Salud, tecnologia y saber medico (review)

Professor Barona Vilar is a distinguished medical historian who has made significant contributions in Spanish. This book aims to provide a global overview of the relationship between public health, medical technology, and academic medicine during the twentieth century. Accordingly, the main chapters are called "Health and Society," "Technological Innovations and Health Industries," and "The Evolution of Medical Knowledge." There is also a sound chapter on the ethical challenges posed by new technologies. The organization is thematic rather than chronological and underlines the interaction between medicine and politics. As the readers of this review can imagine, writing such a book demands great skill. What makes this one a legitimate enterprise is the lack of a comparable study in Spanish and the author's command of contemporary European and U.S. works on the history of medicine. It should also be noted that the book deals not only with Spain but also with other Western European countries and the United States, and that medical events and leaders are better described than are their public health counterparts.

The first section of the book contains a summary of the debates on the role played by medicine and public health in the epidemiologic transition of Western Europe. Professor Barona Vilar and other Spanish historians, such as Josep Bernabeu Mestre, have argued convincingly that education and aggressive public health interventions have played a positive role in the improvement of living conditions in Spain. This book also examines the emergence of welfare states in Western European countries and the United States at the turn of the twentieth century. The author underscores the relationship between John M. Keynes's economic ideas concerning the need for government-sponsored programs, and public health reorganizations that took place in the wake of World War II.

In the second section, the descriptions of how pharmaceutical industries achieved prominence, of how new techniques were adapted to hospital life, and of the motivations of medical specialists to create their own field of expertise are remarkable. The author also examines the policies of the 1980s that tried to dismantle the "inefficient" and "unproductive" health system. "Globalization"—a term used frequently in the book—is taken for granted: it is a natural reality produced by the exponential growth of the international economy, new demographic challenges, the dissemination of rapid information technologies, and emergent infectious diseases. Barona Vilar makes a brave and articulated critique of neoliberal attempts to untangle the social security systems and national health services of Europe, and reinforces the idea that health is a right of individuals.

I have three criticisms of this book. First, there is little that reflects the rich historiography on colonial and postcolonial medicine that has emerged in the past few years. The use of the terms "Third World" and "Primary Health Care" for events of the early twentieth century is anachronistic: the first emerged with the Cold War of the 1950s, and many today consider it outdated or a gross simplification; the second term emerged in the late 1970s with the Alma Ata Conference organized by the World Health Organization and UNICEF. Second, the discussion of the international health agencies that existed after and before World War II is confusing, provides little insight into crucial programs such as the World Health Organization's global malaria eradication program, and ignores the Pan American Sanitary Bureau. And third, the references and bibliography needed more copyediting.

This book should be of use to a Spanish-speaking general audience interested in medicine's recent past. Historians specializing in Spanish history will find sound descriptions of the contributions of national medical leaders such as Santiago Ramón y Cajal, Augusto Pi Sunyer, and Gustavo Pittaluga.