Books like Impure Science

Every book by Annemarie Mol is good but The Logic of Care is simply the best book on what medicine should be. It is short, deceptively simple but leaves no hiding places. Everyone will be able to understand it in the same way from a teenager up through a Professor of Medicine to a Minister for Health but don’t expect any Ministers to admit to reading it any time soon. Mol outlines a relationship-based rather than technology-based medicine. How do we ensure medical techniques help us to live the lives we want to live rather than force us to live lives that suit the companies that make the technologies want us to live? How do we care for people rather than service them?

Medicine loves stories about heroic men who made breakthroughs that have saved lives and given us the life expectancies we have today. It has never celebrated women and yet it was a woman, Josephine Baker, who in two decades starting in 1908, by focusing on antenatal and postnatal care, laid a basis for saving lives that has given us the life expectancies we have today. She did so against fierce opposition from doctors who argued that creating conditions that make infants and children healthy would be bad for medical business. Now that life expectancies are falling, and were falling before Covid, we desperately need to recover Baker and her insights. Her book written in 1939 gives clear hints of how unimpressed she would likely be with today’s medical business.

Modern medicine has dramatically extended life expectancies. But as our life spans extend, our fear of death grows. As our hope of living a long life and seeing our children survive grew, we became more rather than less anxious about losing out. We might have expected the opposite. Aries vividly illustrates how people viewed death as a part of life before the nineteenth century and how they reconciled themselves to it. He picks out 1886 as the point where Tolstoy in The Death of Ivan Illych recognized that medical advances were creating anxiety rather than hope. This book may make you less fearful of death. It will ask you whether you can now achieve serenity half as well as those before us did and whether medicine is bad for our sanity? 

Most of us figure doing evil, even if good results, is not ethical but without this, there would be no medicine. Martin Pernick covers the discovery of anesthesia and the ethical dilemmas this new ability to save lives by poisoning people posed. Anesthesia is a technique and techniques are amoral. How do we ensure they enhance rather than diminish us? How do we avoid seduction into a sleep during which we can be cosmetically enhanced? Is there a limit to how many drugs we give children to manage their behaviour – just because we can? Treating and stopping are not the same as not treating. Pernick doesn’t tell us how to manage this calculus, but he makes us aware modern life involves more of a calculus than we might have thought.   

Emily Martin’s work was some of the first things I read when I wanted to understand how we understand medicine.

There’s such a gap between the health information we’re given and what we actually believe and Martin really covers how Americans have understood the concept of immunity and how we’re influenced by popular culture and the media.

This book is absolutely crucial for understanding both how we look at immunity and understanding how doctors are not free of bias. 

This collection of previously published essays by Charles Rosenberg elaborates many of his ideas about how people make meaning out of epidemics, including his famous theory that epidemics are understood in a dramatic tripartite structure (see “What Is an Epidemic? AIDS in Historical Perspective”). Rosenberg shows not only how the history of medicine illuminates larger themes, but why it matters, both to those of us interested in history and those interested in medical science itself. 

This is the first book I read about sex tourism, which is a growing part of the market for sex work in developing countries. 

This book focuses on the men who provide services to men who are travelling to the Dominican Republic to engage with sex workers. Most of the men in this book identify as “straight” and have to navigate their personal identity and relationships while earning a living providing this service to other men.

I also really like the way this book discusses the health risks and how sex workers use various strategies to minimize the risk to themselves and their partners in an occupation that places them in the cross-hairs of an international market for sex tourism.

In We Are Having This Conversation Now, Alexandra Juhasz and Theodore Kerr blow up the conventions of academic work on epidemics.

In a series of thirteen short dialogues they reflect as activists, media-makers, and scholars on the history, present, and future of AIDS. The reflections on AIDS-related culture and conversation they share, will spark for readers critical questions about how personal experiences, community, cultural production, and interpersonal relations come together.

Doing this kind of reflective work is particularly important now, as we need to begin to understand not only HIV/AIDS, but how it impacts the experience of living amidst other viral pandemics including COVID-19. 

I may be a bit biased on this one since Dr. Goldstein is one of my mentors, but this book really shows the power that narrative has when it comes to understanding illness and assessing risk.

Once Upon a Virus very clearly helps us understand why looking at disease and illness from the standpoint of the community is so important. If we want to promote any type of health behavior or change, we must adapt to the specific community instead of expecting the community to change.

Listening to these stories is crucial for public health and I really wish more people would read this book and understand that!

Scientists now know that the AIDS virus, HIV-1, entered the human population much earlier than is commonly thought—back around 1908, give or take a margin of error, and via a single spillover from a chimpanzee into a human, probably by blood exposure when a chimp was killed and butchered for food. Pepin’s book illuminates how the virus might then, slowly and quietly at first, have spread from a forest in southeastern Cameroun, down tributaries of the Congo River to major cities such as Brazzaville and Leopoldville (now Kinshasa), and from there to the world. Pepin’s work was vastly helpful to me when I assembled my own account of that story, included in my own books.