First, thanks to all readers for engaging the first post in this series.  I think it might already be the most widely-read post in the very short history of this blog.

Andrew Ruis, an historian of medicine and public health at the University of Wisconsin-Madison, left on my post a comment that was so excellent I immediately requester permission to bump it up the post level.  Andrew graciously consented, so here it is, reprinted verbatim, with paragraph breaks added only to ease readability:

“The issue that always floors me with characterizations like Horton’s is that utility is a useful metric for, say, skills, but a poor one for knowledge generation, where utility (beyond statements like “all knowledge is useful”) can only be assessed retrospectively (historically!), to the extent that it can be assessed at all. Research in history of medicine is no different than bench research in biomedicine or any other basic research endeavor, if using utility as yardstick, because no one can predict the future.

I worked for several years at a genomics company where we learned a lot about cancer biology, but whether that knowledge was useful or not was impossible to determine except insofar as knowledge is useful for its own sake. Even evaluating it comparatively–was that knowledge more or less useful than my historical work on children’s nutrition programs?–is impossible to gauge, unless you have some magical Aristotelian formula that assigns precise values to potentiality. Arguments like Horton’s are not about utility per se but about values. He’s basically implying that he (and I think it’s no great stretch to suggest that he purports to represent a far larger group of medical professionals) values biomedical research intrinsically (biomedical = good, for surely he would not declare biomedical research “moribund”), but he values history of medicine only insofar as he can perceive an immediate and obvious use for it (HoM = good iff useful to me right now). That’s not a statement of logic, it’s a statement of belief. What’s worse, it is a shockingly naive view of utility, as if things like epistemological perspective or the way historians frame, investigate, and answer questions isn’t potentially “useful” even if the outcome of any specific research endeavor may not be in some particular context.

The problem, as Carsten, you, and others suggest, is that values, whether well-founded or no, are powerful when shared by people in positions of power. I fully agree with your assessment–that valuation should not be tied to utility–and it seems the most significant challenge historians of medicine face is not convincing medical professionals and the biomedical-industrial complex that we (and our work) are useful but that there is no real way of assessing the utility of our work except, ironically, historically.


(I may have an additional post on this tomorrow or the day after, engaging some conversation Mark Weatherall and I have been having on the Twitterz).