By Woolhandler, Steffie; Himmelstein, David
Monthly Review , Vol. 64, No. 4
Medicine and Empire Howard Waitzkin, Medicine and Public Health at the End of the Century (Boulder, CO: Paradigm Publishers, 2011), 256 pages, $25, paperback.
For the past three decades Howard Waitzkin has been (along with Vicente Navarro) the leading social medicine theorist in the United States. Medicine and Public Health at the End of Empire provides a superb sampling of Waitzkin's wide-ranging work, and a readily accessible introduction to the searching insights offered by a Marxist view of medicine.
Trained as both a sociologist and physician, Waitzkin's career has melded clinical involvement as a primary care doctor in oppressed communities with writing and activism, in both the United States and Latin America. He currently works with G.I. s resisting military deployment.
Much of the book is devoted to meticulous delineation of the myriad ways that globalized capitalism creates the social conditions that make us sick and puts a straightjacket on the health system's ability to respond.
In an initial chapter, Waitzkin reviews the historical role of seemingly benevolent foundations (e.g., Rockefeller) and international health organizations in smoothing the way for the imperial project. He then traces the emergence of the tradition of revolutionary social medicine from Frederick Engels through Rudolph Virchow (a nineteenth-century German physician, much-revered in the mainstream of medicine as father of modern pathology) and Salvador Allende (who was a physician before becoming Chile's first socialist president).
Engels, in his Condition oftheWorkingClass, chronicled occupational conditions such as lead poisoning, black lung, and repetitive stress injury, and he also observed that the noxious conditions in English factories sickened the surrounding communities - prefiguring much of the modern work in environmental and occupational medicine. Virchow's classic investigation of the social origins of cholera and tuberculosis epidemics was reflected in his ardent support for the uprisings of 1848. And Allende, long before emerging as a world-renowned political leader, made major contributions both as a theoretician of the social origins of ill-health and as a practical innovator when he served as Minister of Health in Chile. Waitzkin reminds us that the recent discovery of the "social determinants of health" is merely a rediscovery, generally in defanged form, of these earlier vibrant understandings.
Waitzkin brilliantly exposes the forces that pushed the development of (highly profitable) coronary care technology and assured that this unproven technology overwhelmed alternative approaches to the modern epidemic of heart disease. Indeed, Bernard Lown, who features prominently in Waitzkin's tale as a founder of the intensive care approach to heart attacks, often decries the damage wrought by the focus on medical commodities and high-tech interventions in cardiology, and the concomitant neglect of the human beings who house the hearts. …