Historians have highlighted a growing medical enthusiasm for public health education movies in the early twentieth century. This essay suggests that there is another historiographic tale to tell, of concerns that films might undermine the public health messages they were designed to promote—concerns that threatened continued interest in movies during the Depression of the 1930s. First, focusing on cancer-education movies aimed at the general public released by the American Society for the Control of Cancer (ASCC, founded 1913), the paper argues that the organization's initial enthusiasm for movies was tempered from the late 1920s by a combination of high production costs, uncertainty as to the effectiveness of movies as public-education tools, and the hard economic situation. It was only after 1944 that motion pictures became a stable part of the propaganda efforts of the renamed American Cancer Society. This transformation followed the takeover of the Society by advertisers and businesspeople, led by Mary Lasker, who introduced business models of fund-raising and education, and made expensive communication technologies, such as movies, central to cancer control. Second, the article also traces the persistence of anxieties that movies might undermine cancer control by encouraging emotional responses that led audiences to ignore the lessons the movies were intended to encourage. But whereas such anxieties dampened ASCC enthusiasm for cancer-education movies during the hard economic times of the 1930s, they had no such effect after 1944, and attention shifted to developing techniques of controlling unwanted audience responses.
This paper examines a collection of images of children printed in cancer education and fund-raising materials distributed by voluntary health organizations, released by public relations departments of specialized cancer hospitals, and featured in popular magazines and newspapers beginning in the late 1940s. Children represented only a small fraction of all persons with cancer, yet they became a key component of the media campaign for the disease. What narratives were embedded in the photographs and profiles? Like the March of Dimes' use of young polio patients to promote their programs, "poster children" were strategically used throughout the mid-to-late twentieth century to advance principles of early cancer detection and prompt treatment; to illustrate or, at times, exaggerate promising biomedical advances in the field; and to elicit emotional responses and donations from a wide audience during the escalation of the war against cancer.
This paper explores the cultural representations of cancer in popular Hollywood films released between 1930 and 1970. These cinematic treatments were not representative of the types of cancer that increasingly afflicted Americans, nor were filmmakers and studios concerned with realistic representations of the disease, its treatment, and its outcomes. As in the "epidemic entertainments" of the early twentieth century that portrayed diseases as cultural commodities, popular filmmakers selectively projected some cancers rather than others, favoring those that were less offensive and more photogenic. Although the characters became weak and died, they did so without gross transformations of their bodies. This paper argues that such representations nonetheless informed American attitudes about cancer and the role of medical research in overcoming the disease.
This article examines British medical debates about cancer education in the 1950s, debates that reveal how those responsible for cancer control thought about the public and their relationship to it, and what they thought the new political economy of medicine introduced by the National Health Service would mean for that relationship. Opponents of education campaigns argued that such programs would add to the economic and organizational pressures on the NHS, by setting in motion an ill-informed, uncontrollable demand that would overwhelm the service. But an influential educational "experiment" devised by the Manchester Committee on Cancer challenged these doubts, arguing that the public's fear was based in their experience with family and friends dying of the disease. The challenge for cancer control, then, was to improve that experience and thus change experiential knowledge.
In 1924 the London Committee of the Medical Women's Federation was instrumental in establishing a clinic for the purpose of investigating the radium treatment of cervical cancer. The scheme was later to evolve into a hospital, the Marie Curie, where adherence to the methods developed in Stockholm served to establish radiotherapy as an alternative to surgery in cancer of the cervix. This article examines the women's contribution in the light of feminist and professional struggles over the relative merits of surgery and radiotherapy. It argues that radiotherapy was an issue of special interest to women surgeons, not only because of the long history of feminist opposition to gynecological surgery, but also because it could widen women's access to the medical profession in the face of male exclusion from training posts and honorary appointments at voluntary hospitals.
The treatment of cancer through the twentieth century may be seen as the successive addition of modalities: first surgery; then radiotherapy, especially between the world wars; and then chemotherapy, from the 1960s. This paper explores some of the systematic differences between the modalities, and how these additions were negotiated in different countries, with different long-term consequences for the development of services and specialization. It focuses chiefly on the United Kingdom and the United States, the former exemplifying a centralized health polity, and the latter, liberal markets combined with large and crucial postwar inputs from government. The differences between health polities were especially important for interwar radiotherapy, which in its centralized form appeared as paradigmatic of the analytical/rationalizing mode in modern medicine. Chemotherapy exemplified a more inventive and experimentalist mode that became common after World War II, and that, through the practice of trials, shaped the new subprofession of medical oncology. The interactions of the modalities, at various levels, are modeled as contested cumulations showing strong path dependency. The paper ends by reviewing the present situation, especially for Britain, and by underlining the relevance of history.
Clinical trials are the principal vector for the development of chemotherapy, and they have become such a pervasive element of clinical cancer research that modern oncologists tend to take them for granted. Yet the system of cancer clinical trials amounts to a relatively recent (post–World War II) innovation. Its development has proceeded through ad hoc adjustments, and has produced a self-vindicating, yet open-ended, style of practice. This paper examines the historical development and articulation of the components of this new style of practice (protocols, oncologists, statistics, patients, and diseases), and of the new kind of objectivity they engender, by drawing on selected examples from American and European cancer clinical trial systems.
In 1984 the noted breast cancer activist Rose Kushner published a controversial article, "Is Aggressive Adjuvant Chemotherapy the Halsted Radical of the '80s?" In it, she argued that chemotherapy was being used as indiscriminately as the radical mastectomy had been, before she and others had successfully discredited the disfiguring operation. As with all of Kushner's writings, this article raised valid points in an informed and provocative style, but her attack on chemotherapy was more one-sided than was typical. This may have been due to the highly personal nature of the topic: when she was diagnosed with recurrent breast cancer, she had declined chemotherapy in favor of a hormonal agent, tamoxifen. She also developed a close working and financial relationship with the manufacturers of tamoxifen. Although not seen as a problem at the time, Kushner's dual roles as patient and advocate for a particular treatment foreshadowed conflict-of-interest issues that would take center stage in medicine in subsequent decades.
This paper follows the history of "morphological risk" of breast cancer. In the early twentieth century, surgeons and pathologists arrived at the conclusion that specific anatomical and cytological changes in the breast are related to a heightened risk of developing a malignancy in the future. This conclusion was directly related to a shift from macroscopic to microscopic diagnosis of malignancies, and to the integration of the frozen section into routine surgery for breast cancer. In the interwar era, conditions such as "chronic mastitis" and "cystic disease of the breast" were defined as precancerous, and women diagnosed with these conditions were advised to undergo mastectomy. In the post–World War II era, these entities were replaced by "carcinoma in situ." The recent development of tests for hereditary predisposition to breast cancer is a continuation of attempts to detect an "embodied risk" of cancer and to eliminate this risk by cutting it out.
Hereditary non-polyposis colorectal cancer (HNPCC) helps us understand how medical genetics has changed over the last forty years. The concept of the "cancer family" emerged from the realization that members of some families developed cancer more frequently than members of others, which led to a series of strategies by clinicians in the 1960s to persuade others of this. By the early 1990s molecular genetics had transformed the disease, from one that a few physicians believed ran in families, to one with precise genetic components that researchers generally accepted, and that could be detected through genetic tests. Nevertheless, a diagnosis of HNPCC still requires that the mutated genes be found within a kin group that is generally accepted as a cancer family. Moreover, the "cancer family" construct was crucial in the search for the HNPCC genes. HNPCC's trajectory can be mapped onto important debates about the complex relations between clinical and molecular genetics knowledge and practice.
The 1962 report of the Royal College of Physicians on smoking was a significant event in the history of smoking. Its significance was, however, more than smoking-specific: the RCP committee's appointment, its membership, its work, and the manner of its publication signified the changes within social medicine, and within the medical profession more generally, in postwar Britain. Doctors assumed the right to speak to the public and to government on matters of individual health, and a new risk-based public health was in the process of formation. A public health "policy community" formed, and governments began to assume responsibility for advising the public on health matters. The use of research in the report, and of social research in response to it, was important in the emergence of evidence-based medicine within public health. The paper argues for greater attention to the change in public health epitomized by the report in current debates on the concept of the 1960s "permissive society." It was the harbinger of a new style of "coercive permissiveness" in health.
In recent years lung cancer specialists have complained that due to stigma resulting from the association of the disease with smoking, theirs is a neglected field. This paper demonstrates that in the 1950s and 1960s, when the British Medical Research Council (MRC) started to organize clinical trials for various forms of cancer, this was not the case. Rather, the organizers of these trials saw lung cancer as a particularly promising object of research, for much was known about the disease. The cancer trials were part of a strategy to use the Randomized Controlled Trial (RCT) technology to cement the role of the MRC as the dominant body overseeing medical research in Britain. The organization of the trials, however, turned out to be very difficult, due to ethical problems and the dominance of one form of therapy, surgery. The trial results were deeply disappointing. I argue that these frustrating results contributed to the notion of hopelessness that has come to surround lung cancer, and to the shift of focus from cure to prevention that was triggered by epidemiologic studies identifying tobacco smoke as the main cause of the disease. The paper deals with an important episode in the history of clinical cancer research in postwar Britain, illustrating the ethical and practical problems faced by the organizers.