Contenu du sommaire : Contributions à l'histoire de la recherche médicale en France au XXe siècle

Doris T. Zallen: The Rapkine cycle and the mission Rapkine: promoting medical research in France. It is not always possible to predict from which sources will corne the influences that later prove to be significant in developing new types of research agendas or setting new research policies into motion. One such unanticipated influence on medical research emerged from the ideas and efforts of Louis Rapkine, a biologist and naturalized French citizen. Rapkine is an especially unusual case. He was an intellectual emigre who fled from his medical studies to devote his life to carrying out basic biological investigations, and he preferred to work away from the medical establishment throughout most of his professional life. Despite this, Rapkine managed to make noteworthy contributions to the conduct of medical research in general and to the organization and operation of the French medical research apparatus in particular.

Richard Burian, Jean Gayon: Genetics and medical research in France: the case of Boris Ephrussi (1901-1979). In contrast with other pioneers of the French school of molecular genetics (such as André Lwoff or Jacques Monod at the Pasteur Institute), Ephrussi did not work in a medical context. Trained as a classical zoologist at the Sorbonne, he devoted most of his scientific work to the comprehension of the genetic control of cellular differentiation, being exceptionnally skiful in breaking fronteers between experimental biological disciplines. But he never accepted to inflect his research in the direction of medical purposes, in spite of obvious links between some of the technical tools he used (tissue culture, cell hybridization) and major medical issues (cancer, and cartography of genetic abnormalities). This reluctance must be understood both in terms of a personal intellectual history, and considering the institutional relation between medicine and biology in France.

Jean-François Picard: Scientifîc push or medical pull? French biomedical research from the Institut national d'hygiene to the INSERM (1941-1964) This approach of the medical research history in France focuses on the researchers themselves and assumes a dialectic between doctors and scientists. Biomedical research is typified first of ail by its close link to applied needs; clinical research closely tied to the patient. Secondly, there is research that has developed along lines of genetics and molecular biology. In 1946 this division inspired some biologists (A. Lwoff, L. Rapkine), to propose as the model for the new CNRS, the existing British Medical Research Council which funded three times as many researchers as doctors. In the same time, an active group of medical researchers, principally at the Public Assistance Hospital in Paris (J. Bernard, J. Hamburger) gave their colleagues the chance to establish laboratories at the hospital. A Claude Bernard Association was created in 1952, while, with strong support from higher education, Pr. Robert Debré achieved a real national health reform in December 1958, in the form of new Centres hospitaliers universitaires. In fact, Medical research was already the responsibility of an organization created by the Secretary of State for Family and Public Health in the Vichy regime (Law of 30 November 1941): the Institut national d'hygiène (INH). Significantly, the INH was created in the wider context of the establishment of a national health policy. After the Liberation, it kept its research function and was given a specific budget by the Caisse nationale de securité sociale (which itself had only recently been created) and so it functioned as a conduit for grants to medical researchers. But in 1958 the organization came under the scrutiny of an administrative commission which charged it - among other things - with lax management of the medical research grants. The INH became the Institut de la sante et de la recherche medicale (July 1964). From there, it was INSERM that established a real science policy in medicine. It took up the «concerted action» demanded by the DGRST (ministry of Research) while also professionalizing research. Whereas, the grantees of INH were practically ail doctors, now they constituted only 25 % of those recruited by INSERM (thus, following the model suggested by biologists forty years earlier).

Jean-Paul Gaudillière: French biochemists and biomedicine in the postwar era: two paths between laboratory and hospital. The paper focuses on the changing roles of biochemists in France after World War II to illustrate the emergence of a biomedical research centered on biological laboratories. It shows that the process consisted in a demedicalization of biochemistry. Strong articulations with medical demands were turned into non direct links based on longterm expectations. The paper describes two teams working in hospitals. Similar changes ocured in both places: medical research agencies became preeminent partners; collaborations with biologists, especially with molecular biologists, replaced collaborations with physicians; experimental practices aiming at the construction of diagnostic methods or at the analysis of correlations between chemical changes and pathological processes became second rank priorities; reorganization of work at the bench favored the search for molecular causality and the use of model Systems. The paper emphasizes both the impact of instrument transferts and the influence of state research policies. The comparison of the two groups sheds some light on the connections which were established in the late sixties and based upon interests in potential transferts toward clinical settings.