Disorder: A History of Reform, Reaction and Money in American Medicine
Peter A. Swenson
Yale University Press, 2021
This book is an excellent synthesis of primary and secondary sources for the political history of the medical profession since the early 20th century, with particular emphasis on how these politics informed medical education and practice and health policy more broadly. Swenson's central theme is the commercialization of the profession since the early 20th century.
Swenson presents this overview in 15 chapters divided into 5 parts. After introducing his subject, he discusses “The American Medical Disorder,” “Drug Problems,” “Public Health and the Body Politic,” “Schooling Physicians,” and “Reactionary Turn and Beyond.” He concludes the book with an eloquent polemic on behalf of medicine returning to the “progressivism” of its political activities during the first half of the 20th century.
Throughout the book Swenson contributes insights. To identify a few: he presents a detailed narrative of the politics that generated the Pure Food and Drug Act of 1906, placing this history in the context of the politics of health care reform more broadly; he contributes fresh analysis and insight into the role of the medical profession in the expansion of policy to improve and maintain public health; and he carefully places American policy and practice for responding to infectious disease in its international context.
Swenson is also persuasive in addressing narrower issues. For instance, in discussing governmental response to yellow fever, he writes that “because of military money and authority, good medicine prevailed in the end against political disorder…a progressive victory accomplished by interpenetrating elites of the medical sciences, organizations and the military” (p. 175).
Swenson recognizes that much of the history he presents has been described and interpreted by many previous historians. He could have been more explicit about the strengths and weaknesses of this literature. For example, how it has evolved over time and both past and continuing disagreements among historians as well as about the roles of leading organizations within the medical profession. Nevertheless, this book is a fresh synthesis that will be especially useful for readers who have not paid close attention to the historiography of medical politics and policy over the past several decades. And his closing chapter is a well-argued polemic on behalf of “a new progressivism.”