Transformed States: Medicine, Biotechnology, and American Culture, 1990–2020. By M.Halliwell, New Jersey: Rutgers University Press, 2025. 380 pp. $99.85 (hardcover) ISBN: 978‐1‐97881787‐6

Halliwell's monograph weaves a narrative history of US politics and biotechnology together with analysis of numerous examples of film and literature to produce a rich history of the sociopolitical context of biotechnology in the US between 1990 and 2020. Halliwell draws particular attention to the mental health implications of biotechnology and examines how it has been a sometimes neglected and misunderstood topic in politics and culture across this period. He charts the reciprocal influences between politics and public imaginaries to understand how biotechnology is understood and supported or contested. Halliwell's core research question asks how the fragility of American health can be reconciled with the acceleration of biotechnological innovation in light of optimistic political rhetoric around the potential for biotechnology to radically transform American life. Eight substantive chapters provide worked examples of the clash between rhetoric and reality, split into four parts: Genetic States, which centres on the promise and pitfalls of genetic biotechnologies; Conscious States, which focuses on consciousness, neurobiology and human and artificial intelligence; Dynamic States, which explores the role of biotechnology in extending longevity and affirming gender identities; and Perilous states, which examines how biotechnology can be both a problem and a solution in the context of the large-scale crises of COVID-19 and the climate crisis. These chapters bring together critical reflections on science and politics with an extended exploration of how biotechnology exists in prevailing imaginaries through several deep dives into popular films and literary texts. The methodology is implicit, rooted in Halliwell's critical reading of relevant texts and films and review of key political events and turning points in biotechnology. I found the chapter on gender affirming care to be particularly strong. It centres the needs and experiences of transgender people without treating trans experiences as monolithic, and frames arguments for and against biomedicine around the extent to which it meets the needs of trans people. Moreover, it rightly highlights problems in media representations (e.g., casting cishet women as trans women, relying on the ‘transition as a journey to a destination’ trope) without moralising. The wide array of ideas Halliwell engages with is notable, and this wide view provides the reader with a broad understanding of the landscape of human experience in which biotechnology is implicated. At times, however, extraneous details about individual thinkers (such as multiple individuals' names, dates and titles of their work and names of their institutions/programmes in the same paragraph) distracts from the ideas themselves, ultimately obscuring the takeaway messages. Additionally, some core concepts (e.g., somatic ethics) which reappear throughout the book are underdeveloped, potentially leaving readers who have not engaged with the texts Halliwell draws on to wonder about the relevance or boundaries of these ideas. The book has clear relevance to the concept of the medicalisation of society, particularly as articulated by Conrad (2007), though Halliwell's exploration of how biotechnology shapes our understanding of what it means to be human never engages directly with Conrad's work. Of particular relevance is how the medical aims of treatment, enhancement and enrichment can serve to normalise, repair, or provide a performance edge, with implications for how we perceive possibilities for the human body. Similarly, Halliwell's repeated critiques of politicians and biotechnology industrialists for their inattention, both rhetorically and in practice, to intersectional inequities along lines of structural marginalisation (e.g., race, class and gender) are well-received. His arguments would be bolstered by engagement with Steven Epstein’s Inclusion (2008), which nuances discussions of the harms of exclusion in medical research by highlighting how inclusion can also be predatory and harmful. Epstein reminds us that it is not enough to identify who has been left out; the how of inclusion is tremendously important for determining whether inclusion is harmful or beneficial. Halliwell brings social scientists, such as Foucault and Harraway, into conversation with philosophers (e.g., Heidegger), historians (e.g., Mbembe) and biomedical scientists (e.g., Watson) to great effect. The breadth of topics explored is simultaneously a strength and weakness of the book: Although the diverse array of topics means there is something for everyone, some knowledge which cuts across multiple disciplines (biomedicine, public health, sociology, philosophy, media and cultural studies, etc.) is assumed of readers. For experts in these areas, the book will no doubt be a useful resource, but subject novices may find the book challenging in spots. Overall, Halliwell provides an impressively nuanced, balanced account of a rapidly changing landscape of biotechnology, politics and American culture. By systematically presenting the rhetorical poles of technophobia and technophilia within politics and industry and exploring how associated hopes and fears are represented in fiction, Halliwell charts a hopeful middle-ground which elucidates shifting understandings what it means to be human and how biotechnology is implicated in this shift. Data sharing not applicable to this article as no datasets were generated or analysed during the current study.