Innovations in Health and Medicine: Diffusion and Resistance in the Twentieth Century (review)

This anthology offers readers a set of carefully researched case studies that detail how and why societies in the post-World War II era adopted medical innovations. Editor Jennifer Stanton defines innovation broadly; the acceptance of technological advances, shifts in professional organization, innovations in patient care and disputes concerning medical ethics all receive attention. Taken collectively, these essays reveal that even when uniform national laws, international guidelines, and professional goals and standards exist, the practical implementation of innovations varies widely between locales and even between populations within the same city.

The two micro-studies in the first section, "Close Neighbours," explore the diffusion of innovations within the local context. Debbie Nicholson's thoughtful analysis of ultrasound technology in two Scottish communities reveals that those employing innovations actively modified machines and designed usage patterns to fit local needs. Like Nicholson, Helen Valier and Roberta Bivins stress the importance of communities in determining how and where patients receive treatment. In their insightful and well-written study, "Organization, Ethnicity and the British National Health Service," they note that not all medical innovations are driven by health professionals; for example, the professionally directed reforms of the management of diabetes at the Manchester Diabetes Centre differed significantly from the efforts of the African Caribbean community that produced the Manchester Sickle Cell Centre.

The cross-cultural comparisons in the second section, "Across Nations," examine transplanted innovations. Roberta Bivins's fine study of acupuncture in Britain draws parallels between the nation's reception of acupuncture in the early nineteenth century and in the 1970s. Shifting British attitudes toward China, professional experiences, and lay perceptions, she argues, all helped revive the use of acupuncture and win National Health Service funding for the treatment. Cross-cultural exchanges do not, however, entail acceptance of all elements of a program. While the British rejected the philosophical underpinnings of acupuncture, the Japanese, Aya Takahashi reveals, were eager to adopt Western-style nursing techniques to help achieve military and imperial goals but rejected the Western nurses' feminist professionalism. The American medical profession's failure to accept the Swiss system's central tenets of using metal implants in operative fracture treatment, Thomas Schlich explains in his nuanced cross-cultural comparison, placed the United States years behind the doctors of the closely knit Swiss medical profession and the centrally controlled East German system.

Two of the articles in the final section, "Re-Innovation and the State," examine how competing constituencies influenced the acceptance of "reintroduced" innovations in the care of kidney patients. Jennifer Stanton's statistical analysis of where, when, and why British regional renal centers adopted either of two competing renal dialysis modalities demonstrates the powerful challenge that local studies offer to strictly economic explanations of human behavior. The preferences of local physicians, not cost alone, determined the dominant system of dialysis offered in the different regions of the United Kingdom. Martine Gabolde and Ann Marie Moulin carefully reconstruct the process by which questions of medical ethics, changes in public perception, and technological innovation allowed French surgeons to revive the practice of living donor transplantation.

Competition between health professionals can have unintended consequences. In her analysis of the reintroduction of midwifery in New Zealand, Philippa Mein Smith details how midwives' professional aspirations, state legislation, and the withdrawal of GPs from maternity care reduced women's choices in childbirth care. Kelly Loughlin examines how the British Medical Association lost its authority as the public face of medicine in Britain in the age of television.

Detailed but brief descriptions of recent medical procedures and organizational changes make Innovations most helpful to historians who wish to include more contemporary material in their history of medicine and health lectures. The cross-cultural comparisons add a global historical perspective that can...