Medical expertise in the 20th and 21st century Medizinische Expertise im 20. und 21. Jahrhundert L'expertise médicale aux 20e et 21e siècles

Schweizerische Gesellschaft für Geschichte der Medizin und der Naturwissenschaften Société suisse d'histoire de la médecine et des sciences naturelles Swiss Society for the History of Medicine and Sciences Annual meeting / Jahrestagung / Colloque annuel Medical expertise in the 20th and 21st century Medizinische Expertise im 20. und 21. Jahrhundert L'expertise médicale aux 20e et 21e siècles September 5 6, 2013 Lecture Hall 3 (Sahli) Inselspital Bern (Bern University Hospital) with the support of Swiss National Science Foundation Swiss Academy of Sciences

Programme / Programm Thursday September 5 th 14.15-14.30 Hubert Steinke (Bern) Welcome / Introduction 14.30-15.30 Introductory keynote lecture Thomas Broman (Madiscon, Wisconsin) Dysentery and Prejudice: Johann Georg Zimmermann and Medical Expertise in the Swiss Epidemic of 1765 Coffee break 16.00-16.45 Alexa Geisthövel (Berlin) "Answer to ill-conceived questions in a scientific way. Medical expertise on working ability in the 1920s and 1930s 16.45 17.30 Iris Ritzmann (Zürich) Ärzte als Gatekeeper für Fremdplatzierungen? Break 18.30 20.30 Podiumsdiskussion der Schweizerischen Ärztezeitung Sind Ärzte noch die Experten in der Medizin? Prof. Heinz Bonfadelli (Medienforscher, Zürich) Dr. Christoph Bosshard (Zentralvorstand FMH) Prof. Daniel Candinas (Viszeralchirurgie, Inselspital) Dr. Brigitte Muff (Chefärztin Bülach) Dr. Maya Shaha (Direktion Pflege, Inselspital) Leitung: PD Dr. Eberhard Wolff (SÄZ-Redaktor) Apéro riche

Friday September 6 th 09.00 09.45 Kathryn Schweishelm (Berlin) Carving out a Practice: Plastic Surgery and the Rhetorical Construction of the Expert Post WWI 09.45 10.30 Tanfer Emin Tunc (Ankara) Fixing the Fetus: Prenatal Surgery and the Medical Expertise in the United States Coffee break 11.00 11.45 Silja Samerski (Oldenburg) From Doctor Knows Best to Patient Decides Best: How Risk Medicine Undermines the Physician's Judgment 11.45 12.30 Rodney H. Jones (Hong Kong) Digital Technology and the Future of Expertise: Constructing Expertise in Online Discussions of Genetics Lunch 14.00 14.30 Lukas Engelmann (Zürich) The Stabilization of Medical Knowledge in the AIDS-crisis 14.30 15.00 Stéphanie Pache (Lausanne) Débat sur le Delusional Dominating Disorder et son inclusion dans le DSM-IV: quelle(s) expertise(s) pour définir la santé mentale? 15.00 15.15 Presentation of the Henry-E. Sigerist Prize for the promotion of young scholars in the history of medicine and science 2013 Coffee break 15.45 16.45 Guggenheim-Schnurr-Lecture 2013 Alfons Labisch (Düsseldorf) "Ex-pertes" Wissen und "ex-periertes" Handeln - zu Grundlagen, Entwicklungslinien und Entwicklungsmomenten ärztlichen Handelns Break 17.15 18.15 General assembly of the Society Generalversammlung der SGGMN Assemblée générale de la SSHMSN

Abstracts Lukas Engelmann The Stabilization of Medical Knowledge in the AIDS-crisis The cultural studies scholar Thomas Yingling described AIDS as a "crisis of knowledge:"the material effects of AIDS deplete so many of our cultural assumptions about identity, justice, desire, and knowledge that it seems at times able to threaten the entire system of Western thought - that which maintains the health and immunity of our epistemology" (Yingling 1991, S. 291) It is one of the most obvious stories out of the AIDS crisis, that the distribution of the epidemic did not only deplete societies assumptions on identity, sexuality and intimacy, but that especially medicine»as the most visible - and indeed most popular - form of applied science«(epstein 1996, S. 6) experienced an enormous crisis of credibility. On the one hand, as Steven Epstein has shown in his work, because many of the successful ways of fighting AIDS were not achieved in the laboratory, but developed in preventive work on the streets, within educative politics and within the activists call against any kind of stigmatization. On the other hand, the inability of medicine to contain the epidemic has become a symptomatic element of the early history of AIDS:»Gerade die auch medizinische Unklarheit [...] machten AIDS zur idealen Projektionsfläche für Ängste, Vorurteile und Spekulationen: Das labile Signifikat provozierte den Exzeß des Signifikanten«(Weingart 2002, 23f.) These arguments, based in cultural studies and sociology will be combined with a medical history perspective, relying partially on the arguments developed in my thesis. The endeavor to rehabilitate medical order and the stabilization of medical knowledge in the case of AIDS will be demonstrated within a classical medium of medical knowledge distribution: the atlas. AIDS-Atlases have been published between 1986 and 2008. Bound to the long tradition of visualizing medical knowledge, the AIDS-Atlas tried to capture the new and unusual epidemic. With perspectives from dermatology, virology, immunology and epidemiology the existing knowledge on AIDS was represented in a way, that the atlas was both useful in clinical everyday practice as in research and education. The overall task of the AIDS-Atlas is the distribution of a non-ambiguous clinical picture of AIDS and within the Atlas, the clinical gaze is working to relate what is visible to what was thinkable, thus distributing a medical knowledge of the disease (Foucault 2005). The AIDS-Atlas is an enlightening medium for the programme of the conference. First, the project of an AIDS-Atlas has to be analyzed against the background of the broader crisis of knowledge belonging to the history of AIDS. Here, the atlas serves to establish a very unique and secure way of seeing AIDS from the perspective of institutionalized medical expertise. Secondly, the series of AIDS-Atlases reveals a history of AIDS in which transformations in the ordering of chapters, images and captions mirrors other histories of AIDS, that challenged the medical perspective. Third, atlases argue with pictures: As "dictionaries of the sciences of the eye"(daston und Galison 2007) they point to the question, if the rehabilitation of medical expertise is always bound to the establishment of a clinical gaze.

Daston, Lorraine und Peter Galison. Objektivität. Frankfurt/Main: Suhrkamp, 2007. Epstein, Steven. Impure science. AIDS, activism, and the politics of knowledge. Berkeley, 1996. Foucault, Michel. Die Geburt der Klinik. Eine Archäologie des Ärztlichen Blicks. Frankfurt am Main: Fischer Taschenbuch Verlag, 2005. Weingart, Brigitte. Ansteckende Wörter, Repräsentationen von AIDS. Frankfurt/Main: Suhrkamp, 2002. Yingling, Thomas. Aids in America: Postmodern Governance, Identity and Experience. In: insi- de/out: Lesbian Theories, Gay Theories. Hrsg. von Diana Fuss. New York, 1991, S. 292 310. Lukas Engelmann, PhD, Medizinhistorisches Institut und Museum, Universität Zürich, engelmann@mhiz.uzh.ch. Alexa Geisthövel "Answer to ill-conceived questions in a scientific way. Medical expertise on working ability in the 1920s and 1930s The paper focuses on the German neurologist Viktor von Weizsaecker, an eminent representative of social medicine in the 1920s to 1940s who also contributed to theorizing medical expertise. At that time working capability became a subject of clinical expertise routines as well as a topic of heated debate on the allocation of public ressources. Weizsaecker made a case for reflexivity and suggested an approach that took the complexity of modern societies into account, instead of insisting on absolute truth of natural science. Moreover the frustrating experience with assessment of working ability outside concrete working environments (i.e. in the clinic) made Weizsaecker experiment with new therapeutic techniques and push plans for systematic investigation. The paper shows how, in this case, the practice of giving expertise fed back into clinical treatment and into research. Hence, medical expertise should not be perceived as a one way process of transmitting knowledge. Dr. Alexa Geisthövel, Institut für Geschichte der Medizin, Charité Universitätsmedizin Berlin, alexandra.geisthoevel@charite.de. Rodney H. Jones (Hong Kong) Digital Technology and the Future of Expertise: Constructing Expertise in Online Discussions of Genetics Today more and more people are interacting with complex medical information without the benefit of professional advice. One example of this can be seen in the proliferation of direct-to-consumer genetic testing services offered by companies such as 23andMe and DeCodeMe. This paper analyzes how customers of such services use online forums to share information and advice, engage in joint problem solving, and collaboratively construct knowledge about genetics. The data come from a corpus of customers postings from the public forums of the website for 23andMe. Using tools from mediated discourse analysis, it examines the linguistic strategies participants use to defend and contest scientific claims, manage identities and relationships, and represent the voices of experts like scientists and doctors, as well as non-experts like friends and family members. Results of the analysis show that while participants are often able to reproduce the patterns of reasoning and evidentiary practices of biomedicine, they often use these

practices to challenge mainstream medical consensus and assert a kind of expertise of non-expertise which privileges personal experience and genetic identity over the discourse of doctors and scientists. This construction of lay expertise is not just central to the identity performances of customers. It is also an important component in the economic model of 23andMe and companies like it. More and more, commercial entities outside of mainstream medicine are commodifying lay expertise and citizen science as a way to market their products. This paper makes a contribution to understanding how laypeople appropriate medical information from the internet and other media, from professionals, and from friends and family members, and how they work together with other laypeople to evaluate and make sense of this information and apply it to specific health problems. It also contributes to an understanding of the new economies of expertise in which lay expertise is increasingly commercialized and the expertise of commercial, academic, and governmental institutions is increasingly devalued. Prof. Rodney H. Jones, PhD, Department of English, City University of Hong Kong, enrodney@cityu.edu.hk. Alfons Labisch "Ex-pertes" Wissen und "ex-periertes" Handeln - zu Grundlagen, Entwicklungslinien und Entwicklungsmomenten ärztlichen Handelns Expertise und Experten sind Alltagsphänome hoch differenzierter und verdichteter Gesellschaften. Die Medizin als eines der bestimmenden Subsysteme jeder modernen Gesellschaft bleibt von diesem Phänomen nicht nur ausgeschlossen, sondern erscheint in der Alltagserfahrung der Menschen als ein treibendes Moment der Expertenwelt. Gleichzeitig bleibt die Medizin durch ihr genuines Handeln in besonderer Weise ausgezeichnet: neben ex-pertem und damit Sonder-Wissen ist das Handeln in der Medizin immer an Erfahrung, also an das 'experiri', gebunden. Wissen und Erfahrung sind im ärztlichen Handel auf den Patienten gerichtet. Zwar vom Beginn in der Antike an gegeben, verwischte sich die Dialektik von Wissen und Handeln im christlichen Mittelalter und in der frühen Neuzeit zu einem grossen Ganzen. Im Laufe der Moderne traten Wissen und Handeln immer weiter auseinander - und dies keineswegs nur in der Erfahrungswelt sich stets weiter differenzierenden Wissens und entsprechend differenzierter Organisation, sondern vor allem in den handlungsleitenden Definitionen von Gesundheit und Krankheit. Die Medizin des 21. Jahrhunderts ist in umfassender Weise in individuelle, gemeinschaftliche und gesellschaftliche Lebensvollzüge eingebunden - die Medizin ist gleichsam von der Nachhut der Industrialisierung zur Avantgarde vorauseilender Gestaltung des Lebens geworden. Nach wie vor bleibt indes der Gedanke der Erfahrung in besonderer Weise mit der Medizin verbunden, wie sie von den Patienten alltäglich erlebt wird. Daraus folgt, dass die Aspekte ex-pertisen Wissens als auch ex-perierter Erfahrung besonders wahrgenommen und vor allem auch im ärztlichen Alltag organisiert werden müssen. Auch dies wird in einer hochdifferenzierten Lebenswelt allerdings nicht ohne entsprechende Expertise geschehen können.

Prof. Alfons Labisch, Dr. med. Dr. phil., Institut für Geschichte der Medizin, Heinrich-Heine-Universität Düsseldorf, histmed@uni-duesseldorf.de. Stéphanie Pache Débat sur le Delusional Dominating Disorder et son inclusion dans le DSM-IV: quelle(s) expertise(s) pour définir la santé mentale? Mon travail de doctorat sur l histoire des thérapies féministes en santé mentale donne une place déterminante à la question des rapports entre la production des savoirs, les pratiques thérapeutiques et les politiques professionnelles et publiques dans le domaine de la santé mentale. Pour illustrer ces rapports et la façon dont est y articulée le problème de l expertise, ma contribution porte sur un débat s étant tenu entre plusieurs psychologues féministes autour de la proposition de Paula J. Caplan, une psychologue féministe canadienne, d introduire un nouveau diagnostic dans le DSM- IV, en 1991, le «Delusional dominating personality disorder». Ces échanges, publiés dans Canadian Psychology, illustrent les rapports complexes et multiples qu entretiennent ces actrices et acteurs avec l approche scientifique dont se targue le DSM, l evidence-based medicine. L auteure de la proposition reconnaît dans une certaine mesure que cette proposition est un moyen d action alternative face à un dispositif d élaboration du manuel qualifié de non démocratique et scientifiquement contestable. Il est ainsi intéressant de constater que Caplan construit une argumentation rigoureuse du point de vue scientifique et que c est bien la rigueur scientifique de l entreprise DSM qu elle conteste. Cette position devient une opportunité de discuter plus largement les rapports qu entretiennent des clinicien ne s engagés dans une approche critique avec l opération politique et scientifique que représente le DSM. L on voit à cette occasion qu il serait un peu hâtif de se représenter la production de cette classification comme un travail d expert e s, plus ou moins efficacement influencés par des lobbys. Cette intervention propose une cartographie d un débat mettant en scène les interrogations de professionnel le s de la santé mentale sur la légitimité de l approche scientifique qui leur est imposée et la meilleure façon d y faire face pour défendre leur projet politique et scientifique. Ce faisant, il s agira de mettre en évidence le type d expertise revendiquée par les différents acteurs et ce que ces différentes conceptions de l expertise révèlent plus généralement de leur conception de la science, de la thérapie et de la santé mentale. Stéphanie Pache, Doctorante en histoire de la médecine (PhD en sciences de la vie) et médecin, Institut universitaire d histoire de la médecine et de la santé publique (IUHMSP), UNIL, Lausanne; Chercheuse invitée à l'institut de recherche interdisciplinaire sur les enjeux sociaux (IRIS), EHESS, Paris.

Iris Ritzmann Ärzte als Gatekeeper für Fremdplatzierungen? Fremdplatzierungen werden seit wenigen Jahren historisch aufgearbeitet, auch in der Schweiz. Doch die Umstände, wie es zu diesen Eingriffen ins Familienleben kam, konkret welche fürsorgerischen Netzwerke, pädagogischen Vorstellungen und medizinischen Konzepte dahinter standen, ist erst punktuell aufgearbeitet. Insbesondere stellt sich für die Medizingeschichte die Frage, welche Rolle der ärztlichen Expertise bei der Fremdplatzierung von Kindern und Jugendlichen zukam. Dieser Frage möchte sich mein Beitrag annähern. Dabei soll zuerst geklärt werden, was mit dem Begriff der medizinischen Expertise gemeint ist. Dann steht die Frage im Raum, unter welchen Voraussetzungen eine medizinische Expertenfunktion überhaupt zustande kam. Welche wissenschaftlichen Konzepte, welche sozialen Geistesströmungen, welche Netzwerke waren aktiv, um Ärzte in die Position von Experten zu hieven? Wer gab den Auftrag für eine Expertise und wer überprüfte sie? Inwiefern sich die Expertisen auf die konkreten Lebensläufe betroffener Kinder und Jugendlicher auswirkte, soll primär anhand kinderpsychiatrischer Personenakten untersucht werden (vermutlich vor allem Akten aus der Stephansburg / Brüschhalde, deren Bestände im Staatsarchiv des Kanton Zürich liegen). Welche Kriterien wurden in den Expertisen beurteilt? Inwiefern konnten sie sich auf die Lebensgeschichte Betroffener auswirken? Untersucht wird der Zeitraum zwischen 1925 und 1975. In diesen fünfzig Jahren erlebte die Sozialfürsorge in Theorie und Praxis grundlegende Veränderungen, wie Forschungen zur Eugenik, Anstaltspsychiatrie oder Pädagogik zeigen konnten (Ramsauer 2000; Wolfisberg 2002; Huonker 2003; Hauss et al. 2012; Dubach 2013; Wecker et al. 2013). Zeichnen sich innerhalb dieser Zeit Veränderungen in der Expertentätigkeit ab, und wenn ja, worauf könnten sie beruhen? Da sich das Forschungsprojekt noch in der Entstehungsphase befindet, werde ich noch keine fertigen Forschungsresultate präsentieren können sondern einen Werkstattbericht zur Diskussion stellen. Prof. Dr. med. lic. phil. Iris Ritzmann, iris.ritzmann@bluewin.ch Silja Samerski From Doctor Knows Best to Patient Decides Best: How Risk Medicine Undermines the Physician's Judgment You can consider this high or low, a medical doctor tells his client after he has informed her about her risk of 0.4% of getting a child with a chromosomal disorder. And he adds: That s a downright very personal assessment. The explicit goal of his counseling is to enable his pregnant client to make an informed and autonomous decision about genetic test options. In order to do so, he lectures about inheritance, medical statistics, test options and their risks and chances. According to the guidelines of his profession, he is very cautious not to give any advice, but to leave the decision with the client. She is considered to seek advice at herself, as another counselor puts it (Samerski 2002, 230).

As early as the 1980s, human geneticists formulated a new goal for their services: Autonomous and self-responsible decisionmaking (a.o. Baitsch 1986). Thus, human geneticists are pioneers of a fundamental shift in the status of medical experts as well as in the doctor-patient-relationship: the transformation from the old rule doctor knows best to the new motto patient decides best (Samerski 2009). In the 1970s, social scientists warned about the disabling power of the medical profession (a.o. Freisdson 1970). Today, shared decisionmaking and patient autonomy have become guiding principles for the doctor-patient communication (Akademie für Ethik in der Medizin 2011, Rosenbrock und Hartung 2012). Generally, this disempowerment of medical experts is celebrated as an emancipatory achievement, a liberation from medical paternalism and a bulwark against population policy (a.o. Beauchamps and Childress 2008). In contrast to this, I want to show that not only the struggle for autonomy and democracy, but also the growing medical orientation towards statistics and risk has undermined the authority of physicians and their expertise. Under the regime of risk, the diagnostic and therapeutic judgment of the physician is transformed into the calculated choice between risky test and treatment options. In their role as physicians, health professionals cannot make many of the demanded decisions. On the basis of their duty of care, physicians cannot answer questions such as those whether a pregnant woman should undergo prenatal testing in order to clarify the risk for a child with Down syndrome or whether a women attested the BRCA-gene should opt for the removal of her breasts (Schmidtke 1995). They belong to another epistemic realm which lies beyond the traditional medical ought to. Thus, wherever the triad diagnosis prognosis therapy is substituted by the triad test result risk assessment risk management, the authority of the expert declines and the informed decisionmaking of patients becomes central. I want to analyze this decline of the medical experts authority and their judgment by the predominance of statistics and risk calculation by taking the example of genetic counseling. In the era of prevention and biomedicine, genetic counseling can be considered as a paradigm of today s doctor-patient relationship. What before was the specialty of human genetics, i.e. to attest risk profiles to sick as well as to healthy people, has become one of the core tasks of medicine (Armstrong 2011). On the basis of my empirical research on genetic counseling as well as my ongoing research project on the genealogy of the patient as a decisionmaker I will outline the historical and epistemic breaches which have undermined the rule doctor knows best and lead to the new principle patient decides best. Akademie für Ethik in der Medizin, 2011: Die Selbstbestimmung des Patienten und die Medizin der Zukunft. http://www.selbstbestimmung-des-patienten.uni-goettingen.de/ Armstrong, D., 2011. The invention of patient centered medicine, in Social Theory & Health 9, S. 410-418. Beauchamps, T. L. und Childress, J. F., 2008: Principles of Biomedical Ethics, Oxford. Freidson, E.,1970. Profession of Medicine: A Study oft he Sociology of Applied Knowledge Rosenbrock, Rolf und Hartung, Susanne, 2012: Handbuch Partizipation und Gesundheit, Bern. Samerski, S., 2002. Die verrechnete Hoffnung. Von der selbstbestimmten Entscheidung durch genetische Beratung, Münster.

Samerski, S., 2009. Genetic Counseling and the Fiction of Choice: Taught Self-Determination as a New Technique of Social Engineering, in Signs: Journal of Women in Culture and Society 34, S. 735-761. Schmidtke, J. (1995). Die Indikationen zur Pränataldiagnostik müssen neu begründet werden. In: Medizinische Genetik, 1, 49-52. Dr. Silja Samerski, DFG-Graduiertenkolleg Selbst-Bildungen. Praktiken der Subjektivierung, Universität Oldenburg, silja.samerski@uni-oldenburg.de. Kathryn Schweishelm Carving out a Practice: Plastic Surgery and the Rhetorical Construction of the Expert Post WWI Plastic surgery has been performed in some form for over a millennium; however, most commentators take World War I as their starting point when tracing its history. The standard reasoning behind this is simply that the injuries wrought by trench warfare are largely what forced the early advancement of reconstructive surgical techniques. Less noted, however, is the effect that plastic surgery s association with warfare specifically had on the broader cultural understanding and acceptance of the practice. Prior to the war there were definitely practitioners who sought to modify appearances through medical or pseudo-medical means, but most were marginalized and seen as performing a debased form of medicine, if one at all. The period that followed the war, however, witnessed a struggle for the right to (re)define the field in the public s eyes. This took place between the reconstructive surgeons of the war, who fought aggressively to gain respectability and enforce strict institutional borders around the practice, and the lay practitioners frequently women who were not trained in medical schools who continued for a time to do brisk business. Using printed source material from this era, my paper will examine the public rhetoric used by the newly trained postwar surgeons to construct themselves as respected experts in opposition to the prewar laymen, in particular those who developed and applied chemical peels, known as peelers. I argue that the postwar surgeons were able to leverage their association with masculine combat and fallen soldiers whose surgeries were partly rationalized as necessary for them to gain employment and be self-sufficient upon discharge to gain cultural authority and justify the social merits of plastic surgery, while the lay practitioners were progressively undermined as nonauthorities through their association with mass culture, femininity, and beauty surgeries. Kathryn Schweishelm, Doctoral Candidate, Graduate School of North American Studies at the John F. Kennedy Institute, Freie Universität Berlin, schweishelm@gsnas.fu-berlin.de

Tanfer Emin Tunc Fixing the Fetus: Prenatal Surgery and the Medical Expertise in the United States In the United States, prenatal, fetal, or antenatal surgery grew out of a need in the 1960s to reduce abortion and neonatal problems by fixing physical birth defects in utero. Reducing abortion was particularly crucial in the US given the general illegality of the procedure and the highly-regulated limits on therapeutic pregnancy termination that existed before the 1973 Roe v. Wade Supreme Court decision that decriminalized abortion. Fetal surgery in the US also grew out of the common struggle facing American obstetricians, fetologists, neonatologists (newborn specialists), perinatologists (maternal-fetal medicine specialists), and pediatric surgeons, all of whom were dealing with life-threatening congenital deformities that were very difficult and sometimes impossible to treat after birth when fetal development was complete. Thus, a new medical specialist, the prenatal surgeon, emerged during the last quarter of the twentieth century in the United States a specialist who not only brought the concerns of these experts together, but also assumed many of the functions previously held by physicians in these different fields. The medical expertise of the American prenatal surgeon was immediately bolstered through newly-created professional organizations, the publication of academic articles and journal issues, and the establishment of training programs and postdoctoral positions in the US, all of which formed the basis of a campaign which helped legitimize the authority of this subspecialist. This campaign was reinforced by the construction of prenatal surgery as a normal part of the active management, or medicalization, of pregnancy, which in twenty-first century America has come to involve the selling of technologies such as superfluous amniocentesis, 4-D ultrasound, electronic fetal monitoring, drug-induced deliveries, artificial membrane rupturing, unnecessary caesarean sections especially after vaginal births and cordblood/placental banking. This paradigmatic shift concerning the medicalization of pregnancy, which, in the United States, has been in progress for a century and accelerated by a hyper-reliance on interventionist techniques, has now positioned many physically imperfect fetuses as patients with surgically treatable medical conditions, further deconstructing the notion of the uterus as sacred and impermeable. The focus of this paper will be on the technological strategies, rhetoric, and professional self-fashioning that has accompanied the emergence of the American prenatal surgical specialist which has, in turn, reinforced the culture of medical expertise that is now inextricably coupled with pregnancy, especially those that are deemed high risk. Prenatal surgery, like other reproductive subspecialties, emerged during a time of professional and political struggle including abortion legalization in the 1970s and increasing American social conservatism in the 1980s both of which contributed to the expansion of the field and shaped the public face of the medical specialty. This paper will also examine the American physician as the professional impetus behind prenatal surgery specifically as a technological innovator, political negotiator, and promoter of the procedure itself while problematizing the social and medical pressure that exists in the United States to produce perfect children. Tanfer Emin Tunc, PhD, Associate Professor in the Department of American Culture and Literature at Hacettepe University, Ankara, Turkey, tanfer.emin@gmail.com.

The conference is open to everyone and free of charge, no inscription needed. Die Tagung ist öffentlich, der Eintritt frei. Eine Anmeldung ist nicht erforderlich. Le colloque est gratuit et ouvert à tous sans inscription. Venue / Tagungsort / Lieu Inselspital Bern Entrance 34 Lecture Hall 3, (Sahli, Medizin) From the railway station Bus 11 (bus stop Inselspital) Contact Hubert Steinke Institut für Medizingeschichte Bühlstrasse 26, 3012 Bern 0041 +31 631 84 29 hubert.steinke@img.unibe.ch For further information on our society Für weitere Informationen zu unserer Gesellschaft Pour informations ultérieurs sur notre société www.sggmn.ch Cover illustration: Dr. House and his staff (FOX Broadcasting Company)