Biomedical Platforms: Realigning the Normal and the Pathological in Late-Twentieth-Century Medicine (review)

Biomedical Platforms tells the story of changes in the classification of leukemia and lymphomas, brought about by the use of a Fluorescein Activated Cell Sorter (FACS) that employs monoclonal antibodies for immunophenotyping. The current interest in FACS led Peter Keating and Alberto Cambrosio to study the role of standardized and automated analyses in the organization of hospital-based medicine. Cambrosio and Keating's previous study, Exquisite Specificity: The Monoclonal Antibody Revolution (1995), investigated the rise of monoclonal antibodies technology. Biomedical Platforms adds a new dimension: the use of monoclonal antibodies as a diagnostic tool. As the title and the subtitle of this volume make clear, their new study—unlike the first one—is focused on biomedicine.

In the last thirty years numerous historians, sociologists, and anthropologists have become interested in new developments in medicine. However, the majority of these researchers have taken the entity "modern biomedicine" for granted; only a small minority have attempted to understand in depth what "biomedicine" is and how it works. Keating and Cambrosio belong to the latter category. Discussions on the present status and future trends of biomedicine are often conducted on a very general, and therefore very abstract, level. Biomedical Platforms is an excellent example of the kind of studies sorely needed to make ethical and political discussion on this topic more meaningful and more efficient. The book efficiently displays the importance of the recent "technological shift" in clinical medicine, and the key role of regulation—an activity at the intersection of science, medicine, politics, economy, and the law—in shaping scientific and medical practices.

Biomedical Platforms is an impressive achievement. Keating and Cambrosio creatively use a historical and comparative approach to enhance the understanding of present-day medicine. Observations, interviews, and historical studies made in Canada, the United States, and France highlight both the importance of globalization and the persistence of local and national differences. One important problem remains, however: their uses of the term "biomedical platform." The authors present that term as a magical device that will lead to an understanding of the true nature of present-day biomedicine. They describe medical platforms as a unique phenomenon that emerged from the growing automatization of clinical analyses, and, at the same time, as a fundamental analytic tool for the understanding of new developments in biology and medicine, and a distinct improvement over competing terms such as "molecularization," "infrastructures," "standardized packages," or "experimental systems."

The authors' tendency to overextend the use of the term "platforms" may reflect the unique characteristics of the specialty they studied—hematology. The history of hematology was always strongly (and uncharacteristically) linked with the research laboratory. Studies of blood proteins and blood cells were central to the development of biochemistry, immunology, and genetics. Other medical specialties often had more distant interactions with the laboratory, and it is reasonable to assume that in such specialties the knowledge generated by new technologies will not become as central to the understanding of disease process as it is in hematology. It is not sure that psychiatric or orthopedic practice will be shaped by tools provided by "biomedical platforms" in the same way that the classification of leukemia or the diagnosis of AIDS is.

To sum up, the main achievement of Biomedical Platforms is not the development of a general theoretical framework able to explain biomedicine everywhere, but the thoughtful and detailed study of a single case study that, as all good case studies do, successfully illuminates the whole. The book is highly recommended to anyone seeking to understand the rapidly changing universe of present-day biomedicine.