To Fix or to Heal: Patient Care, Public Health, and the Limits of Biomedicine ed. by Joseph E. Davis, Ana Marta González

Abstract

Reviewed by: To Fix or to Heal: Patient Care, Public Health, and the Limits of Biomedicine ed. by Joseph E. Davis, Ana Marta González Joel D. Howell Joseph E. Davis and Ana Marta González, eds. To Fix or to Heal: Patient Care, Public Health, and the Limits of Biomedicine. New York: New York University Press, 2016. viii + 335 pp. (978-1-4798-7824-6). I sat this morning in the staff room of an academic internal medicine outpatient practice. During a brief lull between seeing patients an impassioned discussion broke among attending physicians, house staff, and medical students about which diseases were “real.” Chronic fatigue syndrome? Fibromyalgia? Chronic Lyme disease? More interesting was the dispute over how we would decide the answer to the question. What sorts of evidence would “count”? Would we need an anatomic abnormality, perhaps evidenced on a scan of some sort? Or a metabolic anomaly? [End Page 230] Perhaps a set of antibodies? This discussion went directly to the heart of the issues explored in To Fix or to Heal. While not directing their critiques explicitly at historians or clinicians, the authors of the book’s essays explore the questions that underlie tensions between a holistic or a reductionist view of medicine. As well as shaping much of the history of twentieth-century medicine, these tensions have become part of the quotidian life of any twenty-first-century clinician (as well as the clinician’s patients). The issues also shape our approach to health and medicine on a larger scale, being an essential part of debates over how best to improve public health and to reduce global health disparities. As the authors make clear, there is rarely a simple answer to the conflict between these two models—the medical world always exists in a state of varying degrees of emphasis. As the authors also make clear, no matter how hard those wishing for a more reductionist view may try to analyze them out of the picture, the moral and social implications of the dichotomy need to remain central to any analysis of health and health care. The impetus for the creation of this book came from a 2010 conference, at which early drafts of four of the chapters were presented. The essays come from a wide range of disciplinary perspectives (including history, philosophy, sociology, bioethics, and psychology) and take on a similarly wide range of subjects. While the book is not explicitly historical, many of the authors take a historical approach to their subject, and there is much here from which historians can learn. The one essay by a historian, Anne Hardy, insightfully traces the history of state policy and how ideas about curing disease and disease prevention relate to each other. Other authors offer historical introductions to their chapters. Bruce Alexander looks at the history of ideas about addiction old and new, and Ana Gonzalez weaves in writers from Aristotle to Nietzsche to Henry Sigerist in her discussion of the dangers of conflating ethical questions with health questions. The collection is bookended (and to some extent held together) by a pair of nicely done essays written by one of the editors, Joseph Davis. In the concluding chapter he attempts some proscriptive musings, calling for a more balanced approach. For example, he warns against the dangers of an unchecked reductionist approach to medicine, and sees physicians as playing a key role in that resistance. Bioethics has moved too far from some of its underlying theological roots, and could become stronger (and less biomedical) were it to exist outside of major medical centers. (The institutionalization of bioethics is addressed in an insightful chapter by John Evans, and another chapter by Jeffrey Bishop looks briefly at the rise and fall of theology in bioethics discourse.) Public health, especially if linked to a social medicine tradition, could offer a counter to an overly reductionist philosophy of health and health care. This is not primarily a historical book. But insofar as many chapters place contemporary policy issues into historical perspective, it may help to enlighten those interested in policy to appreciate the historical dimensions of contemporary debates. Conversely, it could be useful reading for historians who want to...