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Lecture 4

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William Magee

SOC243: Week 4: Jan 31 Outline: I. The Macro Context of Medicalization and demedicalization II. The convergence of forces: political, economic, technological, media and moral III. From medicalization to enhancement IV. Demedicalization and remedicalization. With a focus on Women’s Health V. Quiz Next week I. The Macro Context of Medicalization and Demedicalization Macro processes, politiccal economy, interest groups, social conflict and social control Science technology --- medicine Understandings/(de) Medicalization Lay public > experts Health/illness > bodies Practices ------------ Experiences (illness) Medicalization and demedicalization  Institutional medicalization: a process whereby more and more of life comes to be of concern to the medical profession within institutions controlled by medical professions  Medicalization expands through 2 institutional components: o (a) Retention of control over certain technical procedures by the profession of medicine o (b) Retention of control over access to the profession (through licensing and schooling)  (ie. Becoming doctor, educating others) o People become more attached to particular set of institutions  There were lots of medical schools all over Canada and United States around 100 years ago (different types of home schools); there were different kinds of doctors with different types of training o The Carney foundation sent someone across Canada and looked at all the different types of medical school and said ‘the best medical schools are the ones that are associated with universities’  so only license them if affiliated with universities. But only rich people (white people) went to universities  so they institutionalized class and control over medicine  Creates a system where it’s easier to treat (licenses, these people get funded by OHIP, etc.) and other institutions tend to rely on medical institutions (ie. Judges, can find a psychiatrist to give a community order)  From text: o 1/50 people diagnosed with schizophrenia in Ontario o Doctors can prescribe drug off-label  Once a medicine is approved, they can prescribe it  ‘The drug passed because it cured this problem, but I’m going to give it t you to solve another problem’  The contrast between what the medicine was made for, and what doctors actually use it as  Demedicalization: the removal of institutiosn of medicine from dealing with specific issues o Redefining something as an illness/disease but then it doesn’t become a disease o I.e. people who were homosexual were ill  eventually, as protests, is not considered a disease Conceptual/Definitional Medicalization  Text: The process through which a condition or behaviour becomes defined as a medical problem,… or through which the definition of an illness is broadened  (the text considers all medicalization as conceptual)  Zola: ‘The expansion of what in life is deemed relevant to the good practice of medicine  Defining a problem (form of deviance) in medical terms… developing arguments and evidence that a social problem should be considered a medical problems  How is it medicalized?  Example: midwifery  before, could deliver babies by themselves, now have to align themselves with doctors  doctors advocated that delivering babies need to be medicalized Current (late modern) contestation around medicalization-demedicalization  Anecdotal evidence suggests in late modernity, lay publics have become increasingly sceptical of claims of experts  People started to question motives more  Associated with rise of ‘postmodernism’  many knowledge claims are perceived as ‘undecideable’ and what is considered knowledge is understood as ‘determined by play of power’  The idea of progress is questioned Legitimacy claims of business, professions, governments are more often contested  Claims to safety or efficacy of technologies challenged by consumer groups, NGOs, etc.  In public debates calculations and appeals to rationality are often trumped by feelings, appearances   we need to check on you, because science is not just science, neither is it it pure. Science is always in the interest of somebody  Public concerns with risks and allocation of risks can shift consumption practices, even in the absence of government action, or counter to government paternalism II. The Convergence of forces: political, economic, technological, media and moral  In an extraordinarily short period of time, the relatively small and undifferentiated market of ‘health care’ became an intense object of capital, and in doing so became highly diversified and ever more heterogeneous. (Fred Hafferty)  ‘... novel alliances between political authorities and promisory capitalism’ Rose p18 Claims and Realities and Ambiguities  Much more is claimed than is actually know… most diseases can be managed, not cured… patients are misled by distorting media hype (Kleinman and Hanna)  How do Doctors deal with this flow of information  ‘Pharmaceutical determinism’: The existence [and success] of a medication for a condition used to argue for the biological existence of the condition  Logic might make sense  lots of drugs work, in terms of killing pain, but they’re not doing what you think they might be doing Moral Imperatives and Biocapitalism  In practically all social systems the duration and quality of human life is of such extreme ethical importance that ‘… the technologies for maintaining and improving (life) can represent themselves as more than merely the corrupt pursuit of profit and personal gain…’  Actors that control such technologies not only hold economic power, but also ‘achieve a hold on our economies of hope, of imagination and of profit.’ Rose p22  Moral implications of technology, how it’s done and what directions they’re heading to New forms of biovalue  New technologies allow for new ways to decompose the body, ‘conferring new mobility on the elements of life.’ (Rose p5), and new possibilities for profit through the redeployment of bodies and tissues, which have ‘biovalue’ in the economy  How might biovalue change in the future if antirejection technologies are substantially improved  High demand for kidn
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