---------------
H-Diplo Article Reviews
http://www.h-net.org/~diplo/reviews/
No. 401
Published on 6 June 2013
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H-Diplo Article Review Editors:  Thomas Maddux and Diane N. Labrosse
Web and Production Editor: George Fujii

Commissioned for H-Diplo by Thomas Maddux
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Anna Geltzer.  "In a Distorted Mirror:  The Cold War and U.S.-Soviet
Biomedical Cooperation and (Mis)understanding, 1956-1977."  Journal of
Cold War Studies 14:3 (Summer 2012): 39-63.  DOI:  10.1162/JCWS_a_00247.
http://dx.doi.org/10.1162/JCWS_a_00247

URL:  http://www.h-net.org/~diplo/reviews/PDF/AR401.pdf
---------------

Reviewed by Nikolai Krementsov, University of Toronto and Anne-Emanuelle
Birn, University of Toronto

The Hall of Distorting Mirrors

"In a Distorted Mirror" sets out to examine the extensive efforts at
"biomedical cooperation" between the United States and the Soviet Union
that took place from 1956 to 1977. The article's stated goal is "to trace
the history" of this bilateral cooperation and "to draw out the
expectations and misunderstandings that arose on both sides" (41). The
body of the article is divided into three sections-"The Road to
Cooperation"; "Searching for Common Ground"; and "The Unraveling of
Cooperation"-which promise to illuminate the major stages in that history.
But in fact, the first section deals mainly with the reports and
impressions of members of U.S. 'medical missions' to the Soviet Union from
1956 to 1969; the second depicts the expansion of cooperative efforts in
the early 1970s, focusing on the preparations of the 1972 U.S.-Soviet
Health Cooperation Agreement (co-signed by U.S. President Richard Nixon
and Soviet Premier Leonid Brezhnev) and the Soviet take on the Agreement's
meanings; and the third briefly sketches certain activities undertaken as
result of this Agreement from 1972 to 1977. Why the article follows these
particular chronological divisions, and why it ends on this particular
date 1977 (despite the fact that the Agreement was renewed that very year
for another five years) remains unexplained. The article's main conclusion
is that the  Cold War "analytical framework" of both the Soviet and U.S.
participants profoundly shaped mutual perceptions, creating "a distorted
picture of the structure and function of each other's research enterprise"
(41), which had "grave" (62) consequences for cooperation. How exactly
(and even whether) this analytical framework informed the actual
activities during the twenty-plus years covered in the article, or what
those consequences actually were, remains obscure. Although the article is
a welcome attempt to shed light on an important, and understudied, aspect
of U.S.-Soviet relations during the 'mature' Cold War, it falls short of
its promises for three main reasons: its analytical categories are
muddled, its source base is inadequate, and it pays almost no attention to
the broader national and international contexts of this particular
"biomedical" cooperation.

To begin, the article does not attempt to trace the basic contours of
U.S.-Soviet "biomedical cooperation." The article provides the reader with
no information on when exactly and how this cooperation began, what
different forms it took, how many 'missions' both sides dispatched, or
their temporal, geographical, and disciplinary dynamics throughout the
twenty-plus years it lasted. One has to mine through the footnotes to
learn that the United States sent to the Soviet Union a 'Mission on
Microbiology and Epidemiology' in 1956; a 'Pharmacology and Physiology of
the Nervous System Medical Mission' in 1958; a 'Radiobiology Mission' in
1959; and a 'Second Cardiovascular Mission' in 1964 (the 'first
cardiovascular mission' is not mentioned). Whether there were other
missions before and after these dates or even the total number of such
missions is anybody's guess. On the Soviet side, only one 'mission' (in
oncology) is directly mentioned in the text, and readers are not told how
many Soviet 'missions' went to the United States, which disciplines and
specialties they represented, or what their objectives and results were.
In the text, the reader encounters disparate remarks about certain
cooperative efforts and projects in oncology, virology, and the
construction of the artificial heart without any indication of their
timing, longevity, membership (at the level of both individuals and
institutions), stated objectives, or actual results. The reader remains in
the dark regarding such critical issues as who initiated concrete
missions, how such initiatives were negotiated both internally and
bilaterally, how these negotiations reflected and reconciled different
interests of various disciplinary communities, and how the structure,
directions, and personnel changed over the period under study. Without
this basic information on the forms, mechanics, and dynamics of
cooperation, it is hard to reach any conclusions regarding 'perceived'
successes and/or failures of the twenty-plus-year-long efforts.

This lack of crucial information is further compounded by the confused
analytical categories employed in the article. The "biomedical
cooperation" of the title is supposed to mean exchanges and collaborative
projects in biomedical sciences (research and development), and the
examples of such cooperation referenced in the article include oncology,
virology, cardiovascular diseases, physiology, and microbiology. Yet on
the second page, Geltzer refers to "health care cooperation" (41) and a
few pages later to "Soviet-American bilateral cooperation in health and
medicine" (43), which is a much broader category that encompasses not only
research and development, but also the provision and delivery of medical
care, as well as various preventive public health measures (e.g.
vaccinations), epidemiological intelligence, and sanitary infrastructure.
Throughout the article, however, the locus of cooperation is characterized
as "the biomedical research enterprise" (40, 41, 48), "the biomedical
establishment" (49), "the biomedical community" (49, 51), "biomedical
disciplines" (55) and so on. In the conclusion we are again introduced to
"the U.S.-Soviet exchange in health care" (62). As the article's second
section explains, in the Soviet Union, these two facets - biomedical
science and health care-were closely intertwined (both rhetorically and
institutionally), while in the U.S. they appeared to be widely separate,
which became a major source of mutual "misunderstandings."

What is inexplicably excluded from the article, however, is the fact that
during precisely the same time period, along with the missions focused on
specific biomedical sciences and specialties (e.g. oncology, physiology,
microbiology, radiology, etc.), the United States dispatched to the Soviet
Union a series of 'public health' and 'health care' missions. Notably,
though but one relevant example, a 'U.S. Delegation on Health Care
Services and Planning,' headed by no less a figure than the then U.S.
Surgeon General Jesse L. Steinfeld, was sent to Moscow from May 16 to June
3, 1970, and it was during this very mission that Steinfeld and Dmitrii
Venediktov, a Deputy Minister of Health Protection and the head of Soviet
delegation to World Health Organization (WHO), concocted a plan for
creating what would become the 1972 Agreement.1 In fact, the Soviet system
of universal, state-funded, and planned health care provision and delivery
(what U.S. observers called 'Soviet socialized medicine') had been a
subject of intense interest for U.S. health policy specialists and medical
administrators from its very beginning in the early 1920s2 and it
continued to command their close attention until the end of the Soviet
Union. Odin W. Anderson, a leading analyst of the U.S. health care system
and a well-known critic of national health insurance proposals in the
United States (modeled to a degree after Soviet 'socialized medicine'),
whose opinion on the Soviet system is cited in the article, went on a
similar 'health care' fact-finding mission in 1972. Although she uses
certain archival materials related to the 'health care' missions, Geltzer
fails to differentiate between biomedical and health missions, which
sometimes partially overlapped and were interconnected at the level of
both institutions and individuals involved but ultimately were quite
different sets of exchanges, and thereby  creates  a distorted image of
all of U.S. 'medical missions' as having the same goals, expectations, and
results. This stance is problematic on two levels: first, it fails   to
provide the necessary context for U.S.-USSR biomedical cooperation, and
second, it fails to disentangle the conflated categories of 'health care'
and 'biomedical' exchanges.

A similar confusion surrounds Geltzer's second major category-"exchange
participants" (41, 62). As is clear from the materials scattered
throughout the article, several different groups of actors on both sides
were involved in cooperative efforts: researchers in various biomedical
disciplines, public health officials and specialists, and state
bureaucrats from a variety of government agencies. Occasionally the same
person did simultaneously act in two, or even three, capacities (as was
the case with Steinfeld, who was not only a public health administrator
but also an eminent research oncologist, or Venediktov, whose research
interests, though subordinate to his bureaucratic positions, focused on
system analysis and health care informatics). But in the majority of
cases, the interests, expectations, and perceptions of actors belonging to
different groups differed considerably and were shaped by their concrete
roles (e.g. as a researcher, a clinician, a public health analyst or an
administrator, a State Department bureaucrat, etc.) in the exchanges. Such
differences had to be confronted and resolved. But what we get from the
article is only a brief glimpse of such internal negotiations on the
Soviet side (in the article's second section) depicting discussions at a
meeting of the ruling body (the Presidium) of the USSR Academy of Medical
Sciences.

We learn (only from a footnote) that the turnover of personnel was "much
higher on the U.S. side than on the Soviet side" (58, fn.62), but the
question of how this difference might have affected the
quarter-century-long cooperation is not raised by the author. This
difference should alert a discerning reader to the concrete personalities
on the Soviet side who remained in charge for long periods (such as the
head of the Soviet oncology establishment and one-time president of the
USSR Academy of Medical Sciences, Nikolai Blokhin, or Boris Petrovskii,
the Minister of Health Protection): their personal preferences,
specialties, connections, biases, etc. may well have played a much greater
role in shaping the cooperative efforts than the article leads us to
believe. Similarly, the U.S. participants are a highly diverse group as
regards individual political orientations, previous experiences in dealing
with the Soviets (and other international players), attitudes to the
interrelation of medicine and public health, etc., all of which might have
influenced their expectations, perceptions, and activities in the
exchanges.3 Instead, the article as a whole operates with a
one-dimensional image of a monolithic 'U.S. side' versus an equally
monolithic 'Soviet side.'

Furthermore, in assessing the results of the twenty-plus-year long
U.S.-Soviet biomedical cooperation, Geltzer's article overlooks one of the
most important goals (and consequences) of international relations in
science, medicine, and public health: namely, the building and maintaining
of professional networks that play a critical role in the formation of
disciplines and disciplinary consensus, as well as knowledge and
technology transfers. In omitting the role and importance of the personal
ties and networks forged, the author misses out on the 'successful' legacy
of  U.S.-USSR cooperation, perhaps most notably the role and mutual
importance of the Soviet-American cardiology exchanges in the 1970s on the
alliance formed between Eugene Chazov and Bernard Lown, leading Soviet and
American cardiologists, respectively, to found jointly the Nobel-prize
winning organization, International Physicians for the Prevention of
Nuclear War (IPPNW).4

The article's third major analytic category, a 'Cold War analytical
framework,' is the least clear of all. The key
components/elements/contours of this 'framework' remain unidentified,
while their particular compositions and connections to the Cold War are
assumed rather than examined. For instance, the U.S. perceptions (both
admiration and suspicion) regarding the nature of Soviet public health and
medical systems predate the Cold War by several decades, yet in the
article they are portrayed as an important consequence of the Cold War
'framework.' Furthermore, in the course of the twenty-plus years covered
in the article, the Cold War itself, and the "analytical framework" it
supposedly generated, are presented as being completely static. The waning
and waxing of tensions between the superpowers seems to play no role in
the formation of this framework. Major events of the period-from the 1956
Hungarian revolt to the 1962 Cuban missile crisis to the 1968 Soviet
invasion of Czechoslovakia to the decade-long Vietnam war-are neither
mentioned nor analyzed as factors that might have informed a 'Cold War
framework.' Closer to the article's subject, such critical episodes of the
Cold War-fueled U.S.-Soviet competition and cooperation as the launching
of Sputnik (1957), Yuri Gagarin's space flight (1961), the American Moon
landing (1969), and the Apollo-Soyuz project (1975) are not mentioned
either, even though cooperation in this particular area (for instance, the
US/USSR Joint Working Group on Space Biology and Medicine) was an
important element of U.S.-Soviet "biomedical cooperation."5 The only hint
of the changing character of the Cold War itself occurs in  passing
references to the politics of détente of the 1960s and early 1970s, and to
the "rising tensions" between the superpowers and "the plight of Soviet
dissidents" in the second half of the 1970s (59). In fact, the Cold War
itself does not seem to enter Geltzer's analysis, which further distorts
an already blurred picture of U.S.-Soviet relations and the role of
biomedical and health care exchanges in these relations during the period
under study.

The major cause of these distortions is the article's inadequate and
asymmetric (in regard to its two major players) source base. The
'reconstruction' of U.S. "misunderstandings" derives mostly from
confidential reports [which are preserved in the U.S. National Archives
and Records Administration, (NARA)] by various individual American
visitors to the Soviet Union.6 The 'reconstruction' of Soviet
"misunderstandings" is based largely on a 1977 book (devoted in its
entirety to the subject of U.S.-Soviet cooperation in the field of health
care and medicine) published by one of the major Soviet
actors,Venediktov,7 together with a few incidental records of internal
discussions within the Soviet medical and public health establishments.
Leaving aside the profound differences in the nature of the documents used
for gauging U.S. and Soviet positions, the question remains why the author
did not use parallel sources, such as individual reports by Soviet
visitors to the U.S.; the records of internal discussions within the U.S.
medical and public health establishments, the State Department, and the
White House; and published reports by various high-level U.S.
participants.

We are told that "reconstructing the Soviet viewpoint on these exchanges
presents a considerable challenge," because Soviet "records are scattered
throughout many archives in Moscow and beyond"; "the Russian government in
1993 reclassified entire collections of Soviet-era records pertaining to
foreign relations"; "structural division and date usually organize
collections, with no reference to the content of the records"; and "many
Russian archives are not user-friendly" (48-49, ft. 37). Be that as it
may, what remains a mystery is why Geltzer did not use the State Archive
of the Russian Federation (an analogue to NARA, widely known by its
Russian acronym, GARF) that houses an enormous quantity of materials
generated by the Ministry of Health Protection (fond 8009) and by the USSR
Academy of Medical Sciences (fond r9120)8, two main players on the Soviet
side of collaboration. These two collections are not classified and
inaccessible, but, rather, they are very well preserved, organized and
open to the public; the detailed inventories for both collections are
freely available to global researchers in both published and online
forms.9

Indeed, the materials documenting the Ministry's foreign activities from
1934 to 1968 are all collected in a special inventory (opis'  34), while
similar materials for later years are included in two separate inventories
(opis' 50, 1961-82; and opis' 51, 1982-92). Each folder (delo) in this
collection has a title that clearly identifies its contents. To give just
one example: fond 8009, opis' 34, delo 563 is entitled: 'Materials on
scientific cooperation in the field of health protection between the USSR
and the USA (agreements, aide-memoirs of the State Department, briefs,
records of conversations)'; it indicates the precise chronological period
covered: 'February 11-August 11, 1959'; as well as the total volume of
material: '75 pages.' Similarly, on the U.S. side, published 'NIH Annual
Reports of International Activities,' as well as regular reports on
'Technical cooperation in health' issued by the International Cooperation
Administration of the Office of Public Health, are freely available at any
major research library (with some volumes accessible online10), while the
records of internal briefings and discussions at relevant U.S. agencies
can be easily located in NARA. Yet Geltzer apparently consulted none of
these materials, and her article is based on a very limited, highly
selective, and disparate set of primary sources. Geltzer further missed
the opportunity to supplement the available archival and published records
by oral history interviews with some of the key actors of her story who
are still alive (such as Venediktov or the American Donald A. Henderson,
who directed the WHO's smallpox eradication campaign-see below).11

The last, but not least, drawback of the article is its very limited
attention to the broader national and international contexts within which
the U.S.-Soviet "biomedical cooperation" unfolded and which informed and
shaped the activities of its participants. Such critical events as the
U.S. adoption of Medicare and Medicaid in 1965; the 1968 reorganization of
the Department of Health, Education, and Welfare; President Nixon's 1971
'war on cancer'; and the 1972 expansion of Medicare and Medicaid are not
mentioned. Similarly, the radical reorganization of the party-state
apparatus and its functions during the period of 1964-68 that accompanied
the ousting of Soviet Premier Nikita Khrushchev and the ascendance of
Leonid Brezhnev remains outside of Geltzer's analysis. U.S.-Soviet
"biomedical cooperation" is considered in nearly total isolation from the
two sides' extensive bilateral and multilateral international efforts in
the fields of medicine and public health. Although in 'divining' Soviet
"misunderstandings," the article mentions Soviet involvement with WHO
programs, extensive Soviet ties with socialist countries and Soviet health
"propaganda" in developing countries (48), it fails to provide a
symmetrical assessment of the U.S. position on these issues. In fact, the
crowning achievement of the actual US-Soviet cooperation in this
particular area-the worldwide smallpox eradication campaign conducted
under WHO auspices for which the USSR provided the bulk of the vaccine and
the U.S. much of the funding and infrastructural support-is not
mentioned.12 Furthermore, U.S.-Soviet biomedical cooperation was but one
aspect of a much broader spectrum of bilateral cultural, economic,
technical, and scientific relations between the superpowers. However, the
critical question of what place cooperative efforts in medicine and public
health occupied within this spectrum is not raised. Moreover, the article
fails to engage with the large body of secondary literature devoted to the
cultural (including medical and health care) exchanges between the U.S.
and the USSR,13 to the role of medicine and public health in international
relations,14 and to the place of science in U.S. Cold War diplomacy during
the period covered in this study.15

Sadly, the tendency to produce sweeping generalizations based on
inadequate sources is becoming more and more pronounced in recent
historical publications.


Nikolai Krementsov is Professor at the Institute for the History and
Philosophy of Science and Technology, University of Toronto. He is the
author of Stalinist Science (Princeton University Press, 1997); The Cure:
A Story of Cancer and Politics from the Annals of the Cold War (University
of Chicago Press, 2002); International Science between the World Wars: The
Case of Genetics (Routledge, 2005); A Martian Stranded on Earth: Alexander
Bogdanov, Blood Transfusions, and Proletarian Science (University of
Chicago Press, 2011), and of numerous articles on the history of Soviet
biology and medicine.

Anne-Emanuelle Birn is Professor and Canada Research Chair in
International Health at the University of Toronto. She is the author of
Marriage of Convenience: Rockefeller International Health and
Revolutionary Mexico (University of Rochester Press, 2006); Textbook of
International Health: Global Health in a Dynamic World (Oxford University
Press, 2009) with Yogan Pillay and Timothy Holtz; the forthcoming Comrades
in Health: US Health Internationalists, Abroad and at Home (Rutgers
University Press, 2013) co-edited with Theodore Brown, and of numerous
articles on the history and politics of international/global health. Her
current book manuscript examines the history of the international child
health/child rights movement from the perspective of Uruguay, and she is
also co-editing a book on the history of Soviet-Latin American relations
in health and medicine.


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Notes

1 See a published report of this particular mission, J. L. Steinfeld, R.
Q. Marston, P. B. Storey, Medical Care in the U.S.S.R.: Report of the U.S.
Delegation on Health Care Services and Planning (Bethesda, MD: Department
of Health, Education and Welfare, 1972). For a brief published overview of
similar missions prior to this one, see Joseph R Quinn, Anatomy of
East-West cooperation: US-USSR public health exchange program 1958-1967
(Bethesda, MD: John E. Fogarty International Center for Advanced Study in
the Health Sciences, 1969). See also a detailed analysis of these
missions, their goals, and results in a voluminous unpublished
dissertation by the same author, Joseph R. Quinn, "The U. S.-USSR exchange
agreements in public health, 1958-1967; a review of ten years of exchanges
with the Soviet government in the field of public health," Ph.D.
dissertation, Georgetown University, Washington, DC. 1968. For a general
overview of the US-Soviet cooperation in medicine and health up to 1971,
see also Edward A. Raymond, "US-USSR Cooperation in Medicine and Health,"
Russian Review, 1973,32 (3): 229-240.

2 See Susan Gross Solomon, "The Perils of Unconstrained Enthusiasm: John
Kingsbury, Soviet Public Health, and 1930s America," in Anne-Emanuelle
Birn and Theodore M. Brown, eds., Comrades in Health: US Health
Internationalists, Abroad and at Home, (Rutgers University Press,
forthcoming 2013).

3 For instance, the article could have examined the exact role that
Michael B. Shimkin (who is mentioned in the first paragraph and whose
personal field of research was oncology) played in the "American Medical
Mission on Microbiology and Epidemiology" in  February-March 1956; how his
previous experiences of actually being a member of a similar 'mission' in
1944 and of being barred from visiting the Soviet Union with an 'oncology
mission' in 1946-47 influenced his actions and perceptions in 1956; and
how his 1956 visit might have affected the future directions of
"biomedical cooperation."

4 See Bernard Lown, Prescription for Survival: A Doctor's Journey to End
Nuclear Madness (San Francisco: Berrett-Koehler Publishers, 2008).

5 See, for instance, A.E. Nicogossian, The Apollo-Soyuz Test Project
Medical Report (Washington, D.C.: NASA, 1977); U.S.-Soviet Cooperation in
Space (Washington, DC: US Congress. Office of Technology Assessment,
1985).

6 Since these reports form the major source base for the article's
analysis of American "misunderstandings," the reader needs to know much
more about the nature of these particular sources. Were these reports
voluntary or solicited by specific agencies (e.g. U.S. State Department,
Office of Surgeon General, Office of Public Health, scientific
associations, etc.)? Who were the intended audiences? Are these reports
merely (excerpts from) diaries kept during the trip? Or are they
analytical surveys? If the latter, do they follow a certain format? Do
they contain answers to specific questions? What were those questions and
who formulated them? Do these reports differ in any ways from published
accounts of the 'missions'? Do reports by different members of the same
'mission' differ and in what ways? None of these (and many other)
questions that could establish the relevance, reliability, and provenance
of these sources are addressed.  Moreover, references to the archival
holdings identify their authors but not their addressees, which would have
helped to illuminate some of the above questions.

7 See D. D. Venediktov, Sovetsko-amerikanskoe sotrudnichestvo v oblasti
zdravookhraneniya (Moscow: Meditsina, 1977).

8 The article does make some use of a duplicate collection of the USSR
Academy of Medical Sciences materials housed at the archive of the Academy
itself. Although both collections have the same fond number (r9120), their
contents differ; the inventory of the duplicate collection is only
available at the archive itself in a hard copy, and it is not searchable.
The collection kept in GARF is far more accessible and user-friendly.

9 See the archive's website at http://www.statearchive.ru/383 and a
mirror
site at http://www.rusarchives.ru/federal/garf/nsa.shtml.

10 See, for instance,
http://www.archive.org/stream/annualreport1977nati/annualreport1977nati_djvu.txt

11 Although Geltzer mentions in a footnote that she was "able to interview
several of the [Soviet] participants-both rank-and-file researchers and
high-ranking decision-makers" (49, ft. 37), no references to such
interviews appear in the article.

12 See Donald Henderson, "Smallpox eradication-a cold war victory," World
Health Forum 1998, 19(2): 113-119.

13 To offer just a few examples, see: Nish Jamgotch, ed., Sectors of
Mutual Benefit in U. S.: Soviet Relations (Durham: Duke University Press,
1985); Yakov M. Rabkin, Science Between the Superpowers (New York:
Priority Press, 1988); Glenn E. Schweitzer, Techno-Diplomacy. US-Soviet
Confrontations in Science and Technology (New York: Plenum, 1989); Yale
Richmond, U.S.-Soviet Cultural Exchanges, 1958-1986: Who Wins? (Boulder:
Westview Press, 1987); idem, Cultural Exchange & the Cold War: Raising the
Iron Curtain (University Park: Pennsylvania State University Press, 2003).

14 Chris Osakwe, The Participation of the Soviet Union in Universal
International Organization, a Political and Legal Analysis of Soviet
Strategies and Aspirations inside ILO, UNESCO and WHO (Leiden: A. J.
Sijthoff, 1972); Marcos Cueto, Cold War, Deadly Fevers: Malaria
Eradication in Mexico, 1955-1975 (Washington, DC: Woodrow Wilson Center
Press, 2007); idem, " International Health, the Early Cold War and Latin
America," Canadian Bulletin of Medical History, 2008, 25(1): 17-41.

15 For example, Ronald E. Doel, "Scientists as Policymakers, Advisors, and
Intelligence Agents: Linking Diplomatic History with the History of
Science," in Thomas Söderqvist, ed., The Historiography of The History of
Contemporary Science, Technology, and Medicine (London: Harwood Academic
Press, 1997),  33-62; Ronald E. Doel and Kristine C. Harper, "Prometheus
Unleashed: Science as a Diplomatic Weapon in the Lyndon B. Johnson
Administration," in John Krige and Kai-Henrik Barth, eds., Global Power
Knowledge: Science, Technology, and International Affairs. Osiris 21,
2006, 66-85; and Kristine C. Harper and Ronald E. Doel, "Environmental
Diplomacy in the Cold War: Weather Control, the United States, and India
(1966-1967)," in John R. McNeill and Corinna M. Unger, eds., Environmental
Histories of the Cold War (New York: Cambridge University Press, 2010),
115-137.

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