Interrogating the World Bank's role in global health knowledge production, governance, and finance.

BACKGROUND: In the nearly half century since it began lending for population projects, the World Bank has become one of the largest financiers of global health projects and programs, a powerful voice in shaping health agendas in global governance spaces, and a mass producer of evidentiary knowledge for its preferred global health interventions. How can social scientists interrogate the role of the World Bank in shaping 'global health' in the current era? MAIN BODY: As a group of historians, social scientists, and public health officials with experience studying the effects of the institution's investment in health, we identify three challenges to this research. First, a future research agenda requires recognizing that the Bank is not a monolith, but rather has distinct inter-organizational groups that have shaped investment and discourse in complicated, and sometimes contradictory, ways. Second, we must consider how its influence on health policy and investment has changed significantly over time. Third, we must analyze its modes of engagement with other institutions within the global health landscape, and with the private sector. The unique relationships between Bank entities and countries that shape health policy, and the Bank's position as a center of research, permit it to have a formative influence on health economics as applied to international development. Addressing these challenges, we propose a future research agenda for the Bank's influence on global health through three overlapping objects of and domains for study: knowledge-based (shaping health policy knowledge), governance-based (shaping health governance), and finance-based (shaping health financing). We provide a review of case studies in each of these categories to inform this research agenda. CONCLUSIONS: As the COVID-19 pandemic continues to rage, and as state and non-state actors work to build more inclusive and robust health systems around the world, it is more important than ever to consider how to best document and analyze the impacts of Bank's financial and technical investments in the Global South.

Marketing Masked Depression: Physicians, Pharmaceutical Firms, and the Redefinition of Mood Disorders in the 1960s and 1970s.

This article investigates the redefinition of depression that took place in the early 1970s. Well before the introduction of the third edition of the Diagnostic and Statistical Manual of Mental Disorders, this rather rare and severe psychiatric disorder hitherto treated in asylums was transformed into a widespread mild mood disorder to be handled by general practitioners. Basing itself on the archives of the Swiss firm Ciba-Geigy, the article investigates the role of the pharmaceutical industry in organizing this shift, with particular attention paid to research and scientific marketing. By analyzing the interplay between the firm, elite psychiatrists specializing in the study of depression, and general practitioners, the article argues that the collective construction of the market for first-generation antidepressants triggered two realignments: first, it bracketed etiological issues with multiple classifications in favor of a unified symptom-oriented approach to diagnosis and treatment; second, it radically weakened the differentiation between antidepressants, neuroleptics, and tranquilizers. The specific construction of masked depression shows how, in the German-speaking context, issues of ambulatory care such as recognition, classification, and treatment of atypical or mild forms of depression were reshaped to meet commercial as well as professional needs.

The local roots of 'health for all': Primary health care in practices, 1950s-2000s.

We look at Universal Health Coverage (UHC) through a historical investigation of the "health for all by 2000" policy adopted by the WHO in 1978. Within contemporary debates on access to care, Alma Ata is usually considered as a brief moment of well-intentioned utopia, which buckled to global health's agenda of performance metrics and targeted diseases. Such visions of primary health care (PHC) are shared references in the debates about UHC. Aiming at a less geopolitical and more local approach of the strategy's roots than the existing historiography, the paper draws from historical and ethnographic work on health policies and practices in Tanzania, Oman and Kerala (India), in which PHC was not only envisioned, but constructed as the backbone of local health systems, often prior to Alma Ata. All three states were praised for their PHC achievements. Studying them allows for emphasizing the importance of national trajectories in PHC, as well as revealing shared core issues such as the importance of access and affordability, of the focus on rural centers and the mass training of non-medical personnel, and of the articulation of vertical programs and horizontal system building. It also reveals very different trajectories in terms of duration, priorities, outcomes and international visibility.

New wine in old bottles? The biotechnology problem in the history of molecular biology.

This paper examines the "biotechnology problem" in the history of molecular biology, namely the alleged reinvention of a basic academic discipline looking for the logic of life, into a typical technoscientific enterprise, closely related to agriculture, medicine, and the construction of markets. The dominant STS model sees the roots of this shift in a radical change of the regime of knowledge production. The paper argues that this scheme needs to be historicized to take into account the past in our biotech present. Looking at the development of breast cancer genetic testing and GMOs as examples of mounting issues of intellectual property, risk and regulation, the paper also argues that historians of biology should pay closer attention to the political, the economical and the legal changes of the last thirty years. Solving the biotech problem requires new categories. The notion of "way of regulating" is given as an example of such notions linking the local and the global.

Hormone replacement therapy, cancer, controversies, and women's health: historical, epidemiological, biological, clinical, and advocacy perspectives.

Routine acceptance of use of hormone replacement therapy (HRT) was shattered in 2002 when results of the largest HRT randomised clinical trial, the women's health initiative, indicated that long term use of oestrogen plus progestin HRT not only was associated with increased risk of cancer but, contrary to expectations, did not decrease, and may have increased, risk of cardiovascular disease. In June 2004 a group of historians, epidemiologists, biologists, clinicians, and women's health advocates met to discuss the scientific and social context of and response to these findings. It was found that understanding the evolving and contending knowledge on hormones and health requires: (1) considering its societal context, including the impact of the pharmaceutical industry, the biomedical emphasis on individualised risk and preventive medicine, and the gendering of hormones; and (2) asking why, for four decades, since the mid-1960s, were millions of women prescribed powerful pharmacological agents already demonstrated, three decades earlier, to be carcinogenic? Answering this question requires engaging with core issues of accountability, complexity, fear of mortality, and the conduct of socially responsible science.

Better prepared than synthesized: Adolf Butenandt, Schering Ag and the transformation of sex steroids into drugs (1930-1946).

This paper follows the trajectory of sex steroids in 1930s Germany as a way to investigate the system of research which characterized the development of these drugs. Analyzing the changing relationship between the pharmaceutical company Schering and the Kaiser Wilhelm Institute für Biochemie headed by Nobel Prize winner Adolf Butenandt, the paper highlights the circulation of materials, information and money as much as the role of patents in shaping the study of sex steroids. Semi-synthetic analogs and metabolic pathways thus emerged as shared bio-industrial assets. This collaborative work participated in a more general 'internalization' of biology, which took place in pharmaceutical firms during the 1920s and 1930s as a strategy to standardize and develop biologicals. The construction of the hormone market was also based on Schering's collaboration with a selected group of clinicians who worked out the wide-range of indications associated with these 'natural' drugs. The paper finally shows how the wartime scientific and industrial mobilization in Nazi Germany marginalized the study of sex steroids and led to the dismantling of the KWIB-Schering network.

Molding national research systems: the introduction of penicillin to Germany and France.

In our historical imagination, penicillin plays the role of the good sister of the atomic bomb. It epitomizes the success of the U.S. scientific mobilization and the emergence of modem biomedicine. This chapter discusses the fate of penicillin in France and Germany, comparing the reactions of the two countries to the antibiotic challenge under restricted conditions. The comparison centers on the scientific and industrial practices that created penicillin. It also sheds light on the professional styles, forms of expertise, and political resources that helped shape the meanings and uses of the antibiotic. The French section recounts how the Pasteur Institute and the military administration organized penicillin research and production during 1945-1947. The alliance between the two has roots in the highly peculiar political and social climate of the liberation and in the biotechnological tradition of the Pasteur Institute. The German section focuses on the Kaiser Wilhelm Institute for Biochemistry. The study of the institute, which worked closely with a pharmaceutical company, features the interplay between academic chemists and industry, while providing insights into the research organization under National Socialism.

Changing the scale: slides and electron microscopy at the Virus Laboratory of the Pasteur Institute.

Slides are material objects, the daily existence of which cannot be diassociated from the practice of microscopy. But what happens to slides when the examination tool is no longer an optical apparatus but an electon microscope? This is the core issue this paper examines. The answer it proposes is that electron microscope slides are not slides in the classical sense of the word but complex arrangements of materials including plates, cards, photographs and notebooks, which constitute an imaginary "slide," an assemblage the status and existence of which is defined in reference to the heritage of optical microscopy. To illustrate this argument, the paper follows the experimental work of Odile Croissant, the first electron microscopist at the Pasteur Institute in Paris during the 1940s and 1950s when the practices of the new microscopy were introduced and calibrated.

Exoteric knowledge and esoteric knowledge. Ludwik Fleck, pedigrees and the visualization of pathological heredity.

In Genesis and Development of a Scientific Fact, Ludwik Fleck uses the concept of an "ideogram" to designate the representation of a thought style through an image, which condenses its features in graphic properties. Pedigrees are such ideograms used by scientists and health professionals on the one hand, patients and lay persons on the other hand. Building on Fleck's analysis of the relationships between esoteric circles and exoteric circles, this paper traces the transformation and uses of pedigrees in 20th century medicine. It suggests that pedigrees in eugenics, clinical medicine, human genetics, and molecular genetics have presented distinct and relatively stable characteristics, reflecting the changing boundaries and roles of esoteric and exoteric knowledge.

Normal pathways: controlling isotopes and building biomedical research in postwar France.

During the late 1940s and 1950s, radioisotopes became important resources for biological and medical research. This article explores the strategies used by French researchers to get access to this material, either from the local Atomic Energy Commission (CEA) or from suppliers in the United States or United Kingdom. It focuses on two aspects of this process: the transatlantic circulation of both isotopes and associated instrumentation; the regulation of use and access by the administrative bodies governing research in France. Analyzing the investigations conducted within laboratories associated either with the atomic energy agency or with the local National Institute of Health (INH), the paper discusses the part played by the new tools in the postwar transformation of biomedical research. It contrasts the INH successful development of biological studies and metabolic tracing with the mixed results of CEA in advancing cancer radiotherapy, thus highlighting locally defined "normal paths" to radiobiology.