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).
. Un double mouvement est à l'origine de l'installation de la recherche médicale française. Le premier résulte d'une poussée scientifique. Celle de la biologie et de la physiologie, issue de l'œuvre de Claude Bernard et de Louis Pasteur et qui aboutira à l'installation des laboratoires à l'hôpital. Au lendemain de la guerre, la biomédecine se développe à l'instigation d'une nouvelle génération de cliniciens-modernistes (Jean Bernard, Robert Debré, Jean Hamburger...) sous les auspices d'une « Association Claude Bernard » (1952). Le second mouvement procède d'une demande de santé publique. Issue de la prophylaxie pasteurienne, la médecine sollicite de l'État l'organisation d'un dispositif destiné à combattre les grandes maladies sociales (tuberculose, cancer). Il est réalisé par l'installation d'un premier ministère de la Santé (1920) et l'ouverture d'un Institut national d'hygiène (1941), ancêtre de l'INSERM. En fait, dans le fil d'une nouvelle politique scientifique décidée en 1958, l'INSERM procède de la rencontre de cette logique de santé publique avec la biomédecine.
Jean-François Picard : Impulso cientifico o presion médica ? La investigación médica en Francia desde el Instituto Nacional de Higiene hasta el INSERM. En la base del desarrollo de la investigación médica francesa hay un doble movimiento. El primero es el resultado de un impulso científico : el de la biologia y la fisiología, proveniente de la obra de Claude Bernard y Louis Pasteur, que culminará con la instalación de laboratorios en los hospitales. En la post-guerra la biomedicina se desarrolla gracias al estimulo de una nueva generación de clinicos-modernistas (Jean Bernard, Robert Debré, Jean Hamburger...) bajo los auspicios de la « Asociación Claude Bernard » (1952). El segundo movimiento procède de una demanda de salud pública. La medicina surgida de la profilaxis pasteuriana solicita al Estado la organización de un dispositivo destinado a combatir las grandes enfermedades sociales (tuberculosis, cancer). Este se materializa a través de la creación de un primer Ministerio de Salud (1920) y de la apertura de un Instituto Nacional de Higiene (1941), predecesor del INSERM. De hecho, siguiendo una nueva política cientifica aprobada en 1958, el INSERM es el resultado de la conjunción de este sistema de salud pública con la biomedicina.
