This conference took place in Manchester over a long weekend in July - and its success could be measured 'on the ground' by the numbers of delegates foregoing the blazing sunshine to attend a packed programme. The event was impressive for the range and sheer number of papers - about 80 altogether. The organisers, Carsten Timmermann and Julie Anderson said at the beginning that they had hoped above all to avoid the conference being simply 'old friends talking to themselves' and they certainly achieved an impressive mix. From the perspective of someone attending it was clear that new connections and debates were springing up throughout the weekend, just as old ones were revisited and reinvigorated. Contributions came from anthropologists, political scientists, sociologists and health professionals as well as historians of science, technology and medicine and spanned a period from the sixteenth century to the present. Papers were organised thematically into parallel streams and perhaps the most difficult aspect was deciding which to attend.

As well as bringing the richness of new ideas, the range of disciplines kept everyone on their toes. Some of the most interesting discussions were sparked by input from speakers with a medical background that forced everyone present to reflect upon their own discipline and personal assumptions about evidence, epistemology and knowledge. The nature of evidence was not only debated between disciplines, but also used to map developments in our subject, the history of medicine. Many papers returned to questions about the types of evidence used and tensions in the practice of medicine between scientific, clinical and experiential accounts in interesting sessions on risk, cultures of biomedicine and medical science, trials and evidence.

In the first plenary, 'How might the histories of medicine and of technology learn more from each other?' John Pickstone discussed the case of orthopaedics and offered some notes of caution. It was important for historians of medicine to recognise that medical academe was not necessarily the same as clinical practice. This hope was fulfilled by many papers across the conference which attempted to get beyond high profile debates between politicians, clinicians and scientists to capture the myriad differences in medical practice at local level.

Pickstone also stressed the need to adequately deal with industrial intervention. 'Most medicine is in some sense a commercial activity,' he stated. In the case of orthopaedics, he argued that past medical technologies had often been the result of a contingent coming together of individuals and groups with diverse expertise. However, we must also develop ways of capturing the development of medical technologies in organisations and institutions where there was much less contingency - such as modern pharmaceutical companies. He suggested that we could learn from business history to address the 'techne' of profit and the place of technology and scientific goods in economic systems. One example of this on the first day was a paper examining the artificial arms manufactured First World War Germany to 'recycle' the male wounded into the labour force. This brilliantly illustrated presentation by Heather Perry was a timely reminder of the importance of a wider social, political and economic context to the medical history that we were examining.

In her keynote speech on the second afternoon, 'For Want of a Horse the Kingdom was Lost,' Ruth Schwartz Cowan also discussed the dangers of losing a meaningful history (the Kingdom) for lack of the material (Horse). She suggested that we must still work to explain and address the 'technophobia' that she identified in much recent historical writing. The example of histories of birth control illustrated very nicely the perils of ignoring the 'technologies' themselves, and their cost, availability or use, in the search for diverse political and moral accounts. She also offered the example of her recent work on thalassaemia in Cyprus, arguing that the decision to have mandatory genetic testing could only be understood if one paid proper attention to the nature of the disease itself and the (emotional and economic) cost of the treatments that had been developed.

Schwartz Cowan found the source of technophobia not only in personal fear or lack of skills in dealing with technical accounts, but also in the recent development of 'history' as a discipline, the generations of young scholars who 'angrily pummelled' the privileged accounts of medicine, patriarchy and science. Further discussion picked up on this to mention the specific experiences of the Vietnam War and of the anti-nuclear movement, which also had emerged as an important issue in a paper on the public perceptions of risks of xeno-transplantation by Amy Fletcher and Bronwen Morrell. Stuart Blume suggested that we might also consider why historians and sociologists had suffered from 'sociophilia,' which encouraged further reflection on our own practice.

Clearly however, Schwartz Cowan was talking to the converted in many ways, as papers repeatedly engaged with the design, development, diffusion and use of individual technologies. The conference worked well to put 'material' objects into the picture - and particular devices were frequently used to organise the stories that were being told. These devices ranged from different drugs such as penicillin or L-dopa, surgical techniques and medical appliances, such as the artificial heart or hip replacements to statistical methods. However, in making sense of these technologies the presenters repeatedly had to return also to the individual biographies of inventers, innovators and clinicians, as well as issues of professional development and prestige. An interesting session on the second day covered issues of trials and evidence in medicine. Sejal Patel suggested that the spread of evidence based medicine should be linked to the need for internal medicine specialists to establish a clinical and research identity, while Gerald Kutcher argued that despite attempts to create robust breast cancer trials and consensus statements on the best treatment, clinical treatment remained uneven in practice, and local decisions did not map easily onto national debates. Iain Chalmers' paper on systematic review in medical research sparked a lively debate, which drew on the other presentations to consider the nature of scientific practice and evidence, as well as the reasons that medics or scientists publish.

There was comparatively little explicit theorising in the conference - although the broad selection of 'stories' told offered some fascinating pointers to developing broader questions and themes. In particular, the international spread of the papers was impressive - covering the UK, Germany, the former Soviet Union, the US, Canada and South American countries among others. These papers often hinted at sets of contrasts and comparisons between national experiences. In his final paper, The Politics of End Points, Stuart Blume called for this kind of 'difference' to be explored and used as a basis for local stories about science and medicine. He used the example of the varied political responses to cochlear implant technology to argue that national context was crucial to our understanding. Telling these stories gave positive examples for histories of the 'sciences of the particular' and for sociologies which were able to critique aspects of globalisation.

Blume introduced two theoretical themes - 'jurisdiction' and 'empirical slippery slope'. With the first, he offered a way to draw together the historical examples of the contestation of evidence and the importance of professional and political dynamics in explaining the development and acceptance of new medical technologies. The second concept pointed conversely to the way in which a technology once developed might spread despite attempts to regulate or restrict its use. He suggested that 'evidence is almost always interpreted in such a way as to preserve the status quo' and that ideas about institutional convergence, path dependency or 'lock-in' were important in explaining the process of accepting a technology. In the ensuing discussion, an important point was also raised by John Pickstone and Iain Chalmers, stressing the importance of the drug industry in 'universalising' medical practice and driving innovation - this had been relatively little explored in the papers offered to the conference. Perhaps while historians of medicine have endeavoured to combat technophobia, helped by events like this, there is still some way to go before they pay enough attention to the economics.

The conference ended with further reflexive debate on what medical history might try to offer. Francis Neary raised an interesting question about the extent to which medical historians might take a position on their subjects - could he decide which artificial hip to have, if he needed it? John Pickstone argued that historians could speak to policy by telling stories about contingency and process and by building models to give a historical context to developments such as Evidence Based Medicine. Ruth Schwartz Cowan gave a plea for further thinking about the historical method. The fact that the conference worked, she said, showed that it was possible to tell stories about the local which were recognised as valid because they used qualitative and/or quantitative evidence systematically and rationally. Despite a clear lack of agreement on these points, the conference could I think unite around a quote by the theorist Jacques Ellul that Schwartz Cowan included in her lecture, that 'technologies are neither good, nor bad, nor neutral' and that social contexts matter in explaining them.

The conference was generously sponsored by the Economic and Social Research Council and the Wellcome Trust in addition to the Society for the Social History of Medicine. Special thanks must go to everyone in the Manchester CHSTM (Centre for the History of Science, Technology and Medicine) for all their hard work and particularly to Carsten Timmermann and Julie Anderson for fine organisation, energy and enthusiasm, even when faced with the recalcitrance of Power Point yet again. The effort was worth it when we were treated to presentations and images that helped bring the 'devices' to life. The social side should also get a mention - I am told the Indian meal on the first night was good and the pub crawl on the Saturday was a masterpiece of organisation. The numerous coffee breaks and great food also helped get people talking in what turned out to be a particularly friendly and open conference.