Historians familiar with nineteenth-century medical thought will likely have been struck by the proliferation of claims, over the past two decades or so, that we are on the threshold of a new era of ‘personalized medicine’. Nineteenth-century doctors generally held that their job was to understand and treat their patients, not as cases of particular diseases, but as individuals, each with their own peculiar history and illness. Over the century to about 1950, however, this perspective was overwritten and marginalized by more universalistic forms of knowledge which privileged aetiologically defined disease categories and standardized treatments over an appreciation of personal idiosyncrasy. So does the current language of personalized medicine represent a revival of an older, more individuated approach to healthcare? This is the question that Richard Tutton sets out to answer in Genomics and the Reimagining of Personalized Medicine.

Tutton's answer is unlikely to surprise anyone who pays attention to contemporary medicine. Even those who once most loudly trumpeted the coming of personalization are increasingly turning to other adjectives to describe the changes under way: ‘stratified’ or ‘precision’ medicine are now the preferred terms of art, at least on this side of the Atlantic. Tutton adds depth to this perception. Recent developments are less about ‘personalization’, he argues, than about ‘mass customization’: the differentiation of consumers into sub-populations for targeted promotion of drugs and other medical commodities. Tutton's book seeks to explain how medicine came to be reconfigured in this way. In so doing, it adds significantly to our understanding of the post-war development of biomedicine.

Particularly valuable is Tutton's account of how the pharmaceutical industry has dealt, since the 1950s, with the variability of individual drug response. While ideas of ‘pharmacological individuality’ gained only limited purchase in the immediate post-war years, when mass marketing of medicines was driving the rapid expansion of the industry, by the 1990s a combination of new genomic testing technologies, new regulatory ambitions on the part of bodies such as the US Food and Drug Administration, and new market affordances made biological stratification of patient populations a more commercially practicable prospect. Tutton fleshes out this story with a wealth of empirical material that complements existing scholarship on the evolution of the pharmaceutical industry in the latter half of the twentieth century and the beginnings of the twenty-first.

Likewise, Tutton provides a useful overview of the development of genomic tests to predict medical risk, including the chequered rise of direct-to-consumer testing companies such as 23andMe. In contrast to pharmacogenomics, however, moves to implement personalized risk prediction have been much more strongly contested from within as well as without biomedicine. Tutton documents these developments, too, in considerable empirical detail. Indeed, the book as a whole is based on a very substantial body of research, for which historians of contemporary medicine will have good reason to be thankful.

If there is a shortcoming to this book, it is the difficulty of extracting a clear overarching narrative from the sheer richness of detail and event. Whereas the story of healthcare in the period to 1950 can arguably be told as one of increasing systematization and standardization, the years since have been marked by fragmentation and an explosion of competing factions and sectors, posing a challenge for any narrator. In addition, Tutton also seeks to link late twentieth-century developments to the rise and decline of what, following the social scientist Catherine Waldby, he calls the personalized-medicine ‘imaginary’ – a set of cultural visions, expectations and aspirations that frame and drive biomedical innovation. But as Tutton points out, this imaginary too is contested and contradictory, as well as at odds with much of what has actually transpired. Rather than providing an overall shape to the narrative, his discussion of the personalized-medicine imaginary only complicates it further.

Consequently, for this reviewer at least, Genomics and the Reimagining of Personalized Medicine is rather more useful for its constituent parts than for any single message it delivers. But that should not detract from its considerable virtues. The book is crammed with information and insight which will greatly enrich any attempt to make sense of how medicine has developed over the past sixty-five years, and it should be essential reading for anyone working in that area.