Therapeutic Revolutions

Pharmaceuticals and Social Change in the Twentieth Century

Bibliographic Data

ID3232385
AuthorsNicolas Rasmussen (0000-0002-9498-0921, UNSW Sydney, corresponding author)
Year2017
Volume48
Issue3
Pages402-404
Publication date2017-11-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueThe Journal of Interdisciplinary History (JOURNAL)
Journal identifiersISSN: 0022-1953 • E-ISSN: 1530-9169
PublisherMIT Press - Journals (PUBLISHER)
DOI10.1162/jinh_r_01172
OpenAlexW2770049901
LanguageEN
Citations received8
References cited4

This book is a collection of chapters showcasing work in a new but flourishing area in the history of medicine, the history of pharmaceuticals in the twentieth century. All of the work, some of it reflecting new research but most of it reviewing each author’s older work, adheres closely to the theme of “therapeutic revolution” inspired by Rosenberg’s influential 1977 article.1 In that work, Rosenberg portrayed the nineteenth century as the moment when medicine first adopted science, thus abandoning its traditional interventions (like bloodletting), leading to a dark period of therapeutic nihilism, until the laboratory eventually spawned new drugs and vaccines. Indeed, scientists, drug firms, and policymakers alike claim a new therapeutic revolution for pharmaceuticals during the twentieth century, referring to the dramatic passage from the nerve tonics and snake oils of the 1900s to the magic bullets that have “cured” every major illness besides cancer since World War II.Ten chapters by diverse scholars active in the history of pharmaceuticals look at this recent “revolution” from various perspectives. Anne Kviem Lie and Scott Podolsky examine competing portrayals of the historical trajectory of antibiotics in the 1950s and 1960s. The heroic triumphs touted by drug companies selling combinations of novel “broad-spectrum” products requiring no diagnosis for prescription clashed with the dystopian reports of bacterial resistance and therapeutic failure by advocates of rational prescription (requiring identification of pathogens and reserving certain newer drugs for use only when older ones fail).David S. Jones looks at the revolutionary rhetoric and that of its counterpart, gradual evolutionary change, in mostly recent narratives of progress written by heart researchers and practitioners. His focus is not on the politics of the revolution metaphor but on an exploration of an alternative evolutionary paradigm through such formal theoretical terms as fitness, genetic isolation, extinction, etc. as possible tools for medical historians. Julie Livingstone offers a fascinating look at the leading cancer clinic in Botswana, where northern-trained oncologists struggle to reproduce the drug regimes that clinical trials have shown to be effective in an alien context involving unpredictable drug supplies, transient patients, and insufficient infrastructure of all kinds.Not all of the authors are historians. Global-health luminary Paul Farmer, with Matthew Basilico and Luke Messac, discusses the origins and implications of the mid-twentieth-century “McKeown thesis” that historical decreases in British death rates owed much more to general improvements in wealth and sanitation than to any advances in medicine.2 He argues, contra McKeown, that in certain situations with scarce resources, medicine can improve the health of a population even if the standards of living are poor. Most of the other articles, however, lie within mainstream history of medicine, such as those by editors Greene, Condrau, and Watkins, respectively, about the politics of geographical variation in drug pricing and prescribing in the late twentieth century, the fall and strange return of tuberculosis as a public-health threat and therapeutic target, and the passage of oral contraceptives from being a revolution in pill form to a routine commodity.Rosenberg offers a brief concluding comment, contrasting the “therapeutic revolution” narrative of the past century with medical-historians’ understanding of therapeutics at the time. He contends that we should not be swept away by our era’s faith in science. The same contextual factors that determine the success of a drug today applied to, say, bloodletting in the eighteenth century and earlier—including the social role of the physician that therapy helps to create; the national and cultural settings of medicine; the institutional settings of the therapy in question, especially whether public or commercial; and the idiosyncratic characteristics of the patient or populations on which the therapy acts.In his final sentence, Rosenberg urges us to “think with as well as about therapeutics,” by which he appears to mean that the contextual factors considered to be necessary for a drug’s success can be illuminated in historical research. Indeed, we can learn much about physicians, patients, and societies in studies of the performances—whether clinical trials, newsworthy breakthroughs, or advertising campaigns—contrived to exhibit the curative effects of new medicines. This collection helps to show that the historiography of pharmaceuticals has already proceeded far down that path

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