CHAPTER 8 – SOCIAL CONSTRUCTION OF SCIENTIFIC AND MEDICAL
KNOWLEDGE AND MEDICAL PRACTICE.
Medical and scientific knowledge: historical and cross-cultural context
Positivism, the model of science upon which medicine is based, is described by attributes
e.g., objectivity, precision, certainty, quantification and causality.
Kuhn described the historical development of science and how the methods,
assumptions, and even the very subject matter of science are infused with cultural
Freund, McGuire and Podhurst specified the value assumptions of contemporary
o Mind-body dualism began with Descrates, who argued for the separation of
body and mind.
Inventions such as stethoscope and dissection of cadavers further
entrenched the distinction between the soul/mind and the body as they
made the body a precisely describable and observable empirical entity.
o Physical reductionism emphasizes the physically observable at the expense of
other aspects of the individual e.g., subjectively experienced mental, sensual and
Modern notion of the body as a group of potentially pathogenic organs
made visible through MRIs, CAT scans and X rays illustrate this
o Specific etiology the doctoring of specific etiology was first written by Rene
Assumption that each disease is thought to be the result of a particular
Led to an exaggerated emphasis on the discovery of a magic bullet to
cure one specific disease after another.
o Machine metaphor emphasizes discreet parts e.g., individual organs, and their
interrelationships with other discrete parts.
Led to medical socialization and to interventions e.g., removal and
replacement of parts of the body including the heart, kidney etc.
o Regimen and control body is to be dealt with, fixed and continually improved.
Not only strict health procedures but health promotion policies also
imply that the body is perfectible and under the control of the individual
through such actions e.g., exercise and diet.
Cosmetic surgery is a significant outcome of this perspective.
Manning and Fabrega biologistic view of the body:
o Organs and organ systems and their specific functions are identifiable and
observable as discrete entities.
o The normal functioning of the body goes on pretty much the same for everybody
unless distributed by injury or illness
o People’s sensory experiences are universal
o Disease and experience of disease do not vary from one culture to another.
o Boundaries between self and body and between self and others are obvious
o Death is the body’s ceasing to function
o Bodies should be seen objectively.
Sociological research critiques:
o Observation depends directly on the tools available for measurement and
indirectly on the theories of body and the level of technology in a given culture. o Much of research on the normal person has been on the male person thus less is
known about the functioning of the female body (except reproductive system)
o Cross cultural, anthropological and linguistic studies have shown how people’s
experiences can be articulated only from their available language.
o Cross cultural research shown that what is considered disease on one culture may
be accepted as normal in another.
o A contagious disease e.g., AIDS demonstrates anew that the boundaries between
people are not impermeable but vulnerable.
o Definition of death is not very problematic because of the possibility that
respirators and defibrillators can keep people alive even when they are brain
o Perhaps bodies should be seen objectively, but that is an impossible value to
Medical science and medical practice: a gap in values
Occurs between published biomedical research and the actual practice of medicine.
Montini and Slobin various differences in the work cultures of clinicians and
researchers may play a role in limiting their amalgamation:
1. Certainty verses uncertainty
Scientific work does not depend on or even expect certainty, but rather
focuses on probability in the lab.
Doctors’ work involves patients who want and need certain responses.
2. Evolutionary time vs. clinical timeliness
Scientific truth develops in incremental stages as more and more
hypotheses are confirmed.
Clinician must make timely decisions in response to the expressed and
observed needs of individual patients.
3. Aggregate measures vs. individual prescriptions
Scientist in working with probabilities deals with aggregates.
Practitioner must deal with the suffering individual.
4. Scientific objectivity vs. clinical experience
Scientist believed to try and control all variables in the interest of
objectivity and generalizable findings.
Clinician faced with unique and changing individual with variables that
cannot be controlled and reporting subjectively experienced symptoms
that the clinician has not had time to observe extensively.
5. Constant change vs. standards of treatment
Researcher aware of continuous change in research findings as new
hypotheses are put forward.
Clinician attempts to practice medicine under the direction and with the
support of practice standards that have a longer life than frequently
changing scientific hypotheses.
Evidence-based medicine (EBM) – involves using statistical and other evaluative
techniques for the metaanalysis of scientific literature related to all manner of potential
medical diagnoses in order to inform continually the everyday practice of medicine.
o Assumes the best evidence is gathered and assess through systematic and
Published research may not be representative of the best research
Published findings may be restricted when researchers are funded by
private corporations. Not all evidence is accessible because negative findings often are not
Medical technology: the technological imperative
Evidence suggests that practitioners tend to adopt new technologies before they are
evaluated and that they continue to use them after evaluation indicates they are
ineffective or unsafe.
o Electronical fetal monitoring (EFM)
Power of new technologies has been called technological imperative.
Introduction of new medical technologies and their use patterns have been shown to be
related to 4 social forces:
o Key societal values
o Federal government policies
o Reimbursement strategies
o Economic incentives
McKinlay and McKinlay – developed a mode that could be sued to explain dissemination
of new medical technologies before they are adequately tested: 7 stages in the career of a