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William H. Foege, The Fears of the Rich, The Needs of the Poor: My Years at the CDC (Baltimore, MD: Johns Hopkins University Press, 2018), pp. 280, paperback, $24.95, ISBN: 9781421425290.

was only brought to a formal end with the passage of the 1978 Medical Act, its original egalitarian principles had long been corroded by professional and racial anxieties. Haynes effectively argues that the medical register became instrumental in protecting and promoting a homogeneous vision of British medicine – both by exporting its exponents around the world and by providing access to Britain’s medical market only to those who practised in its image. While the first half of the book reveals a great deal about how other countries interacted with a system designed to privilege British interests, by its close the focus is squarely on the GMC’s efforts to juggle competing interests in its regulation of overseas medical practitioners. This emphasis undoubtedly adheres to Haynes’ introductory description of Fit to Practice as an institutional history of the GMC. Yet, the more insular focus of the second half occasionally raises questions that a broader approach might have addressed. It is not clear, for instance, how the South Asian medical community responded to criticisms of their competence, nor what character an emerging ‘Indian medicine’ was assuming as Britain’s influence waned. Despite the title, ‘practice’ itself receives little attention. If the hegemonic control of white, male elites imbued medicine with any distinct attributes, they are not highlighted. Equally, while race plays a role in the debates over linguistic fluency, gender ceases to be discussed in the later chapters, despite the growing number of women entering the profession. This strand could have enhanced the book’s broader arguments about hierarchies and discrimination within British medicine. Finally, case studies might have helped to give voice to those affected by the policies whose genesis Haynes so carefully reconstructs. Fit to Practice ultimately emerges as a useful guide for considering how the British medical register became a portal for spreading a particular brand of medicine across the world, and for safeguarding it from outside influence. For those wondering what obstacles have prevented Britain from resolving its domestic medical needs with foreign labour, it reminds us not to underestimate the role of bureaucratic tools wielded by small, tractable agencies.