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Chapter 11 OutlineThe Rise (and Fall?) of the Medical Profession

o Doctors have a great amount of social power, political power, and prestige for avariety 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.

o Doctors have traditionally had the power to set their own pay rates and to recommendtreatments 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.

o Doctors have not always been highly valued in society, but since the eighteenthcentury 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.

o In the past 20 years or so, doctors have found some of their powers restricted ordiminished. 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.

o Technology has also affected doctors power and prestigeprocedures that wereformerly 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 sickperson 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 constructwhat it means to be sick (or healthy) has changed throughout history and differs from one

place to another.

The U.S. Health-Care System

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Unlike many other industrialized nations, the United States does not offer universalhealth care. The four main types of health-care coverage in the United States are fee-for-

service, health maintenance organizations, Medicare, and Medicaid.

The Whitehall Study and economist John Komloss study of the height of Dutch peopleshow 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 youlive, have a greater influence on your health than health care and health-care systems.

Technological advances in medicine that determine gender and detect diseases andgenetic 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 whiteshaving 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 socioeconomicstatus 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 apersons 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

TheDiagnostic and Statistical Manual (DSM) provides a standard categorization ofmental 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.

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Global Health

Health disparities between groups within the United States are dwarfed by the disparitiesthat 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 thetwentieth 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, thedisease 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.