Merchants of health: Medicine and consumer culture in the united states, 1900-1940

Journal of American History

Volumn 88, Issue 2, 2001, Pages 519-547

  Tomes, Nancy ^a  

^a STONY BROOK UNIVERSITY   (United States)

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[No Author keywords available]

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EID: 0012263325     PISSN: 00218723     EISSN: None     Source Type: Journal    
DOI: 10.2307/2675104     Document Type: Article

References (239)

1. For such designations of the twentieth century, see Olivier Zunz, Why the American Century? (Chicago, 1998);
2. and Edward Shorter, The Health Century (New York, 1987).
3. On current policy debates, see Donald L. Madison, "Paying for Medical Care in America," in The Social Medicine Reader, ed. Gail E. Henderson et al. (Durham, 1997), 415-46;
4. Henry J. Aaron, ed., The Problem That Won't Go Away: Reforming U.S. Health Care Financing (Washington, 1996);
5. and Mark A. Peterson, ed., Healthy Markets? The New Competition in Medical Care (Durham, 1998).
6. On the failure of President Bill Clinton's health reform bill, see Haynes Johnson and David S. Broder, The System: The American Way of Politics at the Breaking Point (Boston, 1996).
7. Paul Srarr, The Social Transformation of American Medicine (New York, 1982), v.
8. For comprehensive surveys of twentieth-century American medicine, see Kenneth M. Ludmerer, Time to Heal: American Medicine from the Turn of the Century to the Era of Managed Care (New York, 1999);
9. David J. Rothman, Strängen at the Bedside: A History of How Law andBioethics Transformed Medical Decision Making (Ne%v York, 1991 ) ;
10. Starr, Social Tramformation of American Medicine;
11. and Rosemary Stevens, In Sickness and in Wealth: American Hospitals in the Twentieth Century (New York, 1989). The term "managed care" refers to methods of holding down costs, such as limiting the patient's choice of provider and treatment, requiring third-party review of treatment decisions, and offering providers fiscal incentives to practice cost-effective care.
12. These scholars are vitally concerned with the overall accessibility and effectiveness of health care institutions, yet the patient/public appears as the least fleshed-out element of their analyses. For an ambitious but overly schematic effort to provide a patients' perspective on the evolution of modern medicine, see Edward Shorter, Bedside Manners: The Troubled History of Doctors and Patients (New Yoik, 1985).
13. On the impact of social history on medical history, see Susan Reverby and David Rosner, "Beyond 'the Great Doctors,'" in Health Care in America: Essays in Social History, ed. Susan Reverby and David Rosner (Philadelphia, 1979), 3-16;
14. and Ronald L. Numbers, "The History of American Medicine: A Field in Ferment," Reviews in American History, 10 (Dec. 1982), 245-63.
15. A complete bibliography of recent cultural and social histories of twentieth-century health care is beyond the scope of this essay, but here I list major works on key topics. On childbirth and reproduction, see Judith Walzer Leavitt, Brought to Bed: Childbearing in America, 1750-1950 (New York, 1986);
16. and Leslie J. Reagan, When Abortion Was a Crime: Women, Medicine, and Law in the United States, 1867-1973 (Berkeley, 1997).
17. On race and health care, see Edward Beardsley, A History of Neglect: Health Care for Blacks and Mill Workers in the Twentieth-Century South (Knoxville, 1987);
18. Vanessa Northington Gamble, Making a Place for Ourselves: The Black Hospital Movement, 1920-1945 (New York, 1995);
19. David McBride, From TB to AIDS: Epidemics among Urban Blacks since 1900 (Albany, 1991);
20. David McBride, Integrating the City of Medicine: Blacks in Philadelphia Health Care, 1910-1965 (Philadelphia, 1989);
21. and Susan Lynn Smith, Sick and Tired of Being Sick and Tired: Black Women's Health Activism in America, 1890-1950 (Philadelphia, 1995).
22. There are excellent histories of specific diseases. On cancer, see James T. Patterson, The Dread Disease: Cancer and Modern American Culture (Cambridge, Mass., 1987).
23. On eating disorders, see Joan Jacobs Brumberg, Fasting Girls: The Emergence of Anorexia Nervosa as a Modem Disease (Cambridge, Mass., 1988).
24. On polio, see Tony Gould, A Summer Plague: Polio and Its Survivors (New Haven, 1995);
25. Naomi Rogers, Dirt and Disease: Polio before FDR (New Brunswick, 1992);
26. and Jane S. Smith, Patenting the Sun: Polio and the Salk Vaccine (New York, 1990).
27. On sexually transmitted diseases, see Allan M. Brandt, No Magic Bullet: A Social History of Venereal Disease in the United States since 1880 (New York, 1987).
28. On tuberculosis, see Barbara Bates, Bargaining for Life: A Social History of Tuberculosis, ./S76-.7.93S (Philadelphia,!992);
29. Georgina D. Feldberg, Disease and Class: Tuberculosis and the Shaping of Modern North American Society (New Brunswick, 1995);
30. Katherine Ott, Fevered Lives: Tuberculosis in American Culture since 1870 (Cambridge, Mass., 1996);
31. and Sheila M. Rothman, Living in the Shadow of Death: Tuberculosis and the Social Experience of Illness in the United States (New York, 1994).
32. On workers' health, see Claudia Clark, Radium Girls: Women and Industrial Health Reform, 1910-1935 (Chapel Hill, 1997);
33. Allan Derickson, Black Lung: Anatomy of a Public Health Disaster (Ithaca, 1998);
34. David Rosner and Gerald Markowitz, Deadly Dust: Silicosis and the Politics of Occupational Disease in Twentieth-Century America (Princeton, 1991);
35. David Rosner and Gerald Markowitz, eds., Dying for Work: Workers' Safety and Health in Twentieth-Century America (Bloomington, 1987);
36. and Christopher C. Sellers, Hazards of the Job: From Industrial Disease to Environmental Health Science (Chapel Hill, 1997).
37. On experimental science, see Susan E. Lederer, Subjected to Science: Human Experimentation in America before the Second World War (Baltimore, 1995);
38. and Harry M. Marks, The Progress of Experiment: Science and Therapeutic Reform in the United States, 1900-1990 (New York, 1997).
39. On patient activism, see Steven Epstein, Impure Science: AIDS, Activism, and the Politics of Knowledge (Berkeley, 1996);
40. and Robert N. Proctor, Cancer Wars: How Politics Shapes What We Know and Don't Know about Cancer (New York, 1995).
41. On psychiatry and psychiatric institutions, see Joel T. Braslow, Mental Ills and Bodily Cures: Psychiatric Treatment in the First Half of the Twentieth Century (Berkeley, 1997);
42. Elizabeth Lunbeck, The Psychiatric Persuasion: Knowledge, Gender, and Power in Modern America (Princeton, 1994);
43. and Jack D. Pressman, Last Resort: Psychosurgery and the Limits of Medicine (New York, 1998).
44. On twentieth-century disease theory, see Robert A. Aronowitz, Making Sense of Illness: Science, Society, and Disease (Cambridge, Mass., 1998);
45. and David B. Morris, Illness and Culture in the Postmodern Age (Berkeley, 1998).
46. On the new consumer history, see Lawrence B. Glickman, ed., Consumer Society in American History: A Reader (Ithaca, 1999);
47. and Susan Strasser, Charles McGovern, and Matthias Judt, eds., Getting and Spending: European and American Consumer Societies in the Twentieth Century (New York, 1998).
48. Of the now numerous books on consumer culture, I have found most useful Lizabeth Cohen, Making a New Deal: Industrial Workers in Chicago, 1919-1939 (New York, 1990);
49. Dana Frank, Purchasing Power: Consumer Organizing, Gender, and the Seattle Labor Movement, 1919-1929 (New York, 1994);
50. Lawrence B. Glickman,/! LivingWage: American Workers and the Making of Consumer Society (Ithaca, 1997);
51. William Leach, Land of Desire: Merchants, Power, and the Rise of a New American Culture (New York, 1993);
52. Jackson Lears, Fables of Abundance: A Cultural History of Advertising in America (New York, 1994);
53. Charles F. McGovern, "Sold American: Inventing the Consumer, 1890-1940" (Ph.D. diss., Harvard University, 1993);
54. Roland Marchand, Advertising the American Dream: Making Way for Modernity, 1920-1940 (Berkeley, 1985);
55. Roland Marchand, Creating the Corporate Soul: The Rise of Public Relations and Corporate Imagery in American Big Business (Berkeley, 1998) ;
56. Kathy Peiss, Hope in a Jar: The Making of America's Beauty Culture (New York, 1998);
57. and Susan Strasser, Satisfaction Guaranteed: The Making of the American Mass Market (New York, 1989).
58. Contemporary critics often assume, incorrectly, that the managed care revolution inspired the linguistic transformation of patients into consumers. See, for example, Ellen Goodman, "We've Become Health Care Consumers-and We're Getting Indigestion," Boston Globe, June 17, 1999, p. A-23.
59. The term "consumer" came into popular use in the 1970s as part of the patients' rights movement. See Nancy Tomes, "From Patients' Rights to Consumers' Rights: Some Thoughts on the Evolution of a Concept," in Making History: Shaping the Future: Contemporary Themhs in Mental Health Services (Balmain, Australia, 1999), 39-48. This volume contains the proceedings of the Eighth Annual THEMHS Conference of the Mental Health Services of Australia and New Zealand.
60. On the managed care movement as an effort to undo this medical exceptionalism, see David Dranove, The Economic Evolution of American Health Care: From Marais Welby to Managed Care (Princeton, 2000).
61. On the "organizational synthesis," see Louis Galambos, "The Emerging Organizational Synthesis in Modern American History," Business History Review, 44 (Autumn 1970), 279-90;
62. and Louis Galambos, "Technology, Political Economy, and Professionalization: Central Themes of the Organizational Synthesis," Business History Review, ibid., 57 (Winter 1983), 471-93.
63. On the "elites-versus-the-masses" problem, see Brett Gary, The Nervous Liberals: Propaganda Anxieties from World War I to the Cold War (New York, 1999);
64. Ellen Herman, The Romance of American Psychology: Political Culture in the Age of Experts (Berkeley, 1995);
65. and Zunz, Why the American Century?
66. On smoking, see Allan M. Brandt, "The Cigarette, Risk, and American Culture," Daedalus, 119 (Fall 1990), 155-76;
67. Allan M. Brandt, "Blow Some My Way: Passive Smoking, Risk, and American Culture," in Ashes to Ashes: The History of Smoking and Health, ed. Stephen Lock, L. A. Reynolds, and E. M. Tansey (Atlanta, 1998), 164-87;
68. Richard Kluger, Ashes to Ashes: America's Hundred-Year Cigarette War, the Public Health, and the Unabashed Triumph of Philip Morris (New York, 1996);
69. and Cassandra Täte, Cigarette Wan: The Triumph of "the Little White Slaver" (New York, 1999).
70. The difficulty of synthesis is by no means unique to the history of medicine. See Thomas Bender, "Wholes and Parts: The Need for Synthesis in American History," Journal of American History, 73 (June 1986), 120-36.
71. That studies of consumer culture can be sensitive to issues of class and race has been demonstrated ably by Cohen, Making a New Deal;
72. Frank, Purchasing Power;
73. and Glickman, Living Wage. By "subjective experience of illness," I refer to the individual and cultural meanings ascribed to illness, which are clearly shaped by the currents of consumer culture.
74. On the changing dynamics of this influence, see Morris, Illness and Culture in the Postmodern Age, Although in this essay I confine my focus to medicine, the consumer perspective might profitably be extended to histories of public health and nursing.
75. The best general overview on medicine and health care institutions in this period is Starr, Social Transformation of American Medicine.
76. Other important works are: E. Richard Brown, Rockefeller Medicine Men: Medicine and Capitalism in America (Berkeley, 1979);
77. James G. Burrow, Organized Medicine in the Progressive Era: The Move toward Monopoly (Baltimore, 1977);
78. Beatrix Huffman, The Wages of Sickness: The Politics of Health Insurance in Progressive America (Chapel Hill, 2001);
79. Kenneth M. Ludmerer, Learning to Heal: The Development of American Medical Education (New York, 1985);
80. Ronald L. Numbers, Almost Persuaded: American Physicians and Compulsory Health Insurance, 19I2-1920 (Baltimore, 1978);
81. George Rosen, The Structure of American Medical Practice, 1875-1941, ed. Charles E. Rosenberg (Philadelphia, 1983);
82. Charles E. Rosenberg, The Care of Strangers: The Rise of America's Hospital System (New York, 1987);
83. and James Harvey Young, Pure Food: Securing the Federal Food and Drugs Act of 190S (Princeton, 1989).
84. On the scientific and professional changes undergirding turn-of-the-century reforms, see William G. Rothstein, American Physicians in the Nineteenth Century: From Sects to Science (Baltimore, 1972);
85. John Harley Warner, Against the Spirit of System: The French Impulse in Nineteenth-Century American Medicine (Princeton, 1998);
86. and John Harley Warner, The Therapeutic Perspective: Medical Practice, Knowledge, and Identity in America, 1820-1885 (Cambridge, Mass., 1986).
87. On the pharmaceutical industry, see Jonathan Liebenau, Medical Science and Medical Industry: The Formation of the American Pharmaceutical Industry (Baltimore, 1987);
88. John Patrick Swann, Academic Scientists and the Pharmaceutical Industry: Cooperative Research in TwentiethCentury America (Baltimore, 1988);
89. and PeterTemin, Taking Your Medicine: Drug Regulation in the United States (Cambridge, Mass., 1980).
90. On the period as a golden age, see John C. Burnhatn, "American Medicines Golden Age: What Happened to It?," in Sickness and Health in America: Readings in the History of Medicine and Public Health, ed. Judith Walzer Leavitt and Ronald L. Numbers (Madison, 1997), 284-94.
91. This characterization reflects the profession's gains in income and respectability and the balance physicians achieved between basic research and clinical objectives. On the latter, see also Ludmerer, Learning to Heal;
92. and Ludmerer, Time to Heal.
93. Starr, Social Transformation of American Medicine, 198;
94. Kenneth Arrow, "Uncertainty and the Welfare Economics of Medical Care," American Economic Review, 53 (Dec. 1963), 941-73, esp. 949.
95. On the shopping and information problems, see Dranove, Economic Evolution of American Health Care, esp. 8-20.
96. On the physician as economic actor, see Deborah A. Stone, "The Doctor as Businessman: The Changing Politics of a Cultural Icon," in Healthy Markets?, ed. Peterson, 161-82.
97. Edmund Sears Morgan, The Puritan Dilemma: The Story of John Winthrop (Boston, 1958).
98. Morton Thompson, Not as a Stranger (New York, 1954), 373.
99. On the tensions between professional and business ideals, see Stone, "Doctor as Businessman."
100. Ray Lyman Wilbur, "Foreword,"
101. in I. S. Falk, C. Rufus Rorem, and Martha D. Ring, The Costs of Medical Care: A Summary of Investigations on the Economic Aspects of the Prevention and Care of Illness (Chicago, 1933),
102. For the statistics and industry rankings, see Evans Clark, How to Budget Health: Guilds for Doctors and Patients (New York, 1933), 27.
103. For the information on household budgets, see Michael M. Davis, America Organizes Medicine (New York, 1941), 47.
104. Wilbur, "Foreword," vi.
105. On the rising price of medical services and drugs, see the National Industrial Conference Board, The Cost of Living in the United States, 1914-1927 (New York, 1928), 126.
106. For the 10-25% figure, see Falk, Rorem, and Ring, Costs of Medical Care, 583.
107. On the percentage of patient contributions in 1933, see Costs of Medical Care, ibid.,
108. On patient contributions in 1960 and 1997, see National Center for Disease Statistics, Health, United States, 1999 (Hyattsville, 1999), 215.
109. In stressing the centrality of patient contributions, I do not deny the symbolic and practical importance of research funding from private foundations and voluntary health associations such as the National Tuberculosis Association during this period. The uneven quality of information on household budgets and medical spending over time makes it hard to quantify the rise in medical costs. The early budget studies all focused on working-class families and so provide no sense of more affluent households' spending patterns. Data on workers' budgets collected by Carroll Wright in 1889-1890 suggest that about 4% of the total family income was spent on sickness and burial costs. See Daniel Scott Smith, "A Higher Quality of Life for Whom? Mouths to Feed and Clothes to Wear in the Families of Late Nineteenth-Century American Workers," Journal of Family History, 19 (Jan. 1994), 1-33, esp. 9.
110. Data from 1917-1919 cost-of-living surveys done by the Bureau of Labor Statistics suggest that household expenditures on physicians, medicines, and hospital bills amounted to about 6.4% of the total budget in white households, 5.6% of the total in black households. See Joel D. Howell and Catherine G. McLaughlin, "Race, Income, and the Purchase of Medical Care by Selected 1917 Working-Class Urban Families," Journal of the History of Medicine, 47 (Oct. 1992), 439-61, esp. 448-49.
111. On the appeal of the new hospital, see Leavitt, Brought to Bed;
112. Rosenberg, Care of Strangers;
113. and Stevens, In Sickness and in Wealth. On mothers and medicine,
114. see Rima D. Apple, Mothers and Medicine: A Social History of Infant Feeding 1890-1950 (Madison, 1987);
115. Julia Grant, Raising Baby by the Book: The Education of American Mothers (New Haven, 1998);
116. and Richard A. Meckel, Save the Babies: American Public Health Reform and the Prevention of Infant Mortality, 1850-1929 (Baltimore, 1990).
117. On ethnic differences among mothers' attitudes toward physicians, see Alice Goldstein, Susan Cotts Watkins, and Ann Rosen Spector, "Childhood Health-Care Practices among Italians and Jews in the United States, 1910-1940," Health Transition Review, 4 (April 1994), 45-62.
118. thank George Alter for drawing my attention to this study.
119. On new notions of service, see Leach, Land of Desire, 112-50;
120. and Shelley Stamp, Movie-Struck Girls: Women and Motion Picture Culture after the Nickelodeon (Princeton, 2000), 10-40.
121. On patient complaints about the new-style hospital, see Judith Walzer Leavitt, "'Strange Young Women on Errands': Obstetric Nursing between Two Worlds," Nursing History Review, 6 (1998), 3-24;
122. and Rosenberg, Care of Strangers, 310-12.
123. On the tensions inherent in the "flowering of consumerism" in 1920s hospitals, see Stevens, In Sickness and in Wealth, 105-39.
124. Rothman, Living in the Shadow of Death, esp. 105-15;
125. Regina Moranrz-Sanchez, Conduct Unbecoming a Woman: Medicine on Trial in Titrn-of-the-Century Brooklyn (New York, 1999), esp. 138-55;
126. Davis, America Organizes Medicine, 49-50.
127. The need to cultivate appearances in order to attract paying patients is a major theme of a popular advice book for physicians: D. W. Cathell, Book on the Physician Himself: From Graduation to Old Age (1922; Philadelphia, 1928).
128. Leavitt, Brought to Bed;
129. Andrea Tone, "Contraceptive Consumers: Gender and the Political Economy of Birth Control in the 1930s" Journal of Social History, 29 (March 1996), 485-506;
130. Elizabeth Haiken, Venus Envy: A History of Cosmetic Surgery (Baltimore, 1997).
131. On the importance of male spending patterns, see Mark A. Swiencicki, "Consuming Brotherhood: Men's Culture, Style, and Recreation as Consumer Culture, 1880-1930," in Consumer Society in American History, ed. Glickman, 207-40.
132. George Rosen, Fees and Fee Bills: Some Economic Aspects of Medical Practice in Nineteenth Century America (Baltimore, 1946);
133. Stevens, In Sickness and in Wealth;
134. Marchand, Advertising the American Dream, 217-22.
135. On Progressive Era debates about access to health care and equity, see Huffman, Wages of Sickness.
136. The Committee on the Costs of Medical Care (CCMC) published twenty-eight reports, culminating in the summary: Committee on the Costs of Medical Care, Medical Care for the American People (Chicago, 1932).
137. On the importance of the CCMC, see Starr, Social Tramformation of American Medicine, esp. 261-66.
138. On medical economics more generally, see Daniel M. Fox, "From Reform to Relativism: A History of Economists and Health Care," Milbank Memorial Fund Quarterly I Health and Society, 57 (Summer 1979), 297-336.
139. On the disparities in availability of care, see Michael R. Grey, New Deal Medicine: The Rural Health Programs of the Farm Security Administration (Baltimore, 1999).
140. For a summary of depression-era surveys on patients' choice of doctors, see Davis, America Organizes Medicine, 22-35.
141. Citing a 1938 survey of moderate- and lowincome families living in New York City, he noted, "Although many families clung to the idea of a 'Family Doctor," less than one-third of them thought they had such a doctor." America Organizes Medicine, Ibid., 27.
142. On the New Deal battles over health insurance, see Daniel S. Hirshfield, The Lost Reform: The Campaign for Compulsory Health Insurance in the United States from 1932 to 1943 (Cambridge, Mass., 1970);
143. and Starr, Social Transformation of American Medicine, 235-89.
144. On New Deal legacies to Great Society policy, see Grey, New Deal Medicine, esp. 175-81.
145. In addition to the works on advertising cited in note 6, see Stephen Fox, The Mirror Makers: A History of American Advertising and Its Creators (New York, 1984);
146. and Daniel Pope, The Making of Modern Advertising (New York, 1983).
147. Many histories of health and hygiene provide insightful discussions of advertising. On adver-tising and cleanliness, see Suellen M. Hoy, Chasing Dirt: The American Pursuit of Cleanliness (New York, 1995), esp. chap. 5;
148. and Vincent Vinikas, Sa Soap, Hard Sell: American Hygiene in an Age of Advertisement (Ames, 1992).
149. On advertising and body image, see Joan Jacobs Brumberg, The Body Project: An Intimate History of American Girls (New York, 1997), esp. chap. 4;
150. Brumberg, Fasting Girls;
151. and Hillel Schwanz, Never Satisfied: A Cultural History of Diets, Fantasies, and Fat (New York, 1986), esp. 237-68.
152. On advertising and smoking, see Brandt, "Cigarette, Risk, and American Culture";
153. and Patterson, Dread Disease, esp. chap. 8.
154. On advertising and "bad habits" more generally, see John Burnham, Bad Habits: Drinking, Smoking, Taking Drugs, Gambling, Sexual Misbehavior, and Swearing in American History (New York, 1993).
155. On the over-the-counter drug industry, see Rima Apple, Vitamania: Vitamins in American Culture (New Brunswick, 1996);
156. Lears, Fables of Abundance, esp. chap. 2;
157. Charles C. Mann and Mark L. Plummer, The Aspirin Wars: Money, Medicine, and 100 Years of Rampant Competition (New York, 1991);
158. Sarah Stage, Female Complaints: Lydia Pinkham and the Business of Women's Medicine (New York, 1979);
159. and James Harvey Young, The Medical Messiahs: A Social History of Health Quackery in Tu'entiethCentury America (Princeton, 1967).
160. On health journalism, see John Burnham, How Superstition Won and Science Lost: Popularizing Science and Health in the United States (New Brunswick, 1987);
161. and Bert Hansen, "America's First Medical Breakthrough," American Historical Review, 103 (April 1998), 373-418.
162. Nancy Tomes, "Making the Modern Health Consumer," Bulletin of the History of Medicine (forthcoming, 2003).
163. On goodwill advertising by pharmaceutical companies, see Marchand, Creating the Corporate Soul, 17481;
164. on the use of medical endorsements in cigarette ads, see Kluger, Ashes to Ashes, 77-78. The health-image problems of both cigarettes and candy were evident in the uproar over the "Reach for a Lucky instead of a sweet" campaign of the late 1920s.
165. See Ashes to Ashes, 77-78. The health-image problems of both cigarettes and candy were evident in the uproar over the "Reach for a Lucky instead of a sweet" campaign of the late ibid.
166. Nancy Tomes, "We Die Differently Now: Popular Perceptions of the Mortality Transition in the Interwar United States," in Health in America: The Last One Hundred Years, ed. Judith Sealander and Daniel M. Fox (New York, forthcoming).
167. Cancer alternated as the second or third leading cause of death with pneumonia and influenza, the only infectious diseases to remain high on the interwar mortality list. The role of such groups as the National Tuberculosis Association, the American Cancer Society, and the American Heart Association deserves much more attention from historians. The best account remains Selskar M. Gunn and Philip S. Platt, Voluntary Health Agencies: An Interpretive Study (New York, 1945).
168. On the long tradition of equating disease with overconsumption, see Roy Porter, "Consumption: Disease of the Consumer Society?," in Consumption And the World of Goods, ed. John Brewer and Roy Porter (New York, 1993), 58-81;
169. and Roy Porter, "Diseases of Civilization," in Companion Encyclopedia of the History of Medicine, ed. W. F. Bynum and Roy Porter (2 vols., New York, 1993), I, 585-600.
170. James C. Whorton, Inner Hygiene: Constipation and the Pursuit of Health in Modem Society (New York, 2000);
171. Young, Medical Messiahs.
172. On health reform more generally, see Harvey Green, Fit for America: Health, Fitness, Sport, and American Society (New York, 1986);
173. Martha H. Verbrugge, Able-Bodied Womanhood: Personal Health and Social Change in Nineteenth-Century Boston (New York, 1988);
174. and James C. Whorton, Crusaders for Fitness: The History of American Health Reform (Princeton, 1982).
175. For parallel developments in England, see Roy Porter, Health for Sale: Quackery in England, 1660-1850 (New York, 1989).
176. Committee on the Costs of Medical Care, Medical Care for the American People, 14-15.
177. On the persistent appeal of alternative practitioners, which also heightened competition for patients, see Norman Gevitz, The D.O.'s: Ostéopathie Medicine in America (Baltimore, 1982);
178. Norman Gevitz, ed., Other Healers: Unorthodox Medicine in America (Baltimore, 1988);
179. and J. Stuart Moore, Chiropractic in America: The History of a Medical Alternative (Baltimore, 1993).
180. On interwar experts' ambivalence about consumer rationality, see McGovern, "Sold American."
181. For representative medical critiques of uninformed consumer behavior, see Louis F. Bishop, "Preventing Heart Attack," Hygcia. 13 (Jan. 1935), 12;
182. and Wilbur, "Foreword," vi.
183. Elizabeth A. Toon, "Managing the Conduct of the Individual Life: Public Health Education and American Public Health, 1910 to 1940" (Ph.D. diss., University of Pennsylvania, 1998).
184. On health education as a means to discipline consumer spending, see also Applej Mothers and Medicine. For similar reasons, pharmaceutical companies began to advertise heavily in this era.
185. See Marchand, Creating the Corf orate Soul, 174-81;
186. and Jacalyn Duffin and Alison Li, "Great Moments: Parke, Davis and Company and the Creation of Medical Art," his, 86 (March 1995), 1-29.
187. Phillips' Milk of Magnesia advertisement, "He Ate a Whale of a Dinner," Saturday Evening Post, Nov. 19, 1932, p. 48.
188. These generalizations are based on my research in the Competitive Advertisements, J. Walter Thompson Company Archives (Special Collections Library, Duke University, Durham, N.C.). On advertising and the modern body, see also Lears, Fables of Abundance, esp. chap. 6;
189. and Marchand, Advertising the American Dream, esp. chap. 1.
190. On the changing regulatory climate, see Tomes, "Making the Modern Health Consumer";
191. and Nancy Tomes, "Madison Avenue Medicine," Ideas, 1 (no. 1, 2000), 4-17.
192. There has been remarkably little work on the history of dentistry or popular dental hygiene. The most comprehensive work remains Bernhard Wolf Weinberger, An Introduction to the History of Dentistry (2 vols., St. Louis, 1948).
193. On focal infection, see Andrew Scull, "Desperate Remedies: A Gothic Tale of Madness and Modern Medicine," Psychological Medicine, 17 (Aug. 1987), 561-77.
194. For a contemporary view of the sorry state of American teeth, see Falk, Rorem, and Ring, Costs of Medical Care, 47-53.
195. On the consumer movement, see Robert N. Mayer, The Consumer Movement: Guardians of the Market Place (Boston, 1989);
196. McGovern, "Sold American"; and Norman Isaac Silber, Teit and Protest: The Influence of Consumers Union (New York, 1983).
197. On health concerns within the consumer movement of the 1930s, see Gwen Elizabeth Kay, "Regulating Beauty: Cosmetics in American Culture from the 1906 Pure Food and Drugs Act to the 1938 Food, Drug, and Cosmetics Act" (Ph.D. diss., Yale University, 1997).
198. Stuart Chase and Frederick J. Schlink, Your Moneys Worth: A Study in the Waste of the Consumer's Dollar (New York, 1927). The generalizations here are based on my research in the Consumers' Research Inc. Records (Special Collections, Alexander Library, Rutgers University, New Brunswick, N.J.).
199. F. J. Schlink to Katharine A. Kellock, March 12, 1936, folder 14, box 437, Consumers' Research Inc. Records.
200. Arthur Kallet and F. J. Schlink, 100,000,000 Guinea Pigs: Dangers in Everyday Foods, Drugs, and Cosmetics (New York, 1933).
201. On the impact of the guinea pig books, see Charles O. Jackson, Food and Drug Legislation in the New Deal (Princeton, 1970), 16-20.
202. On the passage of the 1938 Food, Drug, and Cosmetics Act, see Jackson, Food and Drug Legislation in the New Deal; and Temin, Taking Your Medicine, 38-51.
203. For comparative perspectives on the American health care system, see Daniel M. Fox, Health Policies, Health Politics: The British and American Experience, 1911-1965 (Princeton, 1986);
204. Lynn Payer, Medicine and Culture: Varieties of Treatment in the United States, England, West Germany, and France (New York, 1988);
205. and Uwe Reinhardt, "Reforming the Health Care System: The Universal Dilemma," in Social Medicine Reader, éd. Henderson et al., 446-59. My thanks to Amanda Frisken for suggesting the comparative significance of the consumerism argument.
206. On the limits of consumer politics, see Alan R. Andreasen, "The Differing Nature of Consumerism in the Ghetto," in Consumerism: Search for the Consumer Interest, ed. David A. Aaker and George S. Day (New York, 1978), 97-108;
207. and Leonard L. Berry, "The Low-Income Marketing System: An Overview," Consumerism: Search for the Consumer Interest, ibid., 109-25.
208. Charles Rosenberg, "Social Class and Medical Care in Nineteenth-Century America: The Rise and Fall of the Dispensary," Journal of the History of Medicine, 29 (Jan. 1974), 32-54;
209. and Stevens, In Sickness and in Wealth, esp. 30-39, 310-16.
210. Gamble, Making a Place for Ourselves; Smith, Sick and Tired of Being Sick and Tired. On hospital segregation,
211. see Stevens, In Sickness and in Wealth, \37-38;
212. and Spencie Love, One Blood: The Death and Resurrection of Charles R. Drew (Chapel Hill, 1996), esp. 218-29.
213. James Jones, Bad Blood: The Tuskegee Syphilis Experiment (1981; New York, 1993).
214. For a good overview of the Tuskegee debates, see Susan M. Reverby, ed., Tuskegee's Truths: Rethinking the Tuskegee Syphilis Story (Chapel Hill, 2000).
215. See also Thomas G. Benedek and Jonathon Erlen, "The Scientific Environment of the Tuskegee Study of Syphilis, 1920-1960," Perspectives in Biology and Medicine, 43 (Autumn 1999), 1-30.
216. Susan M. Reverby, "Rethinking the Tuskegee Syphilis Study: Nurse Rivers, Silence, and the Meaning of Treatment," in Tmkegee's Truths, ed. Reverby, 365-84. Reverby believes that Eunice Rivers, the African American nurse employed in the study, may have aided participants in finding outside treatment.
217. Inmates of prisons, mental hospitals, and orphanages were especially at risk for becoming participants in nontherapeutic human experiments. See Lederer, Subjected to Science, esp. 126-38.
218. See James T. Patterson, Grand Expectations: The United States, 1945-1974 (New York, 1996). His argument has informed my reading of health care developments in this period. The limits of the twentieth-century "conquest" of infectious diseases have been shown by the AIDS epidemic.
219. On the expansion of health insurance, see Starr, Social Transformation of American Medicine, 290-334, 363-74.
220. On the widening range of products and services available after 1945, see Social Transformation of American Medicine, ibid., esp. 335-474.
221. On the "therapeutic revolution" in pharmaceuticals, see Temin, Taking Your Medicine, 58-87.
222. On improving cardiac care, see Julie Fairman and Joan E. Lynaugh, Critical Care Nursing: A History (Philadelphia, 1998), esp. 4-6.
223. On postwar pharmaceutical advertising, see Susan L. Speaker, "From 'Happiness Pills' to 'National Nightmare": Changing Cultural Assessment of Minor Tranquilizers in America, 1955-IVW," Journal of the History of Medicine, 52 (July 1997), 338-76.
224. For the Gallup Poll data, see Burnham, "American Medicine's Golden Age," 248.
225. Richard Carter, The Doctor Business (New York, 1958).
226. On suburban fluoridation controversies, see Christopher Sellers, "Water, Fluoride, and Naturalism in Post-World War II Suburbia," Osiris (forthcoming, 2003).
227. For an overview of these developments, see Rothman, Strangers at the Bedside.
228. For two important manifestos for change, see the Boston Women's Health Book Collective, Our Bodies, Ourselves (New York, 1973);
229. and Ivan Illich, Medical Nemesis: The Expropriation of Health (New York, 1976).
230. On patient advocacy in mental health, see Tomes, "From Patients' Rights to Consumers' Rights";
231. on patient advocacy in the AIDS movement, see Epstein, Impure Science.
232. For overviews of these developments, see George Anders, Health against Wealth: hmos and the Breakdown of Medical Trust (New York, 1996);
233. Dranove, Economic Evolution of American Health Care; and Peterson, ed., Healthy Markets?
234. For the argument that managed care advances health consumers' interests, see George C. Halvorson, Strong Medicine: An Expert's Prescription-Right Now, for Better and Cheaper Health Care (New York, 1993).
235. For criticisms of that argument, see Anders, Health against Wealth.
236. See Starr, Social Transformation of American Medicine, esp. 379-419.
237. See Tomes, "Madison Avenue Medicine." For the intensity of the prescription drug debates,
238. see Marcia Angell, "The Pharmaceutical Industry-To NVhom Is It Accountable?," New England Journal of Medicine, June 22, 2000, pp. 1902-4;
239. and the letters in response, New England Journal of Medicine, ibid., Nov. 9, 2000, pp. 1415-17.