In 1922, fourteen-year-old diabetic Leonard Thompson received the first injections of insulin at Toronto General Hospital. The medication was life-saving and meant that juvenile diabetes (now called type-1 diabetes) was no longer a death sentence. As long as patients had access to insulin, they could live relatively normal, healthy lives. A genuine therapeutic revolution, perhaps. Yet, a century later, rates of type-2 diabetes have mushroomed and now constitute ninety percent of diabetes cases. Try as they might, pharmaceutical companies have no magic bullet for type-2 diabetes, leaving lifestyle adjustments as the primary intervention. So, what story is the most telling? Which narrative conveys most about how to tackle disease in the twenty-first century? These are just some of the themes explored in Therapeutic Revolutions, a compelling attempt to unpack exactly what has been revolutionary about modern medicine. The volume’s chapters combine history, anthropology, sociology, and science studies, including a number of contributors who work at the intersection of medicine and social science. At a time when the term “interdisciplinary” is wheeled out in academia almost as often as the term “revolutionary,” the editors should be commended for putting together a volume that is much more than the sum of its parts. In that spirit, rather than commenting on each chapter, I will focus on some of the book’s key themes. One theme addresses how taking prescribed drugs has become a routine, daily practice for millions of people globally. The original magic bullets, as Scott H. Podolsky and Anne Kveim Lie describe, were antibiotics that treated endemic infectious diseases. Although the course for these drugs might have been over many months, they were not medications that patients would need recurrently (ironically, however, they were still overused, resulting in antibiotic-resistant bacteria). Once previously widespread infectious diseases became less common, the need for such drugs decreased even further. As Janina Kehr and Flurin Condrau argue, this has contributed to the perception that diseases, such as tuberculosis, are “boring,” not worth a great deal of investigation (137). The more exciting – and profitable – diseases were those treated by medications taken daily. Perhaps the most striking example of such daily medications is the contraceptive pill, the subject of Elizabeth Siegel Watkins’ chapter. While the primary purpose of the pill is to prevent pregnancy, the emergence of alternative contraceptive methods have spurred pharmaceutical companies to take advantage of its side effects. Manufacturers have highlighted the “secondary effects” (44) of the pill – ranging from alleviating acne to reducing irritability – in marketing campaigns to retain their market share against competitors and to reimagine their product as a more general lifestyle drug. As such, Watkins concludes, the pill has “helped to normalize daily pharmaceutical consumption” for women (61). Many psychiatric drugs also follow the daily – and lifelong - medication model, yet perform a less straight-forward function than contraception, as the title of Nicolas Henckes’s chapter – “Magic Bullet in the Head?” – hints. Henckes argues that while post-war neuroleptic drugs have been described as revolutionary, the history of the use of such drugs across Europe and North America has been characterized more by “differentiation and conflict … than standardization and consensus” (87). Although the historiography of psychiatry would indicate that this is not a surprise, Henckes’s observation about how psychiatric researchers continue to employ this “revolutionary rhetoric” (88) to convince funders, politicians, and the public that mental illness will eventually be conquered is telling. As many of the other chapters suggest, the notion of a glorious therapeutic revolution in medicine has provided researchers and pharmaceutical companies with an undated promissory note to cure the chronic diseases of today. Another theme discussed in the volume addresses who has benefitted from such therapeutic revolutions – and who has not. Jeremy A. Greene’s chapter is the first of three that analyze the mixed consequences of providing the developing world access to modern pharmaceuticals. Drugs, as Greene describes, have often been synonymous with development, but improving access has been challenging for health organizations, given that pharmaceutical companies operate in a free market. Indeed, as Kristin Peterson’s fascinating chapter on Nigerian drug markets indicates, the chaotic, speculative, and unregulated nature of global pharmaceutical sales has undermined access to life-saving drugs. Even when such drugs become available, as Julie Livingston’s chapter on antiretroviral drugs and cancer elucidates, other problems arise. Antiretrovirals have extended the lives of those with HIV in southern Africa, but many patients end up suffering from the “virus-associated cancers that are facilitated by their HIV-related immunosuppression” (221). Focusing on a Botswana cancer ward, Livingston provides a poignant account of how certain biomedical technologies have the “power … to ease suffering and to potentially stave off death … yet these same goods are proving more complicated and less miraculous than hoped” (224). The remaining chapters are interesting, but share a somewhat pedantic focus on defining what can be considered “revolutionary” in medicine. While David S. Jones considers how the term “evolution” might be a more useful metaphor in describing medical developments (a distinction with which I agree), Nils Kessel and Christian Bonah’s chapter argues that quantitative analysis of West German health data demonstrates that new drugs were not all that revolutionary even in the country where many of them were produced. Similarly, the chapter by Paul Farmer, Matthew Basilico, and Luke Messac considers the McKeown hypothesis in the context of Global South, contending – not particularly helpfully or surprisingly given the massive shift in context from industrializing England to places like post-genocide Rwanda – that it is not overly relevant. Although historians and their students will enjoy reading Therapeutic Revolutions, its deconstruction of the pharmaceutical revolution will not surprise many. Some might even be slightly disappointed that the contributors did not go further in suggesting how modern medicine might learn from its not-so-revolutionary past. Although the reader is left with more questions than answers, the overall impression is that faith in medicine to produce the revolutionary is quixotic; an equal amount of effort should be placed on achieving the basic foundations of health, which might prevent the need for such therapies in the first place. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org
Journal of the History of Medicine and Allied Sciences – Oxford University Press
Published: Jan 1, 2018
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