Book Review

The Doctor-Activist: Physicians fighting for social change

N Engl J Med 1996; 335:1077October 3, 1996

Article

The Doctor-Activist: Physicians fighting for social change
Edited by Ellen L. Bassuk, with the assistance of Rebecca W. Carman. 254 pp. New York, Plenum, 1996. $27.95. ISBN: 0-306-45267-7

There is a long and venerable history of physicians serving as political activists. Rudolf Virchow pioneered the “irritation” theory of cancer and the principles of cellular pathology in the middle of the past century, but he was also the leader of a campaign for compulsory meat inspection in Berlin and the architect of the city's sewage system. Activist medicine continues today in more organized forms, in groups like Physicians for Social Responsibility, Physicians for Human Rights, and International Physicians for the Prevention of Nuclear War.

This collection brings together 10 brief autobiographies of American doctors fighting for social change. The experiences are diverse. Louis Fazen practiced pediatrics with Cherokee and Shawnee in Oklahoma; Edith and Thomas Welty faced the desperate poverty of Haiti and the difficulty of dealing with Navajo “skinwalkers.” John E. Mack tells how he became involved in the antinuclear movement, and Donald P. Francis charts how his early family experiences led him to challenge the mishandling of the AIDS crisis by the Centers for Disease Control (Randy Shilts's And the Band Played On: Politics, People, and the AIDS Epidemic [New York: St. Martin's Press, 1987] expands on Francis's role in these events). All the accounts are personal and remarkably free of pretense; the editor's expressed hope is that knowing something about the lives of successful activists may help galvanize others to take similar paths.

Judith Longstaff MacKay's contribution is one of the more captivating. MacKay has worked for years to combat smoking in China, Mongolia, and other parts of Asia; she helped launch Hong Kong's aggressive antismoking program of 1987 — including a ban on the importation or sale of smokeless tobacco — despite pressures from U.S. Senator Robert Dole and others who threatened to retaliate with trade restrictions. MacKay notes with deserved satisfaction that Hong Kong today vies with Singapore for having the lowest prevalence of smoking in the world, though she also warns that in Asia as a whole the habit continues to spread — and rapidly.

H. Jack Geiger came to medical activism through journalism and the civil-rights movement, campaigning in Wisconsin in the 1940s against racial discrimination in housing and later, in South Africa, for improved medical care in the impoverished black townships. In the early 1960s, Geiger helped found the Medical Committee for Human Rights, Physicians for Social Responsibility, and a widely imitated community health center at Columbia Point in the Mississippi delta. Civil rights and opposition to the Vietnam war were defining movements in Geiger's activism, as they were for several other contributors to the book.

The foreword by Julius B. Richmond of Harvard's Department of Social Medicine suggests that we know very little about what leads one physician rather than another into social activism, and suggests — and I would second the motion — that research be done in this area. He also cautions that the corporatization of medicine may make activism more difficult. Social responsibility has never been a part of the Hippocratic oath, but the men and women writing in this book give us hope that there will always be doctors willing to fight for social and environmental justice. One is also led to suspect, though, that we will never have too many.

Robert N. Proctor, Ph.D.
Pennsylvania State University, University Park, PA 16802