Medical Dominance and Medicalisation

What do terms like ‘medicalisation’ and medical
dominance refer to? These are consistent themes in the sociology of
health and medicine, and sociologists are often critical of the medical profession in a variety of
ways. The sociological critique of medical dominance
can be traced to Eliot Freidson’s two 1970s books, Profession of Medicine and Professional
Dominance. Freidson analysed the ways in a key feature of
all professions, but especially medicine, was the capacity to control their work, which gave
doctors enormous power in relation to health and
illness. The power of medical dominance extends
beyond the work of doctors themselves to encompass their conditions and remuneration,
allied health occupations, such as nurses, their patients, and the very definition of what
constitutes a ‘medical’ issue. Organisations like the American Medical
Association, in Britain the British Medical Association and in Australia the Australian
Medical Association played a key role, through controlling the number of medical graduates and
medical knowledge more broadly. Freidson’s account was developed further in the
1980s, with the publication of Medical Dominance by Evan Willis in Australia, Paul Starr’s The Social
Transformation of American Medicine (1982) in the US, and Gerald Laskin’s Occupational
Monopoly and Modern Medicine (1983) in the UK. The subsequent debate included scepticism
about how powerful doctors really are, and certainly there have been a variety of challenges
to the dominance of the medical profession,
including: neo-liberalism and economic rationalism, which
undermined all professional power, including that of doctors, and withdrew state support for the
medical profession. a growth in consumerism and associated
litigiousness, the change from a cottage industry basis to mass
markets, as medicine has been industrialised the rise of complementary and alternative
medicine, and changing roles of other health care
professionals. It is useful, then, to frame the issue less in terms
of the dominance of the medical profession, and more in terms of a broader social process of
‘medicalisation’, in which doctors are only one set
of players. Peter Conrad and Ivan Illich were among the
leading American critics of what they called
‘medicalisation’ and the medical model. Conrad defined medicalization as:
‘a process by which non-medical problems become defined and treated as medical problems,
usually in terms of illness and disorders’. Medicalisation is the process, then, of re-defining
normal, human bodily experiences in terms of
medical categories. In other words, converting ordinary, everyday
parts of life, such as giving birth, growing old, being dissatisfied with one’s appearance, into a
medical experience. That is, physical experiences that historically
were seen as simply a normal part of growing up, just troublesome aspects of life, are defined
through the intervention of the medical profession
as problematic, becoming medical problems. There are two senses of medicalisation. The first one, which is Peter Conrad’s approach,
refers to it as ‘medical imperialism’. That is, medicalisation is the over-reach of a
legitimate professional approach to dealing with
disease. It’s taking a framework that works very well in
some situations and moving it out into areas way
beyond illness and disease. This is what is meant by the medicalisation of
society. A second way of approaching medicalisation is
to see it as an ideology, or a hegemonic or
dominant discourse. Medicalisation, it’s argued, is a dominant
discourse, with the medical profession going well beyond their role as healers of illness and
disease, to becoming the arbiters of the drawing
of boundaries between normal and deviant. It’s important at this point to pull into the view the
role of the large multinational pharmaceutical corporations, which in many respects have come
to overshadow the medical profession itself. For example, Roy Moynihan’s argument is that the
relationship between the medical profession and the large multi-national pharmaceutical
corporations, with the willing collusion of some patient groups, has underpinned the ways in
which medicalisation has become a ubiquitous
feature of contemporary social life. Moynihan calls it ‘selling sickness’, and disease-
mongering, with the pharmaceutical corporations
being the main drivers of this process. In ‘selling sickness’, the boundaries of treatable
illness are extended to create markets for new pharmaceutical products, a process driven by the
pursuit of profit. There are crucial alliances between the
pharmaceutical corporations, the medical profession, and some patient groups, using the
media to generate an inflated picture of various
conditions as widespread and severe. There are a number of ways in which the
pharmaceutical corporations foster these alliances around a perception of various issues
to do with the functions of the body and the mind
as specifically ‘medical’ concerns. First, the denigration of alternative approaches in
favour of pharmaceutical products. An example here would be the use of anti-
depressant drugs, rather than life-style changes. Second, making false or exaggerated claims
across the spectrum of both physical and mental disorders, sometimes to the point of actually
falsifying research results. Third, working to ensure doctors favour a
narrow bio-organic approach as opposed to an approach framed in terms of public health and the
social correlates of health and illness. For example, should alcoholism, drug addiction or
gambling be regarded as an illness or a character
flaw? The critique of seeing these features of human
behaviour in purely medical terms includes the point that this loses sight of individual, moral
responsibility. Another critique is that this interpretation is driven
by the pursuit of profit by the pharmaceutical corporations, seeking ways of selling new
products to supposedly ‘cure’ these illnesses, when they are in fact generated by particular
social conditions which remain unaddressed,
treating the symptom rather than the cause. In relation to the conversion of ordinary life-
concerns into medical problems, Moynihan gives the example of baldness, arguing that the medical
profession have re-framed this experience as a medical issue, for which of course an expensive
treatment is available. He also points to the framing of relatively mild
symptoms as indicators of very serious disease, for which there is also a more or less expensive
cure provided by the medical profession and the
pharmaceutical companies. His particular example is irritable bowel syndrome
(IBS), arguing that IBS used to be simply managed rather than making any attempt to cure it. However, a PR company was hired to re-frame
IBS as a condition for which there was a treatment produced and sold by a pharmaceutical
company. The brief for the PR campaign was that “IBS must
be established in doctors’ minds as a significant,
discrete disease state’. Yet another arena for medicalisation is the re-
branding of personal or social problems as
‘serious medical issues’. Shyness, for example, was taken by the big
pharmaceutical companies and developed into an
illness – ‘social phobia’ – for which a medical treatment requiring various drugs comes to be
provided. Risks also become (re-)conceptualised as actual
diseases, with Moynnihan’s example being
osteoporosis. Measures of bone density were used as a
predictor of the risk of fractures among middle-
aged and elderly people, but Moynihan argues that the relationship between the two is actually
quite weak. The corollary of profit-driven medical imperialism
is also the failure to address illness and disease is confined to a population which can’t sustain
profitability for the pharmaceutical corporations. When there are health problems in parts of the
world where there are insufficient profits to be made, because the population and the society is
poor, the pharmaceutical companies simply don’t engage in the required research and don’t
develop treatments, so that the rates of illness and mortality remain at levels that would not be
accepted in the developed countries. The most recent example is the resurgence of
antibiotic-resistant tuberculosis in many parts of
Asia and Africa. The core concerns in the medicalisation debate
include the economic dimensions of how human problems are understood and dealt with, as well
as the role played by the interests of the medical
profession and drug corporations. Although it true that the medical profession is not
as dominant in society as it was in the 1950s and
1960s, the tendency towards the medicalisation of social issues and concerns remains a core
characteristic of contemporary society, and the
question of power in relation to health, illness and medicine continues to be a major concern in the
sociology of health.

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