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McMaster University
Health, Aging and Society
Elena Neiterman

Chapter 9: The Social Construction of Scientific &Medical Knowledge & Medical Practice Medical and Scientific Knowledge – Historical and Cross-Cultural Context: -Positivism: model of science upon which medicine is based; described by attributes such as objectivity, precision, certainty, generalizability, quantification, replication, and causality -a number of social theorists and researchers have demonstrated that beliefs regarding scientific objectivity are problematic -Kuhn (1962): described development of science and how the methods, assumptions and even the subject of science are infused with cultural categories -Freund and McGuire (1991): also agreed with Kuhn and said that the value assumptions of contemporary medicine as mind-body dualism, physical reductionism, specific etiology, machine metaphor, and regimen and control -Mind-Body Dualism  Said to have begun with a philosopher named Descartes who argued the case for the separation of the mind from the body  Foucault (1975) described the changes in the 18 and 19 centuries that allowed the physician to view the patient’s body directly through the “clinical gaze” and not merely indirectly through the patient’s verbal descriptions  Specific technical inventions such as the stethoscope gave physicians direct access to bodily functions -physical reductionism  Emphasizes the physically observable at the expense of other aspects of the individual such as the mental, sensual and emotional  Disregards the social, political and economic causes of ill health -the doctrine of specific etiology  Rene Dubos (1959) was the first to write about this  The notion that each disease is the result of a particular pathogen or malfunction is the primary assumption of this view  Developed from the discoveries of 19 century researchers such as Koch and Pasteur who noted the changes on the body due to microorganisms -machine metaphor  Emphasizes discrete parts, such as organs and their interrelationships with other discrete parts  Resulting from this notion is the possibility of medical specialization and the removal and replacement of parts of the body -regimen and control  Outgrowth of machine metaphor  Involves the underlying assumption that the body is to be dealt with, fixed and continually improved  Emphasis on control through such things as the correct number and spacing of checkups as well as the use of early detection technologies reinforces this notion of the medically perfectible body Medical Science and Medical Practice – A gap in values: -Canadian government and medical associations have conferences to bring together practitioners and researchers, to inform practitioners of the latest scientific findings, to inform scientists of the practical issues facing practitioners, and to work towards the development of timely, national standards of practice -the research to date has indicated that the conferences have little or no effect on medical practice -recently, the idea of evidence-based medicine has been influential in medical practice -sometimes evidence based medicine is not reliable because of the fact that the published research may not be representative of the best research Chapter 9: The Social Construction of Scientific &Medical Knowledge & Medical Practice Medical Technology – The Technological Imperative: -practitioners tend to adopt new technologies before they are evaluated and continue to use them after evaluation indicates they are ineffective or unsafe -Butler (1993) found that the introduction of new medical technologies and their use patterns have been shown to be related to 4 social forces  Key societal values 
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