Biomedical Platforms: Realigning the Normal and the Pathological in Late-Twentieth-Century Medicine (Inside Technology)
This book is a straightforward before-and-after narrative history. Before the 1970s, leukemias and lymphomas were diagnosed by morphologic means, by inspecting stained blood smears microscopically and estimating the developmental stage of the cells. The presence of a large number of early-stage cells meant a fast-growing tumor and a bad prognosis. From about the mid-1970s onward, flow cytometry and the fluorescence-activated cell sorter entered the picture, at first as an experimental system and then gradually as the centerpiece of a new vantage point from which to quantify maturing cells by immunophenotyping and to assess their numbers at key stages of the disease. In this system, cell-surface markers, defined as molecular entities and detected by labeled antibodies flowing through a nozzle past a counter, took the place of the stains, the oil-immersion lens, and the pathologist's experienced eye. Authors Peter Keating and Alberto Cambrosio call this a new biomedical platform. They discuss the transition from the use of antiserum, which is raised in rabbits and carefully absorbed to increase specificity, to monoclonal antibodies of exquisite specificity. Along with such antibodies, the flow cytometer evolved from a big, expensive, virtually homemade machine to the neat black box of the later bench models. The authors discuss the transition from the pathology laboratory to the specialist department and the problem of handling museum collections of reference slides of leukemia and lymphoma cells. They also delve into the emergence of a new concept of cell membranes as a kind of undersea garden that is alive with waving fronds, the "clusters of differentiation," or CD markers, that can be detected by the new cytometric system. The authors provide data from Britain, Canada, France, and the United States, with the use of interviews, archives, technical information, and sociological analysis. Biomedical Platforms is the result of many years of research and is so packed with technical, social, and philosophical detail that virtually every line represents a research project and an insight. It reminded me of the lectio continua of the Bible in a Benedictine monastery: every evening, a little bit to meditate on overnight. The sightlines run all the way from the molecular biology of normal cellular maturation to pathology, technology, institutions, biotechnology companies and instrument makers, standardization, and the clinic. The authors inquire about whether there is such a thing as a pathologically specific marker or whether all markers are normal but have altered quantitative relations. It is interesting to note that the book says very little about the acquired immunodeficiency syndrome, in which the cellular markers derived from flow cytometry defined the disease in the early 1980s, before tests for the virus were established. In this case, there was no pre-existing morphologic technique to push aside, no before and after. A finding of a low number of CD4 T cells defined the disease; there was no pathological specificity, only a quantitative change from the normal. Whom will this book interest? That is not easy to say. Hematologists, immunologists, and pathologists will certainly enjoy it. It is their own personal history, and they may even know some of the actors in it. Historians of medicine and their graduate students, if they are interested in the history of immunology, will also read it, since they have doubtless read and admired the authors' other work. Such readers should appreciate the link between epistemology and the practical, the technical, and the clinical -- a connection that the historiography of immunology has often tended to play down -- as well as the attractive idea of the platform. But subtle and insightful as the book may be, it will not have many general readers. Narrative history with a sociological twist is usually more accessible than this. Of course, it might attract some readers who are Benedictines at heart and love the nightly lectio continua.Pauline M.H. Mazumdar, Ph.D.Copyright © 2004 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.--This text refers to an out of print or unavailable edition of this title.