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Elizabeth Fee, PhD and Theodore M. Brown, PhD

Elizabeth Fee is with the History of Medicine Division, National Library of Medicine, National Institutes of Health, Bethesda, Md. Theodore M. Brown is with the Departments of History and of Community and Preventive Medicine, University of Rochester, Rochester, NY.

Correspondence: Requests for reprints should be sent to Elizabeth Fee, PhD, National Library of Medicine, History of Medicine Division, 8600 Rockville Pike, Bethesda, MD 20894 (e-mail: elizabeth_fee{at}nlm.nih.gov).

Clearly, our perspective is considerably different from Dr Henderson's. We do not see eye to eye on many things, and as a result, we have divergent views not only of the past but of our current circumstances as well. Since we don't occupy common ground, it is not surprising that we do not share the same eerie feeling of déjà vu. What you see depends, to a large degree, on where you stand.

On one point, we feel the need to respond specifically to Dr Henderson and, interestingly, it is a point on which we seem to agree. Dr Henderson acknowledges that "the status and strength of public health waned after the [second world] war, a result of many different factors." He cites developments in biomedicine, new vaccines, and antibiotics that, with other factors, "shifted the focus toward curative medicine." He also acknowledges that faculties of schools of public health "became increasingly preoccupied with academia and less with the practice of public health." Absent from Dr Henderson's account of the postwar period is mention of the political climate, which we take to be crucial. As many scholars have noted, the climate of postwar hysteria drove prominent political figures to glorify science as a conflict-free alternative to health and social policy, just as it drove liberal academics into more esoteric, apolitical research areas. It was also the political and cultural climate that allowed certain fields—behavioral science and strategic studies—to grow and flourish while others withered or remained moribund. Public health efforts oriented to biopreparedness and formulated in Cold War terms could obviously flourish, whereas social equity concerns did not. Langmuir's campaign was well suited for its time and circumstances, and thus his efforts succeeded and his programs grew. These were not accidental connections, but more the result of an adaptive process akin to Darwinian selection.

We leave to others the debate over the necessity, wisdom, and political ramifications of current biopreparedness efforts. We insist that history has lessons that can be usefully drawn when its complexity and subtlety are fully appreciated, not rushed over, distilled in some selective fashion, or inappropriately removed from its political context.

[October 26, 2001—The threat of biological weapons is evidently more serious and more immediate than many of us thought in the weeks and months before September 11. Nevertheless, as the United States races to put in place new security forces and barriers, and as the people turn to their newspapers and television sets in daily anxiety, it is still imperative that we think carefully about the long-term implications and consequences of our current choices. Once—as we hope—the immediate threat subsides and we begin to reestablish a sense of security, we may discover that it is much more difficult than we expected to return to priorities that have been temporarily set aside: the plight of the disenfranchised and the uninsured; social disparities in health; human and civil rights; and social justice. Historical experience shows us that it can be difficult to rebalance our priorities and social progress in a context of anxious attention to national security. If history teaches us anything, it is that we should consider very carefully the steps that we take in the present, as these will create the path to the future.]

Accepted for publication August 17, 2001.

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