Viewpoint: the academic encirclement of medicine?

Abstract

Though we all have need of doctors, the amount of faith we place in their advice seems to vary from age to age. At the moment, we live in an era of increasing scepticism. The cost, the effectiveness and the humanity of modem medicine are all the subject of controversy. Has bio-medicine really contributed much towards better health? Or is it mostly due to better nutrition, sanitation and housing? Do surgery or chemotherapy on a massive scale actually cure us or are they both ineffective and iatrogenic, piloducing rather than mitigating human misery? Does medicine free us from disease or does it serve as an instrument of social control? The new philosophy calls all in doubt.The new philosophers are a mixed bunch -historians, lawyers, theologians, acupuncturists, ecologists, community physicians, faith healers, activists, statisticians and social scientists. One of the things we have in common, apart from an interest in health, is the hope that we might wax as conventional medicine wanes. How likely is this? This is the question that this paper sets out to explore, though it focusses on just one segment of the new philosophers, the non-medical academics and their aspirations to re-shape the course of medical practice. It asks what chance have sociologists or statisticians actually got to re-shape the medical world?In attempting to answer this question, the paper is divided into five main sections. The first offers a quick historical sketch of the development of a scientific approach within medicine, while the second describes the rapid growth of various non-clinical disciplines with an interest in health and disease and their assault on the medical citadel. It focusses primarily on the extent to which they are accepted as colleagues by the medical profession and provides several reasons for thinking that the power of the non-clinical disciplines is growing, that some doctors welcome the prospect while others are somewhat alarmed. This interesting vision is then heavily qualified. The third section observes that, for all the extraordinary fragmentation of medicine into different specialisms, the profession has maintained a separate community, a solitary and isolated way of life which normally overrides the internal division of labour. To penetrate this is a hard task indeed. Moreover, as

Indeterminacy and technicality revisited: how medicine and nursing have responded to the evidence based movement

“…In this section of the paper I ask how far different subgroups in both medicine and nursing responded differently to the promotion of EBM and stood to benefit from it. A decade before the rise of EBM, Strong (1984) described how in post‐World War II Britain, the medical bastion had drawn power from its relatively newly gained university credentials. Yet surrounded by academic disciplines each with a desire to either gain a share of medicine's prestige or funding, or to influence its development, Strong claims that cracks appeared in medicine's otherwise impregnable solidarity: the Royal College of Pathologists decided to grant admission to those without medical qualifications while the British Faculty of Community Medicine was also debating whether to admit social scientists.…”

On the analysis of medical work: general practitioners, opiate abusing patients and medical sociology

“…Although this list is in no way complete it does give some indication of the way in which medical sociologists have 'encircled' (Strong, 1984) this area of medical provision in order to explore many of their traditional interests in the social processes of power, domination and communication, and the impact of social class.…”

Ziek is het woord niet : Medicalisering, normalisering en de veranderende taal van huisartsengeneeskunde en geestelijke gezondheidszorg, 1945-1985

“…Hoe moet er beslist worden wanneer een probleem een medische benadering ver-101. Een duidelijke exponent hiervan is Strong (1979Strong ( , 1984. dient en wanneer niet?…”