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  • Biomedicine in the Twentieth Century: Practices, Policies, and Politics
  • Peter Keating
Caroline Hannaway , ed. Biomedicine in the Twentieth Century: Practices, Policies, and Politics. Biomedical and Health Research. Amsterdam: IOS Press, 2008. x + 377 pp. Ill. €130.00 (978-1-58603-832-8).

The papers in this collection cover two distinct periods in the development of biomedicine since the Second World War. The first concerns the period 1945–64 and the vast expansion of clinical research on both sides of the Atlantic, principally in the leading biomedical research centers: the National Institutes of Health (NIH), the Medical Research Council, and the Rockefeller University. The second concerns the fate of biomedicine since the rise of molecular biology in the 1980s and the concomitant privatization of research and the redistribution of research within public/private networks.

Richard Lewontin and Buhm Soon Park set the stage with general overviews of the massive increase of biomedical research funds in the postwar period and the reorganization of research along disease lines in the NIH's intramural program. While much here is well known, the papers that follow offer a useful corrective to the common and often triumphant "rise" metaphor. Gerald Grob shows, for example, that not all that rose stayed risen. In his description of the maneuvers leading up to the passage of the Community Mental Health Centers Construction Act of 1963, Grob notes how the plan had originally sought the creation of about two thousand community mental health centers. In the end, only about a third of the proposed centers were finally built, and those that were built did little for most of the internees of the state mental asylums, the original targets of the centers. Their future lay in the emerging antipsychotics. The new centers did, however, cater to the middle-class clients of the various forms of psychotherapy increasingly delivered by clinical psychologists and social workers rather than psychiatrists. Grob's conclusion—that the prevention of mental illness and the promotion of mental health failed as public policy options—will find few detractors.

Arguing along similar deflationary lines, David Cantor reminds us that the original National Cancer Institute (NCI) mandate stipulated that the NCI provide radium to hospitals throughout the country for routine cancer treatment. Confronted with the option of providing cancer care for the poor or creating an institute for cancer research, Congress had opted for the latter. Free radium [End Page 808] addressed the national shortage of radium without taking the fatal step down the road to state medicine. While Britain, France, Sweden, and Canada offered clear examples of the alternative with their national networks of radium treatment centers, the NCI lobbied vigorously to divest itself of its radium program shortly after its founding. While the NCI continued to lend radium to hospitals into the 1960s, it had long since shifted the vast majority of its budget from routine treatment to research.

Although several papers focus necessarily on the NIH and its institutes, Darwin Stapleton and Angela Creager remind us of the significant role played by other institutions (e.g., the Rockefeller University) and lay movements in the postwar expansion of biomedical research. As Creager notes, long before the emergence of patient activism of the 1980s, campaigns like Christmas Seals and the March of Dimes captured the imagination and the dollars of many Americans and allowed nonmedical groups like the National Tuberculosis Association, American Society for the Control of Cancer, and the National Foundation for Infantile Paralysis to fund significant research and raise awareness of their respective diseases. Carsten Timmermann's analysis of research on hypertension and lung cancer at the Medical Research Council both prior to and after the war shows how, despite its size, Britain participated from a very early stage in the emerging global network of biomedical research.

The collection of papers assembled in this book treats the post–molecular-biology phase (post-1980) of biomedical research in a somewhat sketchier manner. Stuart Blume, for example, describes the transformation of the vaccine system with the departure of private enterprise in the 1960s and its return armed with molecular biology techniques in the 1980s and 1990s, whereas Daniel Kevles offers an overview of human–gene–patenting practices...

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