EAHMH 2011 Book Prize awarded to Ilana Löwy, Preventive Strikes

Announcement

The EAHMH 2011 Book Award goes to Ilana Löwy, Preventive Strikes: Women, Precancer, and Prophylactic Surgery (Johns Hopkins University Press, 2010).

The prize was awarded at the Biennial Conference of the EAHMH in Utrecht on the 4th of September 2011, by EAHMH President, Frank Huisman, who made the following remarks on behalf of the jury:

The Scientific Board of the The European Association for History of Medicine and Health  decided in 2010 to establish a Book Award for the best medical history monograph published in the four years preceding the EAHMH biennial conference. The award of EUR 3000 is made possible through the generous support of the Dutch Stichting Historia Medicinae and the German Robert Bosch Stiftung.

For the 2011 award, books published during 2007 to 2010 inclusive were eligible. Books could be nominated by anyone, including publishers, members of the Association and authors themselves. Nominated books could be on any medical history topic concerning Europe or Europe?s relationship with the wider world. Edited volumes, as well as works with two or more authors, were not eligible.

The jury - consisting of Prof. Anne Hardy, Prof. Robert Jütte and myself

- was unanimous in its opinion.

It is a great pleasure to announce that the winner of the 2011 EAHMH Book Award is Ilana Löwy, for her book Preventive Strikes: Women, Precancer, and Prophylactic Surgery, published by The Johns Hopkins University Press in 2010.

Her book is a major achievement. It concerns the 20th century battle against cancer. More to the point, it is about preventive diagnostics regarding breast and ovarian cancer, and its implications for the lives of women. Löwy's analysis may be seen as a metaphor for modern medicine

- of modern life even. This book is about the tragic consequences of the malleability of life in a secular risk society.

Everybody wants to live a long and healthy life, and most people are prepared to do whatever it takes to accomplish this. But because laypeople are dependent on the expertise of professionals, how the body is conceptualized and how health and disease are defined by these professionals remains critical to the therapeutic response.

Modern scientific tools can identify a predisposition to cancer before any symptoms have become manifest. However, some women so predisposed will never develop cancer. Nevertheless, they have to decide how to respond to the knowledge that they might. They can try to ignore genetic test results, or they can have their breasts or ovaries removed. Löwy meticulously analyzes the history of the conceptualization of the normal and the pathological as well as the history of prophylactic amputations from the late nineteenth century to our own time, comparing France, the United Kingdom and the United States.

Like all good books, Löwy's begins with a perplexing observation: she was impressed by the knowledge, the professionalism and the humanity of clinical geneticists. At the same time, however, she was impressed by their powerlessness. She observed a striking contrast between the sophistication of their conceptual framework and the crudeness of their

solutions: women who seemed to be in perfect health underwent preventive surgery for cancer.

Like all good authors, Löwy uses sophisticated theoretical insights without, however, using them upfront. The work of George Canguilhem, Charles Rosenberg, Bruno Latour and Ulrich Beck has clearly inspired her. Their insights and theories are all-pervasive, but they are kept implicit. In the process, Löwy shows the use of the Science and Technology approach to the history of medicine. While STS can be sterile and descriptive, Löwy uses its method in a concrete, historical way, thus convincingly showing the potential of the approach.

Löwy develops her argument chapter by chapter. Thus, she shows how cancer moved from being perceived as a constitutional disease to a cytological one. As a result, it was transformed from being a disease belonging to surgeons to a disease belonging to pathologists, diagnosed in the laboratory. In order to make sense of biological complexity, pathologists introduced the category of 'premalignant lesion'. At first, this was a rather fluid, tentative category. Over the course of time, however, it took on a real and concrete character, with surgeons proactively acting on it. The introduction of mass screening for malignancies in the 1940s and the introduction of population-based thinking in oncology a decade later built on the logic of this proactive thinking, taking it to the dramatic climax of radical preventive surgery.

The strength of this book lies in its demonstration that the medicalization process is by no means a conspiracy of doctors against patients. The 'cancer script' - as Löwy calls it - is a co-construction evolved by surgeons, pathologists, insurance companies and women. While the diagnostic categories they use are unstable, their framing of cancer has dramatic consequences for the lives of individual women. As such, this story may be read as a comment on the tragedy of the human condition.

In her conclusion, Löwy makes the following observation: 'The desire to transform precancer into a stable diagnostic category can be compared with earlier efforts to stabilize a diagnosis of another "dread disease", with deep social and cultural resonances: the history of the Wassermann reaction for the detection of syphilis'. As you all will know, this latter history was written by the Polish physician and philosopher of science Ludwik Fleck. With this book on what Löwy herself calls the 'lumpiness' of today's oncological practice, she may come to be perceived as the Ludwik Fleck of our times.