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  • The Pursuit of Perfection: The Promise and Perils of Medical Enhancement
  • Sander L. Gilman
Sheila M. Rothman and David J. Rothman. The Pursuit of Perfection: The Promise and Perils of Medical Enhancement. New York: Pantheon, 2003. xxi + 292 pp. Ill. $25.00 (0-679-43980-3).

Sheila and David Rothman of Columbia University are two of the most intelligent and wide-ranging historians of medicine writing today. Having written together one of the most important books on deinstitutionalization (The Willowbrook Wars: A Decade of Struggle for Social Justice, 1984) and separately written numerous important monographs on areas from tuberculosis autobiographies (Sheila) to medical technology (David), they turn to what is both the litmus test for modern medicine and the arena that defines its margins: the pursuit of perfection. This well-written, accessible volume surveys the attempts within biomedical science and medicine (not always the same arena) to "improve" the body. The authors look at the history of the applications of endocrinology (in terms of male and female hormones and human growth hormone) and aesthetic surgery to modify and change the "normal" development and alternations of the body.

The Rothmans are quite smart enough to understand that the very idea of "normal" shifts as these medical fields are developed, and they question the imperative of improvement and progress associated with them. They illustrate effectively how something that may well have the powers of "cure" within one model of medicine quickly becomes extended to the pathologization of the spectrum of human development. Their emphasis lies on the aging process in every sense of that word—from too small stature in childhood, to the question of bodily transformation in the life cycle. Their historical scope is the mid-twentieth century and is heavily but not exclusively North American. This enables the reader to quickly see the perils of the globalization of medical practice and therapy.

For me, the chapter on cosmetic surgery was most illuminating, if only because of my own earlier work in this field. Focusing on Yves-Gérard Illouz, the modern "developer" of liposuction (there are predecessors, of course), the Rothmans show how a procedure with at least initially very limited goals, aimed at bodies defined as "healthy" in terms of weight, came to be a panacea for all weight reduction and body shaping. The marginal role of Illouz as a North African Jew in French medicine supports my own thesis that many of the major innovations in aesthetic surgery come from the margins of medicine—even the margins of aesthetic surgery! Yet liposuction became a worldwide technique only when it was introduced into American surgical practice. The sense that liposuction is the exemplary alienating process of the modern pursuit of perfection as mirrored in the Rothmans' work is but an echo of a scene in David Fincher's film Fight Club (1999, based on the novel by Chuck Palahniuk), where anarchists break into the garbage dump of an aesthetic surgical clinic to steal bags of human fat removed by liposuction in order to turn them into bombs: in a sense, this volume wishes to do exactly this with the wide range of pursuits of perfection that is documented.

The Rothmans share the sense that such marginal actions may well define [End Page 924] what is the acceptable arena of medicine, given that they convert "normal" human activity into pathologies for which they offer a cure. The case studies presented here certainly provide grist for their mill. In addition, the volume is extremely well grounded in contemporary cultural theory—especially the feminist views of the body. Well researched and well presented, this volume may well set the pattern for other wider-ranging books in the history and practice of medicine.

Sander L. Gilman
University of Illinois at Chicago
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