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La Lettre
© B.Eymann - Académie des sciences
Alain Fischer
Member of the Académie des Sciences, Institut Imagine (Paris-
Descartes - Université Sorbonne Paris Cité), AP-HP, Inserm,
Collège de France, Paris
In 1666, Moliere staged
Le Médecin malgré lui
– The
Doctor inSpiteof Himself –, a satirical depictionof the state
of medicine in his time. In the 19
th
Century, empiricism and
the introduction of the experimental method both allowed
curative medicine to progressively emerge. In the 20th
Century, the upsurge of such sciences as mathematics
(epidemiology), physics (imaging), chemistry (drugs) and
biology (genetics, molecular biology) contributed to the
progress of medicine, particularly through the adoption
of a reductionist approach. Tomorrow, with the integration of health data, precision approaches will
possibly develop, provided the human dimension of medicine remains steadfast and the concept of
access to treatments for all is not mere words.
Difficult beginnings?
On the year of the creation of the Académie des sciences,
Le Médecin malgré lui
was one of the many
opportunities for Moliere to mock the ineffectiveness of medicine. Nearly 150 years later, Pierre Simon La-
place, who was reforming the Académie, indicated: "
I do not place doctors at the Académie des Sciences
because they are scientists but for them to be with scientists
" – a clear vision of medicine, as the future
would tell, but also a cruel one, as it still remained hardly efficient. Evidence of this may be found in life
expectancy, which remained pretty much stable from prehistory to the beginning of the 19
th
Century.
Actually, the therapeutic era of medicine only started with penicillin and would only rise on the decline of
the World War II, 70 years ago. S. Shryrock, an American expert in human sciences, wrote in 1947 that
the medical 19
th
Century is characterized by therapeutic nihilism, which is bound to last until the half of
the next century. Medical research had difficulty expanding in France. For instance, referring to a meeting
he had after the war with the director of the French Institut national d'hygiène, François Jacob wrote, in
From empirical medicine
to precision medicine