Provided by Institute of Education EPrints
Sociology of Health & Illness, 20090, 31, 7:1111-1112, Book review by Priscilla Alderson
Mesman, J. Uncertainty in Medical Innovation: experienced pioneers in neonatal care.
Basingstoke: Palgrave Macmillan, 2008 £ 50 (hbk) xi + 219pp. ISBN 9-78-0-230-21672-3
Part of the Health, Technology and Society series, this book aims to analyse actual processes of
managing uncertainty in neonatal intensive care. Examples are drawn from four months of research
in a Dutch neonatal unit and time in a North American (USA) unit. The seven chapters explore the
dynamic of change, the working relationships between the adults, numbers-centred modern
intensive care, and ‘moral’ decision-making, using the examples of a few babies with uncertain
prognoses. The final chapter, rather ominously called ‘The end of the journey’, reviews the book’s
contribution to report ‘fine-grained’ research, and to ‘provide insights into both the reshaping of
societal responses to health innovations.. .and to open up the interface between diagnosis and
prognosis, between men [sic] and machine and between medical facts and moral concerns, and to
examine these interlinked yet discrete processes’ (p180). The book includes many meticulous
detailed reports of medical and nursing knowledge and protocols, complex clinical and social
procedures, and intricate micro-records of babies’ fluctuating health status. The author argues that
technological advances are reshaping the ethics of health care, and that morality is situated.
‘Innovation’ is quite an elastic concept. The fieldwork data were collected in the 1990s. Mesman’s
research theories, methods and findings owe much to USA ethnographies of intensive care from the
1990s and 1980s by Anspach, Frohock and Zussman. Over four decades in my neonatal experiences
and ethnographic research, and work with groups devising medical ethics guidelines, I have found
that, although some clinical knowledge and skills change, similar intractable questions arose in the
1970s.
Some parts of the book could be clearer. The two neonatal units are barely distinguished, although
the USA tends to be the most pro-neonatal-treatment country in the world, whereas the Netherlands
is famed for its caution. One Dutch unit recently raised the lower limit for treatment from 24 up to
25 weeks gestation, whereas one British unit treats a few babies born at 22 weeks. I have long
wondered about this great policy difference, and the book partly explains it. Perhaps premature
babies fare better in US and UK units, where decisions to give or withhold treatment must involve
far more neurological and cardiological expertise than appears to be routine in Dutch units.
Mesman’s detailed debates avoid major questions. For example, how does state or insurance
funding for neonatal care affect parents’ decisions - and stress? What should be done with babies
aged under 24 or 25 weeks who manage to survive for some hours, so that treatment begins, but
then it is found that delay has incurred serious morbidity likely to have been prevented by