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Remaking the American Patient: How Madison Avenue and Modern Medicine Turned Patients into Consumers by Nancy Tomes (review)

In Remaking the American Patient, Nancy Tomes challenges popular understandings of when patients became ‘‘consumers.’’ Many commentators have traced ‘‘medical consumerism’’ to the 1970s, with the women’s health movement, arguing for an explosion in ‘‘patient empowerment’’ in the 1990s with the coming of the internet. In contrast, Tomes begins her history of how patients became consumers in the late nineteenth century, and traces the growth of ‘‘health commercialism’’ to the 1920s, coinciding with the rise of the advertising industry. Insisting that there was never a ‘‘‘golden age’ of placid doctor-patient relationships,’’ Tomes demonstrates patients questioned physicians’ motives and authority throughout the twentieth century. While acknowledging that ‘‘patients had been complaining about doctors. . . long before the 1920s,’’ Tomes finds an important difference in the nature of complaints from this period onward. Even as acceptance of ‘‘the legitimacy of modern science and the values of professionalism’’ had become widespread, there were growing concerns that these values were compromised by ‘‘too close an embrace of commercial values’’ (2–5, 118). Noting that physicians in the United States often critique the rise of ‘‘consumerism’’ among patients, associating the term with the ‘‘late twentieth century advent of managed care and the growing limits placed on medical autonomy by third party payers,’’ Tomes argues that the medical profession itself has ‘‘played a huge if inadvertent role in producing the modern doctorshopper.’’ The centrality of ‘‘free enterprise medicine’’ to health care in the United States, and emphasis on ‘‘physician autonomy’’ and rejection of any ‘‘centralized forms of professional control’’ produced the ‘‘uneven