Universalism and individuality as a structural tension in modern medicine

This paper examines the structural tension between universalism and individuality in modern medicine. By universalism, I refer to the epistemological commitment to producing general, abstract knowledge about health and disease through classifications, generalizable models of physiological process, statistical evidence, and standardized therapeutic protocols. By individuality, I refer to the biological uniqueness of each patient as a concrete organism possessing a singular configuration of traits and circumstances. The central argument is that modern medicine has historically depended on universalist forms of knowledge, while clinical practice must always apply such knowledge to biologically unique individuals. This generates a persistent tension between the abstract-conceptual level of biomedical research and the concrete level of the individual patient at the clinical encounter. After clarifying the notion of biological individuality in medicine and reconstructing the historical emergence of universalism as a foundational principle of modern medicine, the paper analyzes three contemporary domains in which this tension becomes especially salient: external validity in evidence-based medicine, the constitution of reference classes, and the epistemic challenges of clinical practice. Recognizing this tension is necessary for a more precise understanding of both the possibilities and the limits of medicine in its engagement with biologically unique patients.