1. 1 Medical Sociology - Introduction  Health and illness are socially defined using –Science; religious experience, insanity, witchcraft, evil –Associated with stigma or sin –Vary by culture (takes on different meanings) and across time.  ‘Dis-ease’ and ‘dis-ability’ and ‘dys-function’ – implying lack of productivity, activity –Some diseases are obvious (e.g., cancer) –Others, not: –Health levels and health behavior are linked Per capital wealth, economic development, industrialization Age, sex Education and income, social class Form of government Payment system form of health care Race, ethnicity, religion (culturally defined)

2. 2 Medical Sociology - Physicians and their world  Physicians were healers of spiritual ills. –Shamans, priests, priestesses, ‘wise women’, midwives.  Several developments changed that. –Sanitation –Germs, vaccines and antibiotics –Painkillers –Quackery arose and the need for some oversight and overhaul needed 2+ yrs of biology and physical sciences, School affiliated with university Rigorous licensing  Result: better quality but also a trade guild. –Exclusion of Jews, blacks, women. –Pecking order of medical providers –Physician-patient status hierarchy.  Since the 70s, more physicians are women and minorities, patients are better educated and better informed (Internet!), HMOs are the boss, so there’s less hierarchy.

3. 3 Medical Sociology – Health differentials  Reasons –Biological – gender, race, age. –Social and cultural – lifestyle, dietary behaviors –Economic – access to medical care, nutrition, exercise, safe environments, safe occupations.  Differences –Gender – men have brute strength but women are healthier. –Age – age-related diseases for childhood through old age from genetics or exposure –Race – some genetic (e.g., sickle cell, Tay-Sachs). –Social – smoking, diets, meaning of fitness & health, alcoholic consumption, interaction of gender and social behavior. –Economic – Adequate food, health care & insurance  Theorists: –Weber: Health and healthy lifestyles are status symbols –Marx: unhealthy working and living conditions signify exploitation. –Consumerism – wealthy ‘consumers as patients’ negotiate better deals.

4. 4 Medical Sociology – Forms of Medical Deviance  Physician-level (white collar) –Negligent behavior, assault while patient is sedated.  Unsafe staffing & practices at hospitals –Using lower paid assistants instead of RNs.  Treating health issues as criminality –Criminalizing unhealthy behavior (e.g., drug addiction)  Focusing on individual aspects of illness rather than the environmentally or socially constructed or configured causes. –Infertility as a women’s problem and ‘their decisions to delay childbearing’ –Fetal health and women  Harmful experiments –CIA conducted experiments with LSD in the 1950s on unsuspecting agents and civilians. –Using inmates in prisons and mental hospitals.

5. 5 Medical Sociology – Forms of Social Control  “Medicalization … seeks to eliminate, modify, isolate, or regulate socially defined behavior as deviant, with medical means, in the name of health.” (p. 564). –Phrases like ‘disease-management’ or ‘pain management’ – treating symptoms instead of disease, lent itself to treating social behavior as symptoms to be managed and controlled. –Medical information can be used to deny health insurance, employment, marriages… –Medical conditions can be used to excuse behavior –Medicalization confers status to physicians, –Gives patients a role and an excuse.

6. 6 Medical Sociology - Medicalization  Pluses: –Removes stigma –Offers sick role as a way to reconcile problematic self-image. –Optimistic outcome – a disease to be treated and maybe cured. –Expands authority of medicine (debatable plus) –More flexible than judicial control  Minuses –Absolves person of responsibility –Allows ‘moral neutrality’ of medicine to run unchecked. –Conferred social control (power) to medical world without due process –Excuses evil instead of confronting it for what it is.

7. 7 Medical Sociology Discussion Questions for Bad Blood 1.In the Tuskegee experiment, the research question itself had much to do with the outcome of the research process. Discuss how this is so, and think of how similar problems might occur with other research (not just medical). 2.It seems that the medical establishment in general had few or no problems with the Tuskegee experiment. Why would this be so? To what extent is this because medical professionals bear the same social values as others in the society? To what extent is it the result of something specific to medical power relationships? 3.Many people and organizations concerned with AIDS and with public health in general believe that the federal (and now internationally in Africa, many governments) acted slowly on research and prevention. These critics argue that such inaction or slow action was due to a belief that AIDS victims were somehow unworthy or at fault. How do you evaluate this criticism? Do you have an alternative explanation(s)? 4.How could Nurse Rivers have continued to participate the way she did? Explain this behavior based on race, class, gender. Then GOOGLE ‘Nurse Rivers’ Tuskegee obituary and see what explanations you find.