Cancer, Radiation Therapy, and the Market by Barbara Bridgman Perkins (review)

On 24 September 2018, BBC medical correspondent Fergus Walsh announced the launch of a "groundbreaking" radiotherapy machine.¹ He reported that the new technology, known as the MR Linac, allowed physicians to simultaneously scan the body for tumours and deliver X-ray radiation. According to Walsh, the machine was a "dream come true" for radiation oncologists, allowing clinicians to plan, adjust, and administer radiotherapy in real time, a capability particularly useful for treating tumours that shift in size and shape within the human body (such as lung, bladder, and colon cancers).² Although MR Linac was available only at a select few cancer centres in the UK and the Netherlands, Walsh stated that its unique capabilities would be sure to place the machine in high demand. Citing head of the MR Linac project Prof. Uwe Oelfke's assertion that the technology could "fully unlock the potential of radiotherapy" by increasing the precision of cancer treatment, Walsh predicted that MRI-guided radiation therapy programs would soon be integrated into hospitals and oncology centres across the globe.³

Walsh's 2018 article suggested that the release of the MR Linac marked an important moment in the field of radiation therapy – but is the machine really a technological breakthrough? Is there scientific evidence demonstrating that this latest and most powerful (and costlier) device is really the safest and most effective means of treating patients? These are precisely the questions that Barbara Bridgman Perkins grapples with in her new book Cancer, Radiation Therapy, and the Market. In this work, Bridgman Perkins provides a comprehensive history of the field of radiation therapy, paying particular attention to how radiation oncology coevolved with the device industry throughout the twentieth century. Beginning with Pierre and Marie Curie's discovery of radium in 1898 and ending with the development of proton therapy treatment centres in the early 2000s, Cancer, Radiation Therapy and the Market suggests that the success of radiation therapy has had more to do with discipline formation, the development of medical markets, and the rise of corporate capitalism than the efficacy of treatment. Rather than viewing the MR Linac as something new, Bridgman Perkins' work positions the machine as just another device in a long line of radiotherapy technologies that make over-exuberant claims about their cancer-curing capabilities to fuel the growth of a multi-billion-dollar industry.

In order to explore the relationship between radium, capitalism, and health policy, Bridgman Perkins divides her book into three parts. The first section looks at developments in the field of radiation therapy from 1895 to the Second World War, the second from 1945 to 1970, and the third from the 1970s to the early 2010s. In each of these sections, Bridgman Perkins describes the ways in which academic, medical, hospital, industrial, and financial interests converged to drive the field of radiation therapy forward. By tracing the historical development of technologies such as teleradium, supervoltage generators, the cobalt-60 machine, proton therapy centres, and even linear accelerators (nicknamed "linacs"), Bridgman Perkins repeatedly shows how market forces, assumptions, and policies have shaped the development of American radiation therapy over time. She convincingly argues that these developments have often served the interests of providers, payers, and investors, as opposed to individual patients, and have expanded professional, institutional, and economic returns on investment, often at the expense of scientific evidence and improved cancer outcomes. Bridgman Perkins concludes by stating that capital investment in the field of radiation therapy has led to the prioritization of private wealth over public health, thus diminishing a nation's capacity to build a system dedicated to the health of its people.

This work fits well into the growing body of literature on the history of medical markets, as the past fifteen years have seen a resurgence of interest in how the burgeoning consumption of medicine and rising cost of healthcare came to be. Since the early 2000s, a number of scholars have examined the consequences of the commercial economy on American healthcare delivery, using...