Medical Monopoly: Intellectual Property Rights and the Origins of the Modern Pharmaceutical Industry, by historian of medicine and the biomedical sciences Joseph M. [End Page 457] Gabriel, is a significant and beautifully written book. By linking the study of patenting and other monopolistic practices in the pharmaceutical industry, such as trademarks, to the history of therapeutic reform, it makes an original and valuable contribution to the historiography in a variety of fields, from intellectual property to therapeutic reform, medical ethics, and the pharmaceutical industry. Medical Monopoly is therefore of relevance to a broad range of scholars, but also to clinicians, bioethicists, and the wider public concerned by the power of companies and the potential for conflicts of interest within modern medicine.
The central argument of the book is that "the emergence of the modern pharmaceutical industry was both a cause and a function of a profound transformation in the ethical sensibilities of physicians and other actors toward medical patenting" (p. 3), a transformation that occurred in the United States between the American Civil War and World War I. For these actors, who were involved in therapeutic reform in the same period, shifting attitudes toward patents and trademarks became a crucial part of the process to improve medicine by promoting scientific standards in the manufacture, distribution, and use of pharmaceuticals. At a more fundamental level, the book engages with the issues surrounding the scope, meaning, and ethics of intellectual property. By looking back at the moment in time when the pursuit of profit and the advancement of medical science were first linked to one another, and when—ironically perhaps—keeping the boundary between them clearly defined therefore gained paramount importance, Medical Monopoly sounds a word of warning about the corrupting influence of the profit motive on both science and medicine.
Based on extensive research in archives, including those of pharmaceutical companies, medical institutions, regulatory bodies, and a number of district as well as Supreme Court documents, the book largely follows a chronological structure. The Civil War (tackled in chap. 3, "In the Shadow of War") is identified as a major turning point not only, as has been widely acknowledged, in the history of American corporate capitalism, but also, as Gabriel convincingly shows, in the history of the relationship between pharmaceutical patenting and therapeutic reform. Medical Monopoly also takes into account the evolving context of pharmaceutical innovation and the challenges it posed to American pharmaceutical companies, regulatory bodies, and the medical profession, especially since, at first, many of the most innovative drugs (whether synthetic or biological) came from Europe, in particular Germany, which also benefited from a strong patent system following the country's reunification in 1871. These challenges created tensions within the medical profession, eager to support the use of effective new drugs in a bid to establish a "rational" form of therapeutics (where they were the main arbiters of what counted as "rational"), which also meant supporting, and eventually cooperating with the companies that made them—particularly if these were American. Gabriel also identifies Adrenalin, a major therapeutic advance and the result of significant investment on the part of Parke-Davis, which acquired and then successfully defended its patent for the drug in 1911, as the culmination of this transformation, which was strengthened a few years later when in 1918 Congress authorized pharmaceutical patents and trademarks held [End Page 458] by German firms to be confiscated. These measures would greatly benefit the American pharmaceutical industry, which expanded rapidly during the 1920s, as did the industry in other countries that had been at war with Germany and had introduced similar measures.
Thus, Medical Monopoly tells an essentially American story, which I feel could have been made more explicit (for example by replacing "Modern" with "American" in the title). Nevertheless, it is a significant story, not least because of the dominance which the American pharmaceutical industry acquired in the twentieth century—thanks in part to the development of monopolistic practices within the industry and the growth...