The Burdens of Disease: Epidemics and Human Response in Western History, and: The Greatest Benefit to Mankind: A Medical History of Humanity (review)

(p. 87) . In other words, this Task Force recommends creation ofanother (standing) task force. Like Assessing Genetic Risks, Promoting Safe and Effective Genetic Testing in the United States offers its recommendations without any developed arguments to support them. In both books, the term "principle" is used loosely to describe varying degrees of generality. However, the Institute of Medicine committee stipulates four ethical principles that could be tapped in elaborating support for its recommendations : autonomy, privacy, confidentiality, and equity. In contrast, the Task Force mixes topics or procedures with ethical concepts, identifying each of the following as "overarching principles" (p. 12): informed consent, prenatal and carrier testing, testing of children, confidentiality, discrimination, and consumer involvement in policy making. Even if these "principles" represented the same level of generality, their meanings are more overlapping than overarching. The ethical principles of beneficence and nonmaleficence, while not articulated as such, underlie the book's focus on safety and effectiveness. Despite its flaws, Promoting Safe and Effective Genetic Testing in the United States is a valuable resource for anyone to whom genetic tests are professionally or personally relevant. As tests proliferate, that number is constantly increasing. The information provided throughout the text and in the appendices seems more useful than the multiple recommendations, because most of the latter are obvious or overly general . Few readers are likely to disagree with the Task Force's suggestions for insuring safe and effective genetic testing; the challenge of implementation remains unmet. Mary B. Mahowald University of Chicago The Burdens ofDisease: Epidemics and Human Response in Western History. By J.N. Hays. New Brunswick, NJ: Rutgers UP, 1998. Pp. 361. $50.00 (cloth), $24.00 (paper). The Greatest Benefit to Mankind: A Medical History of Humanity. By Roy Porter. New York: Norton, 1997. Pp. 831. $35.00. Is historical knowledge relevant to the contemporary world? Most individuals, including the general public as well as those associated with biomedical, social, and behavioral sciences, would probably offer a positive if highly qualified response to this question. Yet the manner in which history is used tends to be so highly selective as to raise serious doubts about the validity of such responses. Generally speaking, history is employed to validate prescriptions for the present and future; all examples from the past that are contrary are generally ignored. After 1945, to cite one illustration , American political leaders defended their Cold War diplomatic policies by utilizing a historical analogy. They emphasized that the military weaknesses of EnPerspectives in Biology and Medicine, 42, 4 ¦ Summer 1999 591 gland and France during the 1930s encouraged Nazi aggression and led to World War II. The moral was inescapable; the maintenance of peace required a strong military. These very same leaders, however, ignored the example of World War I. In 1914 the possession of powerful military forces by most European nations did not prevent the outbreak of war. I use this example as an introduction to the history of disease and medicine, which has also been utilized for didactic purposes. Prior to 1940 the emphasis was on medical and scientific breakthroughs associated with heroic individuals; the evolution of medicine represented inevitable progress from a dark past to an enlightened future. Implicit in this approach was the belief that the allocation of ever larger resources would hasten the process of discovery, which would lead to better health and greater longevity. More recently, by contrast, historians have developed new interpretive frameworks . They have emphasized that disease has two different if complementary sides. The first is the biological reality. Yet even biology does not stand in isolation; complex environmental and behavioral elements help to shape epidemiological patterns . The second approach involves the study of the meaning given to disease or— to put it another way—the manner in which human beings frame disease. Within this framework such elements as class, race, ethnicity, and gender play significant roles. The meaning attributed to disease has significant consequences, for it dictates societal responses. Lung cancer, for example, is intimately related to the specific behavior of smoking, but there is no stigma attached to those who become ill. The category of STDs, on the other hand, is in many ways similar, but those who fall within...