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  • Comments on the Retrospective Issue
  • Theodore R. Marmor (bio)

The occasion of this special issue provided a good reason to review what led this journal, in early 1982, to accept for publication a chapter from Paul Starr's then forthcoming book, The Social Transformation of American Medicine. Looking back at what we then wrote—as editor and managing editor of the Journal of Health Politics, Policy and Law—offers an interesting glimpse at the difference in context between 1982 and 2004. Reproduced on page 572 is the editorial note that Terry Eicher and I wrote, which is clear if not profound. What I am struck by now is how seriously and earnestly we assumed that thoughtful health policy analysis—historically informed, broad-ranging across law, politics, economics, and philosophy—might make a difference. That is the context in which we did something unusual: publish in a journal a chapter from a contemporaneous book.

What made sense of that in l982 was the presumption that Starr's massive scholarly effort might well "influence some of our most serious understandings and disputes about how the medical care past will shape where we are going." We were prepared to publish thirty printed pages, l.5 times the length of the following (quite good) article by Nino Majone. We describe Starr's work as satisfying our "taste" for "disciplined reflection." I now note how completely indifferent we were to the rather narrow criticism that emerged from some historians about the extent to which The Social Transformation of American Medicine lacked archival, primary sources and "used" the primary scholarship of professional historians. [End Page 569] Since Starr cited (and, I believe, used well) my own book on the politics of Medicare, I had considered that topic and had dismissed the criticism so thoroughly that publishing the chapter seemed delightful rather than distressing. Synthetic scholarship—the work of encyclopedias, first-rate textbooks, summaries of complex and disparate narratives, and so on—is to be judged by its own standards. They are not competitors with discovery of primary materials; visits to archives are to synthetic works as finding gems is to constructing jewelry. Both are important, but the test of the synthetic work is whether it confronts the complexity of the contending views and integrates and narrates in an illuminating, defensible way.

Starr's book did that, however limited it had to be in some respects when we look back from the vantage point of 2004. Indeed, I recall a sentence from the one joint essay that Starr and I published, in 1984, which reflected our modesty about making social scientific predictions: "The point of forecasting," we wrote, "is not to predict the future, but rather to change it. We know too much about the failure of even the most sophisticated demographic and economic projections to hope we could accurately predict the changing structure of institutions" (Starr and Marmor 1984: 234). I shared (and share) these judgments, but Starr wrote them. Anyone reading The Social Transformation of American Medicine in the twenty-first century should note this expression of seriousness and forecasting modesty. The book certainly did not change American medicine in ways Paul Starr would have wanted, but it did shape our understandings and extended our capacity to make sense of a medical world loaded with illusions.

Finally, the issue in which Starr's chapter appeared is itself worthy of some notice (see a portion of that table of contents, reproduced on page 573). The range of disciplines represented is impressive, and the quality of Larry Brown's commentary on contemporary Washington politics is commendable. What strikes me now is how much more crowded the field of health and health policy journals has become, with lawyers writing more for special law and medicine outlets, economists writing for their own journals, political scientists writing much less than others altogether, and policy analysts writing for their own journals as well. The Journal, like Paul's book, then reflected the assumption that we could have a common, broad, and important conversation about what American medicine was and should be like. [End Page 570]

Theodore R. Marmor
Yale University
Theodore R. Marmor

Theodore R. Marmor was the editor of JHPPL...

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