Therapeutic Revolutions: Pharmaceuticals and Social Change in the Twentieth Century ed. by Jeremy A. Greene, Flurin Condrau, Elizabeth Siegel Watkins (review)

“The practice of medicine in 1980 looked quite a bit different than it had in 1930,” write Jeremy Greene, Elizabeth Watkins, and Flurin Condrau, in the introduction to Therapeutic Revolutions (p. 8). A major component of the transformation of medicine in these decades was the massive expansion of pharmaceutical research and development that led to the introduction of scores of new prescription drugs, including antibiotics, corticosteroids, minor and major tranquilizers, oral contraceptives, and the first drugs to treat hypertension. This period of transformation has been termed by physicians, the pharmaceutical industry, policy makers, patients, and some medical historians alike as a therapeutic revolution. But as Charles Rosenberg noted forty years ago in his seminal essay, “The Therapeutic Revolution,” claims of therapeutic efficacy—and thus the basis of therapeutic revolution—are both historically contingent and locally specific.¹

This impressive collection of essays by leading scholars in the history and anthropology of pharmaceuticals builds on Rosenberg’s earlier analysis to problematize the concept of a twentieth-century pharmacotherapeutic revolution. By examining the intersections of pharmaceutical innovation and social transformation in North America, Western Europe, and Africa, the essays underscore the historical contingency and geographic specificity of any such revolution, and reveal what was at stake politically, economically, and culturally for the various historical actors that have mobilized the language of therapeutic revolution.

The volume can be broken into four sections. The first section, with chapters by Scott Podolsky and Anne Kveim Lie, Elizabeth Watkins, and Nicolas Henckes, considers three classes of drugs held as emblematic of the mid-twentieth-century therapeutic revolution—antibiotics, oral contraceptives, and antipsychotics, respectively—and examines the degree to which these drugs were revolutionary and the political, economic, and social gains made by those who mobilized the rhetoric of revolution.

The second section interrogates the measures by which pharmaceuticals introduced in the mid-twentieth century were considered revolutionary: pharmaceutical consumption and statistical measurements of therapeutic efficacy. Using pharmaceutical sales data from IMS Health, Nils Kessel and Christian Bonah show that it was older drug products like analgesics, hypnotics, and sedatives, rather than “revolutionary medicines” like antibiotics and cardiovascular drugs, that dominated the West German pharmaceutical market in the 1960s and 1970s. In their history and ethnography of tuberculosis treatment, Janina Kehr and Flurin Condrau show the ways in which clinical trials data documenting the efficacy of streptomycin to treat tuberculosis in the 1950s was mobilized as “proof of the universal effectiveness of antibiotics regardless of social situation,” even as antibiotic resistance undermined treatment efforts and tuberculosis persisted as a global health concern (p. 135). This “statistical modeling of success” (p. 135), Kehr and Condrau argue, “transformed tuberculosis from a subject of cutting-edge biomedical research into a disease that physicians considered ‘boring’ . . . until it reemerged in the late twentieth century as multidrug resistant tuberculosis and extremely drug-resistant tuberculosis, and thus a subject of renewed biomedical excitement” (p. 12).

The third section shifts focus from the United States and Western Europe to the Global South and examines the intersections of pharmaceutical innovation, international development, and global public health, highlighting the spatial-temporal character and political economy of the therapeutic revolution. Jeremy Greene analyzes the ways in which American lawmakers, physicians, patients, regulators, and pharmaceutical companies mobilized arguments about the cause of and potential solutions to geographic disparities in pharmaceutical access during the 1960s and 1970s in an attempt to shape both domestic health policy and international development agendas. Paul Farmer, Matthew Basilico, and Luke Messac revisit the debate, ignited by Thomas McKeown in the 1960s, over the role of medicine in public health. Their analysis of recent economic, ethnographic, and epidemiological data makes clear that despite the persistent problem of uneven access, pharmaceuticals have contributed to a significant population-level mortality decline in the Global South. Julie Livingston’s history and ethnography...