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International Sociology Reviews
2015, Vol. 30(5) 467 –471
© The Author(s) 2015
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DOI: 10.1177/0268580915598094
iss.sagepub.com
Reviews: Medicine and control
Nicole Trujillo-Pagán,
Modern Colonization by Medical Intervention: U.S. Medicine in Puerto Rico, Brill: Leiden, 2013; 250
pp.: ISBN 9781608464199
Reviewed by Héctor Camilo Ruiz Sánchez, University of Pittsburgh, USA
Keywords
Biopower, colonialism, medical history, medical sociology, Puerto Rico
Modern Colonization by Medical Intervention by Nicole Trujillo-Pagán is divided into six
chapters starting with a structural analysis that gives a historical context to the emergence
of tropical medicine in Puerto Rico. The second chapter depicts how hunger, after a sys-
tematic and complex process leaded by the US to undermine the island’s food sovereignty,
became a field to construct medical knowledge to control the population and the elite of the
Caribbean island. The third and fourth chapters focus on the ideological bifurcation of the
physicians into supporters and non-supporters of the colonial policies, and their institution-
alization as pivotal actors in the public sphere of the Puerto Rican society. The fifth chapter
explores emerging concepts and praxis of race, progress, and national identity from the
perspective of the medical labor and labels. The final chapter brings up new possible
perspectives that could enrich research on this topic.
Trujillo-Pagán’s book is provocative, and invites scholars most likely from history,
anthropology, medicine, and public health to read, and why not, do similar tasks in colo-
nial and postcolonial scenarios. In a Foucauldian-like analysis, Trujillo-Pagán’s book
presents a historical reconstruction and analysis of the US colonial medical intervention
in Puerto Rico, which developed in the late 19th and the early 20th centuries who had as
their main object and subject of experimentation the jíbaros, the name given by the
Spanish colonial regime to the white rural peasants. The jibaros became, then the arena
of medical struggle between the US colonial power, and the local elites. For example,
they were the recipients of one of the first US Army foreign vaccination programs.
Trujillo-Pagán’s analysis provides analytic tools for critically approaching and
understanding medical interventions, the emergence of public health, and the clashes
that emerge between allopathic medicine and other ways of understanding death and
sickness under processes of modernization and colonialism. Her piece sheds light on the
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Reviews: Medicine and control
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468 International Sociology Reviews 30(5)
reconstruction and denaturalization of medical colonial interventions, enterprises that
overlapped with colonial military projects, and the construction of national elites, which
based their power on medical knowledge produced by the colonization of ‘others’ living
within the national frontiers.
Puerto Rican doctors became key figures for developing policies and political ideolo-
gies to guide the national project. The jíbaros represented the premodern legacy of the
Spanish regime, therefore their modernization was required at any cost. Some thought of
solutions that were autonomous and independent from US policies, others thought that
the empire should provide them. Critiques of the island’s colonial dependency pointed
towards how the lack of food sovereignty on the island, which, combined with low
wages, worse than those during the Spanish regime, had created the bad health panorama
around the island, embodied in the jibaro, the racially and class threshold of the Puerto
Rican society at the time.
Under this context it is explained, how tropical medicine was born as a result of the
biomedical approach to understand and control death, disease, and poverty among the
island’s population using US colonial knowledge and logics. As an example, the eradica-
tion of the hookworm became one of the most important policies that focused on the
control of micro-organisms, while leaving aside concerns for political and structural fac-
tors. The early 20th century saw a Puerto Rico devastated by hunger and unemployment,
and affected by a tremendous hurricane that left coffee growers, the axis of the national
economy, with nothing. Hookworms then became the principal objective to give new
meaning to the subjectivities of the jíbaros and the Puerto Rican landscape. Existing
racial taxonomies were re-employed with new medical classifications to configure new
ways to understand and control the jíbaros. Although the colonial knowledge of the
United States had been ‘successful’ in dealing with the control of diseases among its
population the implementation, and the focus of the policies in Puerto Rico on microbio-
logical agents, questions the boundaries of ethics and experimentation in the early stages
of US global public health and tropical medicine.
By the end of the book, then it seems to be clear that the control of death and disease
through biomedicine was part of the US - Puerto Rico colonial enterprise, yet we do not
know much about the different paths it took. Knowing more about dissident physicians,
patients and actors could, as mention, strength the analysis and give to it a more powerful
post-Foucauldian and post-colonialist imprint.
The methodology of the book mainly uses biographies of Puerto Rican physicians to
examine the different lines of thought and discourse that emerged from the crucial figure
of ‘the doctor’ in the colonial transition. Although the colonial knowledge of the United
States was successful in dealing with death within its borders through the implementa-
tion of public health policies, in Puerto Rico the focus was on the microbiological agents.
This shift allowed a new conquest of the tropics, this time through the control and colo-
nization of the individual conceived as part of a population.
Trujillo-Pagán provides an in-depth explanation of the Puerto Rican case, relying on
biographies and newspapers. Physicians, which have played important roles in the his-
tory and development of the 19th and 20th century elites in Latin America and the
Caribbean, playing prominent roles in the construction of national projects. The iconic
Che Guevara was also a physician, for example
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Reviews: Medicine and control 469
This book is an invitation to create post-Foucauldian analyses in the tropics to reveal
power and resistance relationships in the context of medical and public health discourses
and practices. Gender-critical approaches, such as the voices of subordinate actors/
classes/stakeholders, and critical readings of humanitarianism would complement
Trujillo-Pagán’s careful reconstruction of this important part of Puerto Rico’s and the
Americas medical history.
Author biography
Héctor Camilo Ruiz Sánchez is a doctoral student in anthropology at the University of Pittsburgh.
His research interests are in the fields of critical medical anthropology, masculinities, and HIV/
AIDS in Colombia and South America. Address: University of Pittsburgh, Department of
Anthropology, 3302 WWPH, Pittsburgh, PA 15260, USA. Email: hector38@gmail.com
Sara Shostak,
Exposed Science: Genes, the Environment, and the Politics of Population Health, University of
California Press: Berkeley and Los Angeles, 2013; 297 pp.: ISBN 0520275187
Reviewed by Keith Rinier, Rhode Island College, USA
Keywords
Environmental sociology, medical sociology, public health, sociology of science
Exposed Science drafts a set of detailed images depicting the evolving face of environ-
mental health policy, highlighting the academic, political, and legal battlegrounds that
are the result of diverging opinions on the evaluation and implementation of environ-
mental interventions and safeguards. Utilizing the ‘gory details’ to extrapolate on the
‘big picture’ of environmental health science, Shostak measures definitional discrepan-
cies between influential academic and government institutions by articulating the docu-
mented evolution of ‘evidence-based’ practices with evidence derived from controversial
case studies and verbatim narratives of those professional health scientists involved in
contemporary decision making. This review finds Exposed Science functions as an
informed observation of the questionable behavior of professionals (despite empirical
evidence) and, although I applaud the author’s ability to remain objective while interfac-
ing with political subject matter, we still need a more vehement exposé of the non-sci-
ence and nonsense that undermines the efficacy of environmental health sciences.
Shostak argues that, instead of answering the age-old inquiry of is it genetics or is it
the environment, professional institutions in the environmental health sciences have pur-
sued avenues of commonality in order to preserve and improve the overall impact of the
industry. As she describes, divergent needs require converging: techniques in toxicology
testing must be improved, existing theories are mutually beneficial when integrated, and
the genetics–environment interplay needs to be defined in concrete terms. It is no longer
a debate of who is doing the better science when competing ends align themselves to a
mutually beneficial cause, and, in a reality where scientists are bred for chasing grants
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