The author, a history professor, reviews the responses of medical, political, and legal institutions to the fetal alcohol syndrome. Leaving the biomedical discussion to standard medical textbooks, she focuses in this book on a social context beyond the consulting room. Golden recounts the reluctance of physicians and society to accept alcohol as a teratogen, in spite of warnings dating back centuries. For example, Josef Warkany's monumental 1971 work on congenital malformations did not indict alcohol nor even include it in the index (the complete syndrome includes malformations of the face, viscera, and brain). The concept of a fetal alcohol syndrome emerged in the 1960s and 1970s, during a revolutionary expansion of knowledge about teratogenesis. It was the era of the realization that "the face predicts the brain," when physicians recognized many face-brain malformation syndromes and correlated them with abnormal karyotypes or exogenous teratogens. Golden points out that wide publicity about thalidomide-induced phocomelia had primed the profession to expect the identification of other teratogens in humans. She reviews the polarized debates among religionists, feminists, and legislators as to whether to consider maternal alcoholism, with its potential for harming the fetus, as a moral failure or a disease that requires compassionate treatment. Should the law punish an alcoholic mother? Is the harmed child justified in suing her? Is brain impairment due to the fetal alcohol syndrome a justifiable defense for a criminal or, as attorney Alan Dershowitz contends, an "abuse excuse" that replaces personal responsibility with a diagnostic label? In the debate over "medicalizing" deviancies such as alcoholism and compulsive gambling as sicknesses, I would hope that physicians would prefer medicalization to punishment. Because each new discovery opens a Pandora's box of reactions, physicians need to find effective means of public education that will elicit productive responses from society. In this area, Golden highlights the shortcomings of the news media, government agencies, and the courts and points to the resistance of manufacturers to publicizing warnings that raise liability concerns or that may result in controversial legislation. Golden writes clearly, though occasionally repetitiously, and provides abundant references. She avoids personal polemics and evangelizing. Her modus operandi is to quote opposing viewpoints in their historical context and then underline contradictions. At times the reader may almost wish for recommendations, but Golden eschews easy answers. Most physicians and health workers will find the book interesting and provocative and will come away with a much fuller appreciation of the complex responses that medical discoveries trigger in society. These are excellent outcomes for a book. William DeMyer, M.D.
Copyright © 2005 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
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Message in a Bottle
raises key questions about public policy, the politicization of medical diagnosis, and the persistent failure to address the treatment needs of pregnant alcoholic women. Janet Golden traces the history of FAS from a medical problem to moral judgment that stigmatizes certain mothers but fails to extend to them the services that might actually reduce the incidence of this diagnosis. The women most in need of effective treatment and compassion are more likely to receive blame and punishment. Golden has written an accessible, readable, and important book. (Lynn M. Paltrow, Executive Director, National Advocates for Pregnant Women)
Golden's book is a must-read for anyone interested in alcohol problems, maternal-fetal health and society's response to a newly identified risk. It tells the fascinating story of the discovery of the fetal alcohol syndrome and its subsequent effects on medicine, public health, government, law, journalism and public opinion. When alcohol is involved in public health considerations, the result is always controversy, contention, and publicity. FAS is no exception. The needs of addicted women still go largely unmet while society condemns these women as unfit mothers. (Sheila B. Blume, M.D. Former medical director, Addiction Services, South Oaks Hospital, Amityville, New York)Message in a Bottle
provides a much-needed overview of a crucial topic in the recent history of medicine and public health. Golden has delved deeply in the primary and secondary literature, and has pulled the major episodes in the story of fetal-alcohol syndrome into a coherent narrative, producing not just the story of FAS, but a thoughtful and thought-provoking analysis of an exceedingly complex and controversial subject. In order to understand the medical, social, legal and political aspects of FAS, the author argues, we must address in significant ways, medicine, feminism, issues around reproductive freedom, the media and politics. Golden has written a brilliantly researched and compelling book; I hope it will be widely read and discussed. (Christian Warren, New York Academy of Medicine)
Janet Golden's Message in a Bottle
explores the fascinating history of the discovery of alcohol's damaging effects on fetuses. [Golden] does a solid job of delivering the science that backed the diagnosis, as well as the social context that shaped America's view of the condition...In the first chapter, Golden promises to provide a comprehensive look at the discovery of fetal alcohol syndrome, as well as the scientific, historical and social context that framed the debate over the condition. She delivers on all counts. Most interestingly, the book explains how laypeople and doctors alike were hesitant to accept that alcohol might be dangerous...The book details the chronology of changing medical knowledge and delivers its information remarkably well. (January W. Payne Washington Post Book World
Golden's is a model study of the wide-ranging sociocultural consequences that can follow the clinical identification and description of a new syndrome. (Robin Room The Lancet
2005-06-11)Message in a Bottle
by Janet Golden is the most comprehensive and easily read text on the history, politics, public health debate, legislation, psychosocial and family dynamics, and media discussion concerning fetal alcohol syndrome. This is a must-read for any professional involved in the study of alcohol abuse and neurodevelopmental outcomes of children, fetal medicine, pediatrics, social work, psychiatry, and other areas of mental health. (Denis Viljoen Journal of Clinical Investigation
This book is an almost essential read for students of developmental disabilities and diagnostic clinicians. For other readers it offers an engaging and informative insight into the effects of the discovery of new diagnoses on wider society. (Raja A. S. Mukherjee British Medical Journal
Janet Golden's versatile cultural and medical history of Fetal Alcohol Syndrome (FAS) in America is an enlightening addition to the literature on the social history of medicine, alcohol and drug problems, and women's health...This book would work well as a text in an undergraduate class on society and medicine or gender and health. At the same time, Golden's well-researched and documented study will enhance the knowledge of professionals in many fields, including history, gender studies, medicine, communications, and sociology. (Pamela E. Pennock American Historical Review