Podcast Summary: New Books Network

Episode: Vanessa Rampton, "Making Medical Progress: History of a Contested Idea" (Cambridge UP, 2025)
Aired: February 15, 2026
Host: Dr. Miranda Melcher
Guest: Dr. Vanessa Rampton

Overview

In this episode, Dr. Miranda Melcher interviews Dr. Vanessa Rampton about her book Making Medical Progress: History of a Contested Idea. The discussion explores the origins, transformations, and continuing debates around the concept of “medical progress.” Rampton traces how the idea has evolved from ancient times through the Enlightenment, World War II, and up to the present day, emphasizing its deep entanglement with philosophical, technological, ethical, and social dimensions. The conversation also addresses whose interests are served by “progress,” patient empowerment, and justice, as well as how history can help critically unpack contemporary claims about breakthrough medical advancements.

Key Discussion Points & Insights

1. Intellectual and Practical Origins of the Project

[02:43–05:09]

• Rampton’s Background: Vanessa Rampton outlines her philosophical interest in concepts like freedom, justice, and especially “progress.” She was struck by how medicine is often held up as the quintessential example of progress in history, compared to other more contested domains (e.g., politics).
  • “Medicine may be the one field where we can talk about progress.”
• Academic Trajectory: The project began with a fellowship allowing her to take a new direction, applying her interest in progress to the medical field.

2. The Historical Emergence of “Medical Progress”

[05:19–09:19]

• Ancient to Enlightenment Contexts: Before the Enlightenment, people didn’t conceptualize “medical progress” as we do; terms like “improvement” were present but did not connote the modern sense of progress.
  • “Medicine has never been...something that's unified, that's had a consistent mandate over time, or any stable standard for which we can measure progress.” — Rampton [05:42]
• Role of Religion: In medieval Christianity, health was subordinate to eternal life—limiting the focus on medical improvement.
• Enlightenment Shift: The 18th century’s confidence in human potential and breaking with religious constraints fostered a vision of potentially limitless medical progress, despite mismatch with actual technological achievements at the time.

3. The Technological Breakthroughs and World War II

[09:19–12:24]

• Impact of the War: WWII and the nuclear era marked a major rupture: technological miracles (atomic power, vaccines, organ transplants) colored expectations of medical progress.
  • “If there's a technological breakthrough, it tends to be associated with very high hopes for medical progress.” — Rampton [10:01]
• Political & Military Drivers: Investment in scientific medicine paralleled Cold War aims—keeping citizens healthy was as much about political stability as public health.

4. Moral Responsibility and the Rise of Bioethics

[12:24–16:13]

• New Ethical Questions: As breakthroughs accumulated (e.g., open heart surgery, antibiotics), so too did concerns about the consequences and responsibilities of medical innovation.
  • “There was a new awareness...on behalf of physicists of the moral weight of their innovations...It was somewhat later that biologists started to talk about their innovations as potentially having the same moral weight and potential for harm.” — Rampton [12:24]
• Shift from Paternalism: The 1960s and 70s saw a move from treating patients as passive recipients to viewing them as active agents. Paul Ramsey’s The Patient as Person (1970) signaled this change.
  • “Not just about better techniques applied in a paternalistic manner...the patient should have a say about what happens to them in care.” — Rampton [16:40]

5. The Entanglement with Social Justice

[18:26–22:26]

• Beyond the Individual: Ideas of medical progress interacted with social movements—medicine as a tool for broader social change, e.g., addressing health disparities due to capitalism or class.
• Universal Health & Persistent Inequities: Even as universal health care spread in some countries, outcomes remained unequal, prompting questions about who truly benefits from progress.
  • “Our medical techniques are improving...Universal health care was...becoming available...But health outcomes remained different across social groups.” — Rampton [19:08]
• Social Determinants of Health: “Medical progress” became linked to addressing systemic factors like education, work, and living conditions, not just medical technologies.

6. Ongoing Tensions and Debates

[22:26–24:32]

• What Gets Prioritized: Should resources go to expensive cutting-edge therapies or wider-reaching preventative measures?
  • “There can be tensions between expensive medical treatment for a single patient and medicine that aspires to provide health to the largest number of patients possible.” — Rampton [22:50]
• Persistent Debate: These trade-offs and disagreements about “what kind of medical progress we want” remain unresolved.

7. Visions for the Future

[24:42–27:03]

• Sustainability & Environment: Rampton suggests that future visions could revisit ancient ideas of harmony between individual and environment—medical progress as “sustainability.”
  • “A healthy individual depends on...harmony with a healthy environment...not a very prominent idea, but one I'd be hopeful about going forward.” — Rampton [24:42]
• Current Emphases: Despite the potential, “medical progress” remains heavily associated with high-tech frontiers (AI, genomics), often at the expense of social factors.
  • “If you ask any AI-driven large language model what is medical progress, something like equitable health access is not going to be on the list...” — Rampton [24:42]
• History as a Guide: History shows that “there are always many possible futures at any one historical moment.”

8. Personal Reactions to Writing the Book

[27:03–29:08]

• Strong Opinions: Rampton was struck by how deeply people personally identify with or resist critiques of “medical progress,” often sharing their own survival stories as evidence for its value.
  • “People have very strong opinions...if I talked about a critical view of medical progress, people would take me aside to say, ‘But I wouldn't be here without it!’” — Rampton [27:25]
• Soft Critique: Her approach is not to deny technological gains but to contextualize and complicate the one-sided narrative.

9. Final Reflections & Takeaways

[29:08–31:37]

• Critical Tools: The book aims to help readers think about which dimensions of health are emphasized (physical, psychological, social, environmental) in any given claim about “progress.”
  • “Even as we're all broadly in favor of medical progress, we just have to think carefully about the claims any one person is making...often...only talking about one particular dimension of health.” — Rampton [29:08]
• Power Dynamics: Readers are encouraged to consider whose interests are served—and which aspects are ignored—when “medical progress” is invoked.

10. Rampton’s Next Project

[31:49–33:45]

• Assisted Dying & End of Life: Currently, Rampton studies assisted dying, exploring how cultural representations (films, books) shape beliefs and practices, and how notions of “progress” appear in the context of death and dying.

Notable Quotes & Memorable Moments

• “Medicine may be the one field where we can talk about progress.” — Rampton [02:55]
• “Medical progress...never been something that's unified, that's had a consistent mandate...or any stable standard.” — Rampton [05:42]
• “This idea of really a breakthrough technology, a nuclear era...fed into ideas about medical progress.” — Rampton [10:01]
• “There was a new awareness...biomedical research started to talk about [their] technologies as potentially having the same moral weight and also the same potential for harm.” — Rampton [12:24]
• “The patient as an autonomous agent...this was associated with the rise of bioethics.” — Rampton [16:40]
• “Universal health care was...becoming available, but health outcomes remained different across...groups.” — Rampton [19:08]
• “These tensions...persist and...don't really get resolved.” — Rampton [22:50]
• “I close the book by talking about a vision of medical progress as sustainability.” — Rampton [24:42]
• “History shows that there are...always many possible futures at any one historical moment.” — Rampton [24:42]
• “People were often interested and kind of compelled to share their stories...how I was interested in bringing a critical or reflective view to medical progress.” — Rampton [27:25]
• “Any kind of narrow concept...if it's an intervention that's powerful on the biophysical aspect...what about these other dimensions?” — Rampton [29:08]

Timestamps for Key Segments

• Introduction to the Book & Project Origins — [01:31–05:18]
• Historical Foundations of “Medical Progress” — [05:19–09:19]
• Technological Shifts and WWII — [09:19–12:24]
• Rise of Bioethics and Patient Empowerment — [16:20–18:26]
• Medical Progress and Social Justice — [18:26–22:26]
• Contemporary Debates and Future Directions — [24:32–27:03]
• Personal Reflections and Project’s Reception — [27:03–29:08]
• Key Critiques and Reader Takeaways — [29:08–31:37]
• Rampton’s Current Work and Closing — [31:49–34:01]

Conclusion

This thoughtful conversation provides a nuanced overview of how “medical progress” has always been a fraught, contested idea, shaped by shifting knowledge, ethics, technologies, and social movements. Dr. Rampton encourages historical and critical attention to the different dimensions and interests at play whenever “progress” is invoked—reminding us that the future of medicine is open, shaped by the choices and values we bring to it.