Journal of Health Care for the Poor and Underserved

Our Present Complaint: American Medicine Then and Now provides a historical background of the evolution of American Medicine into the present system, which many patients find disjointed and impersonal. This book does not provide a chronological history of this evolution; instead, it is a collection of essays on the interplay between sociological and reductionist approaches to disease and its cure. Charles Rosenberg is the leading authority on medical history in the U.S., and this book benefits from his keen insight into the complexities of a fractured system.

Medicine, though essentially concerned with human biology, has traditionally been informed by the social and cultural contexts of human disease. Rosenberg argues that modern Western medicine, based so strongly in biology, has developed a paradigm that suffers from an undue and reductive focus on the individual. Rosenberg traces the roots of this phenomenon to the early 19th century and the rapid development of human anatomy and laboratory sciences, which helped elucidate the biological mechanisms of specific disease. With greater mechanistic insights, there was a rush to label and quantify each symptom into disease categories. The standardization of medicine resulted in improved efficacy of treatment but also legitimized the utilization of narrow definitions to constrain clinical flexibility in treating a particular patient. Rosenberg sees insurance companies and pharmaceutical firms as major players in limiting treatment choices in this, as he puts it, "tyranny of diagnosis."

A major focus in the book is the field of psychiatry, and its struggle to define boundaries between the normal and the deviant, with special attention to the consequences of this history for racial and ethnic minority group members. Another essay concerns advancements in genetic research and the rush to provide deterministic judgments on the strength of it. Rosenberg provides two parallel histories of the development of medical genetics. The first describes an exponential growth in knowledge of molecular basis of human disease and the second the historical use of hereditary explanations of human diversity that acknowledged idiosyncratic differences of human nature and circumstances. His comment on the field of bioethics also straddles the two faces of American medicine: the intimate physician–patient relationship and the overarching medical system.

Although acknowledging that medicine has always been a business, Rosenberg candidly admits his own discomfiture with the recently blatant commercialization of medicine. The primary audiences for this book are health care practitioners, and Rosenberg [End Page 700] does not shy away from providing his own comment on how this meticulous history of medicine should be used by his audience to inform and define their present roles in the increasingly complex and fragmented health care system. He argues that clinicians should continue to play an important role in social advocacy for their patients as they are best suited to evaluate the effects of technical innovations in medical practice. In doing so, they will also avoid being marginalized in the march towards technalization of medical diagnosis.

Throughout the book, Rosenberg brings in examples from popular media coverage of medical issues while analyzing their complexities in light of his own expansive discernment. This serves to provide a social context to his arguments as well as sustain reader interest. This book is deeply edifying and is recommended for patients and providers alike.