (DVN), shows that the introduction of self-testing and self-regulation was not only very welcome for many DVN members, but also brought about a qualitative change in their views of diabetes and themselves. They continued to present themselves as 'healthy', 'normal' and 'independent', but that was no longer based on their disciplined adherence to prescriptions from doctors and dietitians. They had now become 'professionals' themselves, who practiced 'diabetes as a profession'. Some interesting parallels can be drawn between this historical case and current data-intensive care. This illustrates that historical reflection, by analogical reasoning, can be helpful when questioning current medical-technological developments.

'If it can't be coded, it doesn't exist'. A historical-philosophical analysis of the new ICD-11 classification of chronic pain.

Chronic pain entails a large burden of disease and high social costs, but is seldom 'in the picture' and barely understood. Until recently, it was not systematically classified but instead viewed as a symptom or sign. In the new International Classification of Diseases, (ICD)-11, to be implemented in 2022, 'chronic' pain is now classified as a separate disease category and, to a certain extent, approached as a 'disease in its own right'. Reasons that have been given for this are not based so much on new scientific insights, but are rather of pragmatic nature. To explore the background of these recent changes in definition and classification of chronic pain, this paper provides a historical-philosophical analysis. By sketching a brief history of how pain experts have been working on the definition and taxonomy since the 1970s, we demonstrate the various social and practical functions that underlie the new ICD-11 classification of chronic pain. Building on this historical-empirical basis, we discuss philosophical issues regarding defining and classifying chronic pain, in particular performativity and pragmatism, and discuss their implications for the broader philosophical debate on health and disease.

[From instrument to technological medicine; the medal collection of the Dutch Journal of Medicine]. / Van instrument naar technologische geneeskunde.

The Dutch Journal of Medicine holds a unique and comprehensive collection of commemorative medals. In the autumn of 2018, the journal arranged an online exhibition to display an extensive part of the collection and incorporated these objects into a wider historical context. This article presents a description of part ofthe web exhibition. In the light of Willem Einthoven's (1860-1927) work, we argue that around 1900 the first signs of technological medicine were becoming apparent. By focusing on a small number of medals, in this article we describe how the increasing importance of applied technology in medicine is reflected in the self-representation of the medical specialties that were beginning to emerge during the same period.

[Medical history in the information age; new impetus for the section 'Historical perspective' in the Dutch Journal of Medicine]. / Medische geschiedenis in het informatietijdperk. Nieuw elan voor de rubriek 'Historisch perspectief'.

Over the past half century, medicine has evolved into 'informational medicine'. Physicians today no longer necessarily have to possess specialist knowledge, but have to know how to access this knowledge. This means that it is important that they do not just 'grab' for loose bits of information, but systematically and judiciously search for relevant knowledge. Medical-historical insights could be helpful, alongside critical-appraisal skills. Medical knowledge has a certain structure that has developed historically under the influence of assumptions (some implicit), presuppositions and social forces and interests. By exposing this underlying structure, medical history provides an overview of and insight into relationships within medical knowledge and practice. Now in particular, in the current age of information and disinformation, there is a great need for such 'overviews'. This offers opportunities for the revitalization of the 'Historical perspective' section in the Dutch Journal of Medicine (NTvG), especially if this section evolves into a shared platform for physicians and historians.

[David Sackett and 25 years of evidence-based medicine: person and the context]. / David Sackett en 25 jaar evidencebased geneeskunde: Individu en context.

David Sackett, the father of evidence-based medicine (EBM), died recently - exactly 25 years after the term EBM was coined. This coincidence calls for reflection on the historical significance of EBM and on Sackett's role. The rise of EBM appears to be part of a much broader development: a shift from 'trust in the experts' to 'trust in numbers' that occurred under the pressures of the socio-political conditions of the late twentieth century. Insight into this historical context contributes to a better understanding of the emergence, merits and weaknesses of EBM and of the current tensions between medical professionals and insurers. However, context alone does not explain everything; the course of history - and the history of EBM - is partly determined by special men and women, individual reformers who manage to set things and people in motion. David Sackett is an excellent example of this.

[Smoking in a risk society: 50 years after the Surgeon General's report]. / Roken in een risicocultuur: 50 jaar na het rapport van de 'Surgeon General'.

Exactly 50 years ago, the U.S. Surgeon General explicitly warned about health damage caused by cigarette smoking. His 1964 report is often regarded as a definitive breakthrough in the battle against lung cancer. This report is worth remembering, not so much as a milestone of medical progress, but rather as marking the origin of new disease patterns and a new health culture. As such, the report may prompt reflection on the foundations of our healthcare system and the mission of medicine in the 21st century.

[The pendulum, the gap, and the clinic. Leendert Bouman (1869-1936) and the 'psychological turn' in Dutch psychiatry]. / De pendel, de kloof en de kliniek. Leendert Bouman (1869-1936) en de 'psychologische wending' in de Nederlandse psychiatrie.

In recent historical literature, the Dutch psychiatrist Leendert Bouman (1869-1936) is named 'the godfather of psychological psychiatry'. He is regarded as one of the exponents of a shift or 'pendulum' movement from a biological-materialistic to a psychological, phenomenological orientation in the Dutch psychiatry of the Interbellum. As a professor of the orthodox calvinist Vrije Universiteit of Amsterdam, he explicitly opposed a 'soul-less', biological-reductionist psychiatry. In addition, he played an important part in the introduction and spread of new'psychological' theories and especially Karl Jaspers' phenomenology in The Netherlands. It is one-sided and misleading, however, to refer to Bouman as a 'psychological' psychiatrist. Most of his scientific work was of a neurological and biological nature. He did not see biological (or nomothetic) and psychological (or idiographic) approaches as mutually exclusive, but as necessarily complementary. In this he followed Jaspers' distinction between and complementary use of the causal connections of psychic life (explanatory psychology) and meaningful psychic connections (psychology of meaning). Boumans pluralist orientation was rooted in his fundamentally clinical attitude toward psychiatry. In his view, a psychiatrist was in the first place a clinician. In the clinic, he stressed, a psychiatrist has to view and examine each individual patient in his bio-psycho-social totality. The case of Bouman illustrates that the history of psychiatry is by far richer and more complicated than is suggested by the standard account of that history being characterized by a pendulum movement and a one-dimensional struggle between 'somatic' and 'psychological' schools. It also suggests that the interaction between theory and clinical practice should be emphasized as an important dynamic factor in the history of psychiatry--next to or even above the dichotomy between 'biology' and 'psychology'.