Biomedicine in the Twentieth Century: Practices, Policies and Politics (review)

The collection of essays published under this title is the product of a 2005 conference held at the NIH to honor Victoria Harden on her retirement as Director of the Office of NIH History. As the volume's editor Caroline Hannaway tells us in her introductory essay, however, Harden was clearly more than just a Director. Hannaway specifically credits Harden as having "invented" and "constructed" that office in the first place, signaling the negotiated and contingent nature of Harden's quest to locate a space, both intellectual and physical, for history at the NIH.

This encomium sets the stage for the essays to follow, many of which flesh out different aspects of the development of the NIH's structure and significance and, in this way, offers their own stories of construction and invention. What emerges, finally, is a vision of the NIH as an agency that essentially grew, and came to flourish where it was planted.

Though Hannaway expresses the hope that these essays will be a "catalyst for a wide range of substantive research on twentieth-century biomedicine," the essays included here, methodologically speaking, are not wide-ranging at all (7). Though transecting multiple substantive historical issues—heart transplantation, vaccine innovation, scientific instrumentation, in addition to the genesis and organization of the NIH—these essays ultimately illustrate a united methodological shift toward viewing biomedical history as the result of forces like contingency, synchronicity, and chance, making terms like "invention" and "construction" de rigueur, and away from narratives that only recognize discrete causal factors. They also reveal a common struggle to discover an analytic position that acknowledges the sheer size and power of biomedicine in the postwar without unreflectively offering these characteristics determinative roles in the assigning of historical significance. As a result, the best of these essays have sought and discovered significance within a complex and interactive confluence of mutually shaping factors.

Angela Creager's excellent study of the relationship between lay health organizations and the federal government in the post-World War II period stands out in this regard. Here she reveals the limitations of historical accounts that primarily see in the story of postwar science policy an instantiation of the federal government's tremendous power in the post-World War II period. Instead, by describing the lay health agencies use of war as a rhetorical device, Creager reintroduces the public as an agent actively involved, sometimes in surprising ways, in the construction of its own health care. In a similar vein, Leo Slater, in his essay on synthetic anti-malarial drugs, tantalizingly presents the molecule (the mole-cularization process more specifically) as both an underrepresented historical "agent" and an entity around which the history of twentieth-century biomedicine might be usefully restructured.

While Creager and Slater introduce new agents in the explication of biomedicine's history, others reinterpret familiar agents, effectively casting doubt on the fixity of their agendas and the intentionality of their goals. David Cantor's fascinating study of the NIH's brief dalliance with a treatment-oriented radium loan program in the late 1930s and early 1940s challenges those limiting historical narratives that pigeonhole the NIH as an institution of research, and research only. In turn, Susan Lederer and Gerald Grob offer compelling discussions of the confluence of factors that "invented" heart transplantation technology and "constructed" mental health policy.

In each of these essays, the greatest analytic pay-off comes from the debunking of the notion that inflexibility and inexorability are fundamental components of American biomedicine's history. This suggests that one of the things most on the minds of these scholars might have been the production of a methodology that will clarify why biomedicine has the shape, force, and position that it does right now. As Stuart Blume notes in his exceptional explication of the history of what he calls "the vaccine innovation system", there is a pressing need for this history to also produce "an agenda for future research...