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FIGS. 6A/B Images from Kahn, Man in Structure and Function (Kahn 1943, 60
and 180, figs. 42 and 121, respectively)
Being an active member of the left-liberal culture in Berlin during
the Weimar years and a practicing Jew, Kahn quickly realized that
there was no future for him in Nazi Germany. He immigrated to the
United States, where he would start a second career as popular
science writer, though not quite as successful as in Germany. He
managed to solicit a two-volume English translation of his German
five-volume masterpiece under the new title Man in Structure and
Function (Kahn 1943), thereby pinpointing the signature of his
visualization style. Kahn pioneered a form of visualization
FIG . 6A, 6B
that was scientifically correct and optically inspiring with its many
references to modern culture, but which he especially developed for
visualizing anatomy together with physiology. In contrast to Netter,
Kahn focused on the healthy body and its functioning, though he
regularly included chapters on diseases as examples of functional
disturbances and to explain their pathophysiology. With his style,
Kahn mediated between modern culture and the human body using
one to explain the other and thereby familiarizing his audience with
both.
There is no evidence of a personal contact between Netter and
Kahn, but given Kahn’s historical prominence it is almost impossible to
imagine that Netter developed his typical style of visualization without
familiarity with Kahn’s images, while their different biographical and
professional trajectories easily explain some of the visual differences.
Netter was a professional illustrator, using his medical background for
his decisions regarding selection and abstraction. Kahn, by contrast,
was a physician with a liberal agenda who used his skills in
conceptualizing visualizations (for many of his images he developed
the visual idea only and relied on professional designers for the
execution). His inspiration to rely on technological analogies and
machine models for physiological functions shows him in the specific
role of a popularizer of medical knowledge with an extraordinary
attitude toward modern culture. If the Netter approach revolved
around focus, plane, and point of view, Kahn embraced the political
utopia of a healthier life achieved by an enlightening education about
the body’s functions (including liberal views on human sexuality). For
achieving this, Kahn blended form and function, anatomy and
physiology, morphology and process, where Netter concentrated on
diseases and their pathology.
Both styles of visualization connect scientific knowledge with
broader conceptions of nature, culture, and human life. They do so
for didactic purposes. The images operate by embedding medical
knowledge in daily life. The image from the LifeTime
Initiative does not engage directly with these styles of didactic
images, but we argue that their prominence in medical education
contributes to its appearance as “natural.” Abstraction and zooming
in, so familiar since Kahn’s revolutionary visualizations and Netter’s
three cardinal elements of focus, plane, and point of view, orchestrate
the design decisions in the background of figure 1.
FIG S. 5 AND 6
FIG . 1
5
Conclusion:
Infographics and Imaginaries
Our contribution to this volume has focused on a single image
from a biomedical article, meant to present a vision for biomedical
research and practice to a broader scientific community. Our analysis
suggests that the image is neither the visualization of scientific data
nor a mere illustration of the text but makes a significant contribution
to the articulation of the vision expressed in the article and lends
rhetorical support to it. The combination of associations, scientific
content, and legibility exhibited by the image is typical for the genre of
infographics. We will discuss this notion in this final section in order to
connect our observations on the LifeTime image with a more critical
evaluation of the Initiative, thereby exploring potential significance for
visual studies of science.
Scientific publications include images that exhibit a wide variety of
functions. Some reproduce evidence, such as traces or inscriptions
produced by instruments; some visualize data derived from
quantifying such traces; some represent models derived from the
data (Rheinberger 2023). Yet others show aspects of methods (e.g.,
schematic representations of experimental designs or research
technologies). Accordingly, there is a growing discussion in visual
studies of science on what such visualizations actually represent and
how they take on a role of their own in the life sciences so that they
can even be regarded as a form of experimentation (e.g., Coopmans
et al. 2014). The image we discussed here plays none of these
roles. Instead, it is an image that expresses a vision of future
medicine by alluding to other types of images. Its role is to align a
continuously transforming style of data-intensive, molecular
biomedicine with an understanding of health and disease that
combines cellular pathology with a long-term perspective on
pathogenesis. This kind of visionary image is less frequently
discussed in the visual studies of science, and the analysis of this
particular exemplar might thus complement existing studies. Here, we
suggest conceptualizing the image as a type of infographic that is
geared not toward representing data but to communicating and
interpretating complex information.
Infographics is not a new type of visualization; Charles Joseph
Minard’s famous visualization from 1869 of Napoleon’s failed Russia
FIG . 1
FIG . 1
campaign in 1811/12 is often regarded as the starting point of the
genre. The designer Edward Tufte declared this to be “one of the
best statistical graphics ever” (Tufte 2006, 122), because Minard
combined comparison with contrast, causality, structure, and
multivariate analysis to a completely integrated diagram, making it a
piece of evidence in itself. Minard superimposed on a roughly
topographical map of Europe, spanning from the French Empire’s
border on the left to Moscow on the right, a representation of the
shrinking numbers of Napoleon’s soldiers along their path toward
Moscow in the upper half in brown and on their return in black
beneath it. In the lower part of the map, he tracked the temperature
of the respective days when the army reached a location by dotting a
line from the name to the graph at the bottom.
Minard not only found a solution for integrating a temporal axis into
the topographical representation of space and spatial relations;
indeed, his map was a two-dimensional representation of a four- or
five-dimensional space of knowledge. Minard conceived of a visual
synthesis of a complex historical event—in fact, a single image for a
disastrous decision resulting in a sheerly endless series of events until
eventually close to nothing of Napoleon’s massive army returned to its
home territory. He achieved an integration of several layers of
information into a coherent picture, a Latourian “immutable mobile”
with autonomous epistemic potential. Before Minard’s diagram, there
was no way of representing these heterogeneous events “naturally” in
a two-dimensional plane, as this form of representation had to be
conceived in the first place. The map’s conventions had to be agreed
upon, and a standard needed to be implemented. Today, this kind of
graphic, representing the amounts of material or personnel as width
of the arrow, is known as a “Sankey diagram,” named after another
graphical innovator.
In Section we showed how medicine has developed its own
tradition of infographics that established new ways not only of
integrating multidimensional medical knowledge, but of communicating
a vision of the body in the medical realm to a broader audience by
applying focus, selectiveness, abstraction, and the blending of visual
languages. Infographics in this context might be seen as peripheral to
knowledge making, as they seem to belong to science education or
the communication of science to a wider public. However, in a context
where scientists are increasingly specialized, while at the same time
research policies and funding schemes demand ever larger
interdisciplinary consortia of collaborators with vastly different
backgrounds, infographics, as part of viscourses (Knorr-Cetina
1999), take on crucial roles in communication among researchers and
coordination of scientists with stakeholders closely associated with
their research, such as funders, university administrators, or patient
groups. Such is the case with the LifeTime image.
Formally, this image is not a data visualization like Minard’s map,
and yet, like the early infographic, it integrates not only the
temporal dimension, here, of an individual’s lifetime, with the spatial
dimension, here, of the cellular body. As shown in Section , through
its visual metaphors and references it also contextualizes the
visualization of the aging process in a conceptual space of cellular
disease and in a research culture of molecular analysis. Like Minard’s
image it combines graphics with text, and like Netter’s and Kahn’s
work, it achieves its rhetorical force from decontextualizing and
recontextualizing physiological and pathological phenomena.
FIG. 7 Charles Minard’s map of Napoleon’s defeat in Russia (published 1869)
Unlike in Netter’s and Kahn’s images, the focus of the LifeTime
image is not on the anatomical body with its functions and
malfunctioning, nor on the body in its sociocultural situatedness in a
world of modern technology, but on the cellular body as a bundle of
individual trajectories, some of which assume a pathological path. If
we look at figure 1 again, at the left-side entry point, the blue tube-
FIG . 1
FIG . 7
like lines enter the life stream as mostly “healthy cells.” In the
transparent box of life’s incidents—internal stimuli and external factors
from exposure to changing environments—only some of them reach
“healthy aging,” while others meet a less lucky fate. Thus, in addition
to representing a specific way of cellular development going astray,
i.e., pathological deviation, the clusters represent the possible fates
of an entire organism, i.e., the human being or patient. Cellular fate
and personal fate become one. Or, in the symbolism of the image,
there is no person-level fate; there is only a cellular process that
makes up a life.
The vision promoted by the image is that disease, whether
primarily genetically or environmentally induced, can be detected
close to its origin in the developmental process, and hence such
deviation from the normal can be addressed, mitigated, and
potentially corrected before the arrival of clinical symptoms. Thus,
this vision of medicine promises that an individual’s fate to become ill,
which is determined by the fate of cells entering a disease trajectory,
can be known, and ultimately medicine can intervene in the personal
fate as located in the cell. Disease, then, is no longer destiny, but a
person’s health trajectory is controllable and changeable.
Returning to Canguilhem’s discussion of the normal and the
pathological, one might caution that organisms exhibit intrinsic
variation and react dynamically to various stimuli. Whether the
pathologically relevant variations can be detected long before the
manifestation of clinical signs in an ocean of cellular reactions can be
doubted. This is not the place to discuss the plausibility nor the ethics
of the vision of interceptive medicine, but it should be clear that the
notion of disease as fate, inscribed into the molecular signatures of
our cells, and the idea that fate can be overcome by technologies for
deleting or rewriting our cellular scripts neither appears achievable at
this point, nor is it necessarily desirable.
The vision expressed in the image, as we pointed out, is located in
the broader imaginary of personalized or precision medicine and in
line with a broader biomedical shift in healthcare from environmental
and social determinants of health to individualized disease, emerging
toward the end of the twentieth century (Quirke and Gaudillière
2008). While the vision of LifeTime emphasizes increased temporal
and spatial depth and resolution in the analysis of pathogenesis (and
possibly dissolves classical conceptualizations of the pathological, as
discussed earlier), on a social level it is continuous with earlier visions
of molecularized and individualized medical surveillance and
intervention. Hence, recurrent criticism of the social order that
simultaneously supports and is created by biomedical technologies
articulated from within medicine as well as in the humanities and
social sciences apply here as well. Healthcare as envisioned by
LifeTime risks:
1) increased (bio-)medicalization, i.e., the trend to place
aspects of life into the realm of medicine that were not seen in that
way before (Hofmann 2016; Clarke et al. 2003), in this case, life
before the onset of disease;
2) inescapable overdiagnosis, i.e., the diagnosis of conditions
that would not have caused harm when undetected, but still might
trigger interventions connected to costs and potentially negative
effects (Hofmann 2016), in this case, regarding deviant trajectories
with a benign fate;
3) unbalanced interventionism, i.e., a focus on diagnosis and
treatment, in this case, of cellular processes in the absence of illness,
as a technological fix at the expense of prevention by means of
addressing social and environmental determinants of disease (Tabery
2023);
4) commercialization, i.e., the push to translate medicine and
research into business development, in this case involving the
recruitment of increasingly younger people as potential patients and
consumers in the economy of medical services and pharmaceutical
products (Clarke et al. 2003).
What is important for us is to see how the image is not merely
illustrating the text in the LifeTime article but co-creates the new
articulation of the biomedical imaginary (Erikainen and Chan 2019;
Meunier and Herzog 2023) to which this criticism pertains by
purporting it as a rational enterprise that claims an objective approach
to disease, based on automated procedures, big data, and
technologies, rather than on a patient’s illness or suffering as the
starting point for medical intervention. It does so as much through its
intricate use of visual metaphors expressing the underlying notion of
pathological processes and by references to research technologies
that can be marshalled to detect and intervene on them, as through
its specific omissions. The most striking absence in the image is the
environment in which the body develops and that influences the
molecular relations within and across cells through epigenetic
processes, microbiota, and other interfaces. Thus, the cellular
processes themselves appear as the only available locus of
intervention. Furthermore, the image eclipses the person through the
abstract representation of bodies as clouds of cells, as mentioned
above. Everything beyond the level of cells matters only insofar as it
has an impact on the cellular level. Life is depicted here as a process
but not as a biography. In this way, resilience achieved by viable
social relations or the negative impacts of social processes, as
emphasized by critics of biomedicine, are eclipsed here as well. At
the very least, these omissions make the LifeTime image an
interesting object for the visual studies of science as a locus for
observing the intersection of social and political values on the one
hand and epistemic values as reflected in methods and theoretical
assumptions on the other hand.
As an exemplary infographic for visionary science, figure 1
communicates a vision of cell-based interceptive medicine within the
socio-technological imaginary of precision medicine. The image
exhibits an epistemic value system in the life sciences that has
emerged gradually in the last seventy years and can be described in
terms of molecularization and datafication. This scientific perspective
has interacted in many ways with social agendas of individualization
and market economies, i.e., the very sociopolitical context excluded in
the biomedical perspective. The absence of the person with its
biographical life, full of social circumstances and accidental
environmental conditions, serves to make the claim that it does not
matter how cells came to deviate, whether through an inherited
mutation or exposure to environmental harm. The deviation will be
detected through monitoring the body as a collection of cells, thus
making the individual’s life subject to institutionalized and marketized
control. Overall, we show how in the case discussed visualization not
only functions as a didactic addendum but also adds crucial
plausibility and legitimacy to the project by representing the idea as
something imageable (and not just imaginable) and hence
achievable.
1 See the LifeTime Initiative website, https://lifetime-initiative.eu/ (Accessed:
June 10, 2024).
2 See the LifeTime Initiative website, https://lifetime-initiative.eu/lifetime-strate
gic-research-agenda-2/ (Accessed: June 14, 2024).
3 Johannes Richers, personal communication. For Richers’s work, see http
s://www.jorichers.com/ (Accessed: June 10, 2024).
4 See the LifeTime Initiative website, https://lifetime-initiative.eu/lifetime-conf
erence-2-0/ (Accessed: June 10, 2024).
5 See the Max Delbrück Center website, https://www.mdc-berlin.de/news/ne
ws/new-berlin-cell-hospital-announced (Accessed: June 10, 2024).
6 See the Max Delbrück Center website, https://www.mdc-berlin.de/news/ne
ws/preparations-new-einstein-center-begin (Accessed: October 29, 2024).
7 See the Max Delbrück Center website, https://www.mdc-berlin.de/de/news/
press/virchow-20-von-der-intervention-zur-praevention (Accessed: June 10,
2024).
8 See the Berlin University Alliance website, https://www.berlin-university-alli
ance.de/excellence-strategy/exzellenzcluster/ImmunoPreCept/index.html
(Accessed: June 5, 2025).
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