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Springer International Publishing AG, Part of Springer Nature 2018 1 M Biomedicine and Its Historiography: A Systematic Review Nicolas Rasmussen Contents Introduction ....................................................................................... 1 What Is Biomedicine? ............................................................................ 2 Biomedicine’s Postwar Development ............................................................ 7 The Distribution of Activity in Biomedicine and in Its Historiography . ...................... 14 Conclusion ........................................................................................ 19 References ........................................................................................ 20 Abstract In this essay I conduct a quantitative systematic review of the scholarly literature in history of life sciences, assessing how well the distribution of the activity of historians aligns with the distribution of activities of scientists across fields of biomedical research as defined by expenditures by the cognate institutes of the United States NIH. I also ask how well the distribution of resources to the various research fields of biomedicine in the second half of the 20th Century has aligned with morbidity and mortality in the United States associated with the cognate disease categories. The two exercises point to underexplored areas for historical work, and open new historical questions about research policy in the US. Introduction I have taken an unusual approach in this essay to ask a question that, to my knowledge, has not been addressed before: how well, in terms of subject matter, does our historiog- raphy describe the domain of biomedicine? I shall define the subject matter by treating it N. Rasmussen (*) University of New South Wales, Sydney, NSW, Australia e-mail: [email protected] # Springer International Publishing AG, part of Springer Nature 2018 1 M. Dietrich et al. (eds), Handbook of the Historiography of Biology, Historiography of Science 1, https://doi.org/10.1007/978-3-319-74456-8_12-1 2 N. Rasmussen as an actor’s category; that is, I define biomedicine according to the way the concept was used by scientists and policy-makers in the institutions they created at mid-century. I shall briefly describe the early history of the institutionalization and growth of this kind of research activity after the Second World War. Then I shall bring quantitative evidence to bear in a way that is somewhat novel to map the distribution of resources, hence research activity, among the major fields within the biomedicine of the United States during the five decades that followed the War. (I focus on the United States because it was the polity supporting and shaping biomedical science far more than any other and because it exerted additional influence as the West’s Cold War leader.) The first major purpose is to ask in quantitative terms how well the distribution of research effort among biomedical fields matches the importance of the different fields of research to the health of the US population – as political leaders and technocrats of the day acknowledged that they should – or whether, on the other hand, there are interesting historical questions about why some fields attracted disproportionately little or much cultural and political favor. This leads me to propose a number of topic areas for further research by historians of biomedical research policy and politics. An additional purpose for charting the distribution of health research resources is that it enables one to address the novel question noted above and an issue central for this collection: assessing how well the biomedical historiography aligns with the historical trajectory of biomedicine itself. That is, I ask whether historians are distributing their efforts to the various fields of the biomedical enterprise in a way roughly matching the past distribution of efforts by biomedical researchers and policy-makers generating the activity itself. Here, too, we will be able to identify apparent mismatches between events and attention and offer some hypotheses about why certain fields appear relatively under- or overstudied by historians. To identify mismatches I apply a quantitative method to the historiography – systematic literature review – rare for the history of science and medicine but standard in certain biomedical fields. In a stand-alone review article, I would follow these three quantitative sections – dealing in turn with the biomedical research enterprise over time, its fit with population health needs, and its fitwiththe historiography purporting to describe it – by drilling down into several particularly active areas of biomedical historiography, looking qualitatively at the prevalent questions being addressed and fashionable approaches to answering them. However, given that this review is part of a collection in which many of the other historiographic articles deal with areas of life science that overlap what I (following the US National Institutes of Health, NIH) have broadly defined as biomedicine, I will leave such qualitative analyses to the other authors. The main aim of my largely quantitative survey is to point out historio- graphic lacunae and raise new questions for historians; it is also intended to demonstrate that quantitative systematic review methodology can be productive, but not to rule out other more qualitative approaches. What Is Biomedicine? The first task of any literature review must be to define the subject matter. Bibliometric tools (such as Google Ngram for book contents or ProQuest Historical Newspapers for American journalism) show that as a term in English usage, and Biomedicine and Its Historiography: A Systematic Review 3 arguably too as a generally accepted concept, “biomedicine” appears around 1960 and becomes ubiquitous by 1970. So, while both clinical research and experimental biology with deliberate medical application certainly dates to the nineteenth century, for example, in Koch’s and Pasteur’s famous vaccine trials and Helmholtz’s and Bernard’s work on nerve action, and while furthermore medicine has increasingly borrowed concepts, practices, and authority from laboratory sciences since the late nineteenth century (Vogel and Rosenberg 1979; Starr 1982; Ludmerer 1985; Rothstein 1987; Porter 1998), the postwar period manifests this melding of science and clinical technique on a new scale. After the Second World War, government funding for research dramatically expanded in the United States, quickly over- shadowing private philanthropies such as the Rockefeller Foundation and Institute – which before the War had been the preeminent patrons of both biological and medical research, and not only in the United States. In the postwar United States, the position of dominant patron was rapidly assumed by the National Institutes of Health. In the mid-1970s, for example, NIH funding accounted for 40% of US health R&D, as compared with about a 25% share from all other government funders, about 30% from the private sector, and less than 5% nonprofits and philanthropies. The overwhelming dominance of the NIH among all US funders of life science is also attested by a comparison of the agency’s 1970 budget of more than $1 billion with the $49 million research budget of the National Science Foundations’ (NSF) division of Biological and Medical Sciences (Table 1). Indeed, in terms of resources, the NSF as a patron of life science was roughly equivalent to one of the more modest NIH Institutes (Strickland 1972; Brown 1979; Shyrock 1980; Bloom and Randolph 1990; Kohler 1991; Appel 2003; Hamowy 2008). As implied by the mushrooming NIH budget and proliferation of NIH Institutes from the late 1940s through the 1960s, briefly discussed below, health-oriented science became a social priority in the United States like never before. That commitment to biomedical research, by the world’s richest nation amidst a global scientific community shattered by war, made the United States the dominant force in health research globally. Indeed, it was not until the mid-2000s that the US share of world health research and development spending fell beneath 50%.1 Beyond mere spending power, we may also point to literature indicating that in biomedicine as in science generally, during the Cold War many Western countries tended to emulate the “Free World’s” leader in order to demonstrate solidarity and furthermore that the East Bloc often felt compelled to compete with US scientific strengths (Gaudillière 2002; Krementsov 2002; Krige 2006). This cultural leadership in the postwar period offers another reason why the American biomedical research enterprise shaped others throughout the world. Thus, putting aside qualms about provincialism, for 1US public and private combined biomedical research spending still accounted for half of world spending in the mid-2000s (Moses et al. 2015). I am not aware of reliable figures earlier than this, but given the postwar state of European and Asian economies until the 1980s, it would be safe to suppose that before the 1990s the United States would have accounted for far more than half. 4 Table 1 Budgets of NIH Institutes founded before 1970 and NSF research budgets (in current $1000s) over time NIH Institute Founded 1960 budget 1970 budget 1980 budget 1990 budget NCI 1937 91,257 181,454 999,869 1,634,332 NHI (NHLBI) 1948 62,237 160,634 527,488 1,072,354 NMI (NIAID) 1948 34,054 97,342 215,364 832,977 NIDCR 1948 10,019 28,754 68,303 135,749 NIMH 1949 67,470 NA 212,000a 727,000b NIAMD (NIDDK) 1950 46,862 131,761 341,206 581,477 NINDB (NINDS) 1950 41,487 97,315
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