Standardization in public sphere

“At the turn of the twentieth century, public health expanded to include endemic diseases like tuberculosis (refs) and sexual transmitted diseases (refs). Large programs were created to prevent and treat these diseases, and each issued administrative imperatives for more standardized practices of classification, prevention, diagnosis, and, increasingly as we shall see, treatment. . . During this [interwar] period, the public domain of medicine also reached into therapeutics. With the development of effective therapies like Salvarsan for syphilis and radium therapy for cancer, public health programs now frequently included a therapeutic component. . . . Like the programs to prevent TB, cancer-care programs deployed new technologies that were complex and sometimes dangerous, notably the use of x-rays and radium, and that required guidelines and protocols for their safe and effective use (refs) (Weisz et al., 697, 698). . . . In 1931, American College Surgeons published two sets of guidelines, one for organizing cancer services in hospitals, the other a manual of fracture care. In 1938, American Academy of Pediatrics produced practice guidelines for immunizations of children: “A number of features characterized these early international and American efforts at guideline and protocol development. First, a variety of groups were involved: public health agencies at various levels, state and national governments, private associations devoted to specific diseases, and medical societies of all sorts . . . Second, although creating guidelines for practice occasionally was possible, the result frequently was the standardization of categories, measurements, and instruments to produce reliable knowledge. Third, the attempt and failure to produce effective procedural guidelines sometimes led to the standardization of design and terminology” (702). . . . The pressure for guidelines thus has many sources: the recognition of and unhappiness with the variability of competence based on training and credentials; the need for protocols for the proper functioning of new research techniques and complex therapeutic technologies and procedures; and the demands for public accountability and standardized organizational procedures generated by the inclusion of more and more health care practices under the jurisdiction of large-scale public organizations” (715-716).