Chapter 11 Outline The Rise (and Fall?

) of the Medical Profession

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Doctors have a great amount of social power, political power, and prestige for a variety of reasons: Doctors offer a universally valued producthealth and longevity; there is a limited number of doctors due to the extensive education and training required to become a doctor and the strict regulation of the profession; doctors are very concerned with their standing among their peers; people trust doctors with very personal information and expect individualized treatment; and doctors use specific props and scripts to assert their power.

Doctors have traditionally had the power to set their own pay rates and to recommend treatments and follow-up visits at their discretion. This latter power contributed to a problem called supplier-induced demand. Doctors also have the power to prescribe medications, and they are largely a self-regulating group through the work of the

American Medical Association and state medical boards. Doctors have not always been highly valued in society, but since the eighteenth century their power and prestige have steadily grown as they got much better at treating illness and injury (through advances in technology and knowledge) and as they banded together as professionals and developed licensing systems. In addition, doctors assumed a dominant role in their relationship with hospitals because they

were the ones bringing in new patients. In the past 20 years or so, doctors have found some of their powers restricted or diminished. As health-care costs have skyrocketed, new ways of paying for health care have emerged that restrict the ability of doctors to set their own fees. There is now more external regulation of the medical profession and there has been a significant increase in the use of alternative medicine such as acupuncture, chiropractic, and

herbal medicine. Technology has also affected doctors power and prestigeprocedures that were formerly performed only by a doctor can now be taken care of by nurses or physician assistants; pharmaceutical companies challenge doctors as much as they collaborate with them; and patients can become a lot more knowledgeable about their condition and possible treatments through Internet research.

What Does It Mean to Be Sick?

Sociologist Talcott Parsons developed the concept of the sick role, which assigns a sick person two rights and two obligations. However, this conception is very individualistic and does not take into account how social conditions can affect a persons health. Like many other seemingly universal or stable concepts, illness is a social construct what it means to be sick (or healthy) has changed throughout history and differs from one place to another.

The U.S. Health-Care System

Unlike many other industrialized nations, the United States does not offer universal health care. The four main types of health-care coverage in the United States are fee-forservice, health maintenance organizations, Medicare, and Medicaid. The Whitehall Study and economist John Komloss study of the height of Dutch people show that social factors such as where you live, what you do for a living, and how much money you earn, particularly in relation to other members of the society in which you live, have a greater influence on your health than health care and health-care systems. Technological advances in medicine that determine gender and detect diseases and genetic anomalies in fetuses raise difficult ethical questions and have major social implications. Multiple births (often due to assisted reproductive technology) and premature births present further medical and ethical dilemmas. There are numerous health discrepancies between races in the United States, with whites having the best outcomes overall. The starkest differences can be found between whites and blacks. While some of this is due to differences in socioeconomic status, there are still significant differences between whites and blacks with the same income and education level, which implies that racism plays a role in peoples overall health. Three main theories exist that attempt to explain why people with higher socioeconomic status have better health: selection theory, drift explanation, and the theory that social position causes health. The theory that social position causes health has three interpretationsthe psychosocial interpretations, the materialist interpretation, and the fundamental causes interpretation. Married people tend to live longer, but it is not clear whether marriage actually benefits a persons health or if healthier people tend to get married. Women live longer than men, which can be attributed in part to the types of illnesses each sex is more susceptible to as well as to how willing each sex is to seek medical care. Large families and children born close together are both associated with higher child mortality rates, due to greater demands on parents financial and emotional resources.

The Sociology of Mental Health

The Diagnostic and Statistical Manual (DSM) provides a standard categorization of mental disorders and their definitions. Changes in this manual, particularly from its second to third editions, have strongly influenced how mental illness is understood and treated. Beginning with the manuals third edition, a much greater emphasis was placed on diagnostic psychiatry (identifying symptoms of specific underlying diseases and treating them) over dynamic psychiatry (identifying the internal conflicts that produce a mental illness). There has been a significant increase in the use of pharmaceuticals to treat mental illness. Some negative aspects of this change include a devaluation of the benefits of talk therapy; the overprescribing or misprescribing of pharmaceuticals; the stigma attached to taking medication for mental illness; and the increasing power of pharmaceutical companies who have benefited from the growth of the diagnostic approach.

Global Health

Health disparities between groups within the United States are dwarfed by the disparities that exist between the United States and developing countries, many of which are still struggling to provide their citizens with safe drinking water, sanitation, and basic health care. Malaria, which is far from being eradicated in many countries, has been identified as a major obstacle to economic development. The development of antibiotics was one of the greatest medical achievements of the twentieth century, but antibiotics are becoming less effective as resistant strains of diseases emerge and diseases once thought to have been conquered reappear. Even though a wide range of drugs have been developed to combat HIV and AIDS, the disease continues to ravage many developing countries because people (and governments) cannot afford to buy the drugs and, even if they can, their lack of access to proper nutrition and clean water can limit the drugs effectiveness.