UNC Press congratulates Nancy Tomes, winner of the prestigious 2017 Bancroft Prize in American History and Diplomacy from Columbia University for her book Remaking the American Patient: How Madison Avenue and Modern Medicine Turned Patients into Consumers. Tomes presented the following remarks at the awards dinner on April 29, 2017.
***I want to start by thanking the Bancroft Prize Committee for this incredible honor. My state of mind for the last few weeks is best summed up by the word, “wow,” which just keeps popping out of my mouth.
My sense of having wandered into an alternate reality is even more intense because of my very conflicted feelings about this book. It was very difficult for me to write. Although I’d had moments of struggle with my previous books, when they were done I liked them. I thought, hey, these are pretty good. With this one, as it went off to the printer I felt an emotion close to dread: I have not got it right yet, but I have to let it go.
The idea for the book started out innocently enough: I’d been writing about germs, and how advertising about their dangers helped to reshape many aspects of everyday life. So, I thought to myself, wouldn’t it be interesting to think about how the dynamics of modern consumer culture, particularly advertising, have shaped our expectations of medicine. In that happy toddler phase, I had a lot of fun looking at old ads. But like a teenager, as the project matured it got more and more difficult. (I hasten to say here this child metaphor has nothing to do with my real child, who is sitting here tonight, who was and is a delightful daughter!) But this book child was a pain: at times sullen, at times maniacal, dragging me into all kinds of unpleasant places I didn’t want to go (like thinking about health insurance!). It was the one I felt I had to send to the corner to learn how to behave. What was supposed to be a quick little aside of a book turned into a monster that took almost eighteen years to complete, years when I made myself and those around me miserable with wails and moans: whatever possessed me to try to write this book? I would look gloomily at my graduate students and say, never ever try to do what I am attempting: a book that spans a century and attempts to reinterpret the history of American medicine from a patient/public perspective. This way madness lies.
For a lark, I recently went and typed in “American health care system” on Google Scholar: there were 3,590,000 results. As I wrote, I certainly felt the weight of all that has been written about that system, famous around the world for its complexity and its dysfunctionality. (Yes, we did know it was so complicated, Mr. President!) Whatever possessed me to think that there was something else that needed to be said? And yet I persisted.
Thinking about those issues was like entering a funhouse with distorted mirrors: people used the same words—patient, consumer, choice, value—and meant very different things by them. In search of the origins of this strange concept of the “patient as consumer,” I kept going back further and further, looking for where it came from. The roots turned out to be a lot earlier than I expected: the 1920s and 1930s, not the 1970s. It still surprises me to read advice given in Americans in the 1930s—that you need to check your doctor’s credentials and read up on treatments before you have them—that with barely adjusted phrasing could appear on the Internet today. I found that as early as 1954, somebody had the idea of forming an American Patients’ Association to create a voice for patients that would counter that of the AMA, the AHA, the pharmaceutical industry. While I discovered that these critics had had a lot more political impact than they’d gotten credit for in previous histories, their demands for change were deflected and co-opted all too easily, in part because of how bound they were by their own position of white middle-class privilege. That deflection also resulted from the endless creativity of entrepreneurs who skillfully adapted the language of consumer choice to their own advantage. Continue Reading Nancy Tomes: Remarks from the Bancroft Awards Dinner