Images and Texts in Medical History—Jeremy Greene

On April 11-13, 2016, the National Library of Medicine will host the workshop “Images and Texts in Medical History: An Introduction to Methods, Tools, and Data from the Digital Humanities” funded by the National Endowment for the Humanities (NEH) through a generous grant to Virginia Tech, and held in cooperation with Virginia Tech, The Wellcome Library and The Wellcome Trust. Seventy-Five participants and observers will gather to explore innovative methods and data sources useful for analyzing images and texts in the field of medical history. The program will include hands-on sessions with Miram Posner and Benjamin Schmidt and a public keynote address by Jeremy Greene. Circulating Now interviewed the presenters and today we hear from Jeremy Greene.

Circulating Now: Tell us about yourself, your education, and how you became  interested in the history of medicine and the digital humanities.

Informal outdoor portrait.Jeremy Greene: Initially I was supposed to study monkeys.  In college I had a hard time deciding between the life sciences and the social sciences and the humanities, so I trained in a field that seemed like the obvious intersection between them: biological anthropology.  I spent a summer living in a rainforest in Western Uganda studying chimpanzees and colobus monkeys, but found that following monkeys in the forest all day, ticking off whether they were eating, sleeping, or grooming, wasn’t nearly as interesting to me as talking with the people who lived in the villages around the park and worked as research assistants, maintaining trails, cooking and doing laundry and a variety of other forms of informal work around the field station.

A man and woman holding an umbrella that protects them from the rain falling from a cloud labeled AIDS.

AIDS: you are capable of protecting yourself
Entebbe, Uganda : STD/AIDS Control Programme, Ministry of Health, 19–?
National Library of Medicine #101455597

It was the early 1990s and a lot of people had someone sick in their family, from endemic malaria or newly epidemic HIV/AIDS (which nobody would refer to by name), and many of them sought medical attention at the field station, asking for any spare medicines we might have. It was my first introduction to the social complexity of medicine, the integration of biological and the social fields that any medical or public health practice necessarily entails. I became a physician and a historian so that I could continue to work at that interface, and my subsequent education: first in medical school, then in graduate school in anthropology and the history of science, then in my residency in internal medicine, ever since that point has involved a tacking back and forth between the clinic, archive, and classroom. I try to maintain that even though I am both a physician and a historian I have one coherent job: that my time in the clinic guides the questions I research as a scholar, and that my historical research in turn informs my own clinical practice.

CN: What do you see as important issues in medicine and health today which could benefit from research in medical history and the digital humanities?

A poster encouraging vigilance against drug tampering.

United States Pharmacopeial Convention, c1986
National Library of Medicine #101438438

JG: Nearly everything.  One thing I have always found exciting about the history of medicine is just how very much of it remains unwritten, and how many important research opportunities are available for those with interest and the ability to see how to bring historical analysis to bear on their own field of interest. My own research interests have clustered around the complex role of technology in health, with my earlier work focusing on therapeutic technologies (especially pharmaceuticals) and my present work focusing on information technologies. But the fields of medicine, health policy, and public health contain so many tangible topics that can be better illuminated through historical analysis. I’ve been spending a bit of time this year on Capitol Hill speaking with House and Senate committee on the problem of prescription drug prices, and have been consistently impressed with how sharply limited the institutional memory of people working in health policy can be—and how clearly useful comparisons with historical moments before the year 2000 can be. Alternately, in communities of practitioners, I have found a widespread interest in historical thinking, especially among doctors who have seen the knowledge basis of practice change dramatically during their careers. The same can be said for activist and advocacy groups, bench scientists, clinical researchers, medical educators—it’s hard for me to be prescriptive regarding specific questions in medicine that need historicization—I’d rather spend my time advocating the importance of training any interested party in the value of historical analysis. We just started up an online masters’ program at the Johns Hopkins University School of Medicine this year to provide more opportunities for practitioners and policymakers to learn skills of historical analysis, and so far the results have been very encouraging.

CN: Have you ever made a discovery in your scholarship that made you say “Wow!”?

JG: Yes, all the time, and that feeling is one of the most sustaining things about historical research. Some of these “wows” are with a little “w’ instead of a big “W”, and don’t always have an exclamation point after them, but when I am engaged in historical research I am constantly on the lookout for things that surprise me, stories or sources that I didn’t expect, ways in which the material pushes pack at my received knowledge and forces me to rethink my understanding of a concept or an event.   Often that pushback comes from reconsidering very mundane things.  For example, when I was working on my most recent book, Generic: The Unbranding of Modern Medicine, I found a collection of old prescription bottles from the 1950s and 1960s.  They represented a certain kind of garbage that never got thrown out, more charitably called historical ephemerata, but these empty bottles didn’t have beautiful inked signatures or amber colored glass: they were just plastic bottles with typewritten labels. But as I was handling them  I noticed something, or rather the lack of something, that really surprised me. They were clearly recognizable as prescription bottles, printed with an Rx, the name of the doctor, name of the pharmacist, name of the patient, and basic instructions.  But what was missing was the name of the drug. I thought I knew quite a bit about generic and brand names of drugs by that point, but I was really surprised to find that neither name was present on these bottles.

This caused me to dig a little deeper into pharmacy ethics and law, and I learned to my surprise that it was actually standard practice as late as 1968 for pharmacists not to tell patients what medicine they were putting in their bottles. In fact, it was considered unethical and even illegal to do so. By the late 1960s, when a few doctors began publishing articles suggesting it might be a good idea to start letting all patients know what was in each prescription bottle, they were roundly lambasted by physicians who believed that doing so would take away the power of one of the most powerful therapeutics in the entire materia medica: the placebo. I had not really considered that American physicians were still actively prescribing placebos in 1968—really quite an interesting point if you stop to think about it—and would not have realized this if it wasn’t for that pile of old prescription bottles.

Another moment like this occurred last year, when I was taking care of a patient with poorly controlled diabetes and no health insurance, who told me that he had a hard time regularly taking insulin because it was so expensive. I assumed—like many of my colleagues in primary care—that an old drug like insulin was generically available.  But when I looked into it further I realized that, even though insulin as a drug has now been produced for 95 years, and was first patented in 1923, there is no generic version currently available in the U.S. market. This prompted an investigation with my coauthor Kevin Riggs into the complex, cyclical history of insulin patents to understand how this wonder drug from nearly a century ago is still only available in the U.S. market in expensive brand-name formulations. We published this paper in the New England Journal of Medicine and I think of it as another example of how important to be on the lookout for clues in the mundane world of big-picture issues that we all have systematically learned to ignore. Historical analysis can be a powerful tool to defamiliarize the structures of the present day.

Images and Texts in Medical History: An Introduction to Methods, Tools, and Data from the Digital Humanitieswill be held April 11-13 in the NIH Natcher Conference Center in Bethesda, MD. Two sessions will be free and open to the public, see the full schedule here. Current information about NIH campus access and security is here. The Keynote Address on Tuesday, April 12, at 11:15 ET will be live-streamed globally and subsequently archived for future viewing, and if you are on Twitter you can follow the event @medhistimage and at #medhistws.

Stay tuned all this week as Circulating Now brings you interviews with the presenters from “Images and Texts in Medical History.

With thanks to our collaborators at Virginia Tech, Tom Ewing, Claire Gogan, and Jonathan MacDonald.