Chapter 13 Chapter Overview & Learning Objectives

Chapter Overview

Medical sociology is based on the view that medical practices and beliefs are intensely social. Healing, for example, is a social process shaped by a person’s age, gender, ethnic background, “race,” and social class. Much of medical sociology is rooted in policy sociology which seeks to generate sociological data to help governments and medical professionals develop healthcare policies, thereby improve healthcare delivery in Canada. Medical sociology also draws on critical sociology to investigate the practices of multinational companies (Big Farm and Big Pharma), medical schools, hospitals, and for-profit clinics. It also scrutinizes how the profit-seeking operations of these ‘health’ players affect the lives of multitudes.

The first ‘medical’ sociological term may have been coined by structural functionalist Talcott Parsons (1902–1979) when he developed the concept of the sick, or patient, role in 1951. The sick role includes two social expectations that a patient is expected to fulfill (try to get well and seek the help of a qualified health professional) and two roles that society around a patient is expected to fulfill (exempt the patient from “normal social responsibilities” and take care of the patient). The sick role allows an individual to be temporarily “deviant.” However, structural functionalism problematically presumes uniformity of individuals’ experiences with regard to illness. A critique of the universality of Parsons’s theory came first from Earl Koos (1954) who argued that the ability to play the sick role is class-based because people in lower classes have less means to play it. Other critiques looked at how gender, “race,” and ethnicity shape individuals’ ability to play the sick role. Most recently, Ivan Emke noted that the sick role model changes over time. He suggested that, due to changes in the new economy of the twenty-first century and neoliberalism, there were new expectations of the sick role. Most importantly, people are more responsible for their illness and illness is frequently attributed to individual choices, such as smoking or not eating healthy. Secondly, people are increasingly expected to only put limited demands on the health care system, which is rooted in concerns over the presumed unnecessary utilization and abuse of the health care system. Hence the social causes of an individual’s illness due to social inequality, marginalization, corporate greed are neglected.

Conventional medicine understands diseases in terms of their natural course of development: get ill, experience symptoms, use medicine to alleviate symptoms, get well (or sicker). However, a disease also goes through a social course which refers to social interactions that a person goes through in the process of being treated and that is shaped by social factors including ethnic background, culture, class, age, and gender.

Biomedicine, sometimes known as “conventional medicine,” applies the standard principles of western scientific disciplines in the diagnosis and treatment of symptoms of illness. Biomedicine has been criticized as looking at health from a reductionist perspective. The biomedical model attributes medical conditions to a single factor treatable with single remedies, tends to ignore contextual cultural factors of disease and healing, and has been criticized for being absolutist by failing to recognize that there are different cultures of medicine that have different ways of practicing medicine. Other approaches to medicine used to treat patients are known as alternative, or complementary medicine (e.g., acupuncture, massage therapy, etc.). These approaches are based on the notion that a person’s psychological state affects his or her ability to fight diseases. Recent research on psychoneuroimmunology has shown links between one’s emotional and mental health on his/her abilities to fight diseases.

Medicalization, according to Change and Christakis (2002), is the “process by which certain behaviours or conditions are defined as medical problems . . . and medical intervention becomes the focus of remedy and social control.” This process entails defining certain behaviours or conditions as medical problems, not social problems. Medical interventions become the focus of remedy and social control. An example of medicalization is viewing obesity as a personal failing (overeating, weak willpower) instead of seeing it as a result of environmental factors such as the increased availability of fast food, low income, and the sedentary aspect of many jobs. Medicalization promotes the commodification of healthcare by identifying certain (normal) conditions as diseases that should be treated with “commodity cures.” For example, relatively normal age-related issues such as male baldness or erectile “dysfunction” in aging men is regarded as a “medical problem” and patients are offered “cures” for them. Posttraumatic stress disorder (PTSD) is another condition that has recently been medicalized; however, the social, cultural, political roots underlying the PTSD are never identified.

Ivan Illich, a pioneer in the criticism of medicalization, argued that “[t]he medical establishment has become a major threat to health.” Illich identified three forms of what he called iatrogenesis, which refers to “doctor-generated epidemics.” It averts people from preventing and treating their own illness. Illich criticizes industrial-corporate society for making people sick. The three forms are clinical (diagnosis and cure are worse than illness), social (hidden conditions that make society unhealthy), and cultural iatrogenesis (doctors are the experts and patients are given no credit in their recovery). Critics of medicalization will point to the commercial interests of “Big Pharma,” which profit from developing, manufacturing, marketing, and overpricing drugs.

Medicine intersects with several social elements. For example, the connection between healthcare and “race and ethnicity’ is evident in the doctor shortage that exists in many Canadian communities. Four major parts of this problem are that immigrant doctors face many obstacles in being able to practice medicine here; rural communities are underserved because most doctors prefer to live and practice in urban centres; the brain drain, which involves medical professionals leaving their country of origin; and finally, doctors’ associations that allow Canadian-trained doctors to maintain their own power by restricting the ability of internationally trained doctors to practice. An example is the large numbers of Filipino nurses in Canada while Canada accepted very few other health professionals (such as doctors) from the Philippines and elsewhere.

The interplay of “Race” and medicine is further understood by the racialization of disease, which occurs when a disease becomes strongly associated with people of a particular ethnic background. An example of racialization is the SARS outbreak in Toronto in March 2003. Due to its origins in China, the disease was racialized by portraying mainly Asians as carriers of the disease and the media hype thus propagated a great deal of fear-mongering. This situation led to discrimination against Canadians of Asian descent. The individuals who appeared to originate from East Asia could have also been affected.

Gender and medicine often intersect. In 1959, only 6 per cent of medical school graduates in Canada were women compared to 62.2 per cent in 2011. Today, there are more women than men in medical school. This trend could be termed as the feminization of medicine. However, men and women specialize in different fields and practice medicine differently. For example, women are more likely to become family doctors and less likely to become surgeons than men, women are also more likely to screen patients for preventable illnesses and less likely to be sued for malpractice. At the same time, nursing is a female-dominated medical field. In 2011, only 9 per cent of all Registered Nurses were men, almost half of them worked in Quebec. As well, male nurses are recruited predominantly from visible minority groups. Some of them were medical doctors, specialists for years in their countries of origin, but after emigration to Canada they could not qualify to resume their profession. Indigenous men and women are equally underrepresented among health care practitioners. 

Finally, social class and medicine intersect as well. In 1971, Dr. Julian Tudor Hart introduced the idea of the inverse care law—the stipulation that people with the greatest need for good medical care have the least access to it. In poor communities where need for medical care is often highest, there are doctor shortages, overworked doctors, and obsolete facilities and equipment. Another area where social class comes into play is in the ‘social location’ of medical students in Canada. In a recent Ontario study comparing first- and fourth-year medical students, first-year students were more likely to come from homes with lower family incomes, to graduate with higher debt loads, and had to consider finances in their decision to enter medical school, and were stressed out by their financial situations. Ontario was chosen for the study because tuition rates had increased the most at that time compared to the rest of Canada. Contrarily, there were no such social class differences reported between student cohorts in provinces without major tuition hikes.

Learning Objectives

After reading chapter thirteen, you will be able to:

• Describe the core characteristics of medical sociology.
• Define the “sick role” and briefly describe expectations associated with it, drawing on examples.
• Compare and contrast biomedicine and alternative medicine.
• Critically discuss the shortcoming of the biomedical model.
• Define medicalization using examples.
• Distinguish between three types of iatrogenesis.
• Discuss the impact of class, gender, and “race” and ethnicity on health and health care.
• Analyze the role of the Big Pharma in commodification of medicine.
• Recognize class consciousness in terms of the collusion of the Big Pharma and modern medicine to create the ‘need’ to feel sick.
• Situate the power relations in doctor-patient relations.