Book Reviews

Abstract

Sociology of Health & IllnessVolume 27, Issue 4 p. 541-550 Free Access Book Reviews First published: 05 July 2005 https://doi.org/10.1111/j.1467-9566.2005.00455.xAboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Weinberg, D.B. Code Green. Money-Driven Hospitals and the Dismantling of Nursing . New York : Cornell University Press, 2003£15.95 (hbk) 213pp. ISBN 0-8014-3980-9 Hart, C. Nurses and Politics: the Impact of Power and Practice . Basingstoke : Palgrave Macmillan , 2004 £14.99 (pbk) xv + 332pp. ISBN 0-333-71006-1 Davies, C. (ed.) The Future Health Workforce . Basingstoke : Palgrave Macmillan , 2003 £50 (hbk) xvi + 262pp. ISBN 1-4039-1903-8 What exactly is the point of nursing? What distinguishes it from other healthcare professions? How should it be led and managed? Should it be accountable to patients, managers or itself? How will nursing – and the other health professions – change in the next few years? These are some of the key questions posed – and partially answered – by Dana Beth Weinberg and Chris Hart from their American and British vantage points. Celia Davies and colleagues range across the future of more than a dozen parts of the varied healthcare workforce (paid and unpaid) to address similar issues. Weinberg presents a fascinating and well-written account of the merger of two Harvard teaching hospitals in the late 1990s – the Beth Israel and the New England Deaconess. Two different views of nursing from within the profession clash in this microcosm of the destruction of professionalism by the power of the market. Beth Israel had a long and distinguished record of valuing the professional contribution of nurses, and championing the concept of primary care nursing (nursing as a holistic approach to patient wellbeing, rather than a series of discrete technical tasks). Meeting the professional needs of nurses was equated with meeting patients’ needs, and the full involvement of nurses in the management of the hospital was a sine qua non. One index of this approach was the level of educational qualification held by Beth Israel nurses – 94 per cent had a Bachelor's degree in nursing, compared with just 43 per cent at the New England Deaconess. For many nurses, it didn't come much better than this. But the Beth Israel hospital was losing $1 million a week. Financial pressures forced a merger with the neighbouring group of hospitals, led by the New England Deaconess, and the culture changed completely. History was re-written overnight as the cherished regime became an expensive anachronism and an unjustifiable exercise in professional self-interest –‘provider capture’ rather than meeting the needs of the market. There was a dialogue of the deaf between Beth Israel's nursing and the new management, compounded by the fact that the merger appears to have been severely mis-handled. Now, you could forget the mission of nursing: the new slogan was ‘no margin, no mission!’ Nursing tasks were given to (cheaper) ‘Patient Care Technicians’; nursing management was merged with general management; workloads increased dramatically. The result for Beth Israel nurses was betrayal and the destruction of a cherished ideal; for the managers, it was increased efficiency and (hopefully) survival. But one of the most interesting features of this case study is the fact that the nurses involved did not all share the same view of their proper role, and of their future. Before the merger, for example, nurses in the New England Deaconess had themselves developed the role of Patient Care Technician, seeing it as an excellent way of freeing nurses from tasks which did not require their level of expertise; they also argued that Primary Care Nursing might have outlived its usefulness, as patients’ lengths of stay had shortened dramatically. For many of these nurses, task-focused division of labour and accountants’ notions of cost effectiveness were nothing new – and not necessarily anathema. The book is a gripping account of organisational change and merger, and the all-powerful financial dynamics of US healthcare are clearly explained by Weinberg. Much of the aggravation for all concerned stemmed from the way in which the merger was mishandled, down to the fact that all the plum jobs in the new organisation seemed at first to be given to former Beth Israel staff, provoking the inevitable backlash from Deaconess and change of policy. But the impartial observer is left looking for objective evidence about the issue which is surely at the heart of all this – the impact on the quality of patient care. Unfortunately, there is very little, beyond what some perhaps would claim to be the ‘bleedin’ obvious’. Nurses argued passionately for the importance of ‘knowing the patient’; but not all nurses agreed, and managers remained puzzled, not really seeing the connection between such ‘woolly’ notions and hard empirical data about outcomes. Clearly, the pressures of the new regime on many nurses were intolerable; but if the old vision was financially unsustainable, what was the alternative? Chris Hart tries to persuade the reader that he has one. He is a Nurse Consultant working in mental health services in London, and his vision is of ‘republican management’ and ‘shared governance’. A core argument is that most managers in the health service are divorced from the realities of clinical care, and are simply unable to understand the operational complexities of the organisation they are supposed to manage. Hart argues that all managers should be drawn from the staff groups they manage – Beth Israel's notion of nurses managed by nurses – and should retain an element of clinical work. Unfortunately, he is at his most polemical when describing current management. There is a notable absence of references or other evidence, for example, to support assertions such as ‘very few [managers] will have had any training whatsoever in the art and science of managing people’ (p. 185), and his description of the performance of management teams may be amusing, but contributes little to serious debate: the common response of a managerial team is to review operational procedures. To be busy. To hold meetings. To be busier. To write new policies. Hold more meetings. To be busier still. To ask for reports and statistics. Attend even more meetings. To be so busy that one can't be accessed. To re-organise and re-structure and then re-review. If that doesn't solve the problem, it can be done all over again (p. 186). The book begins with a brief history of the profession, to emphasise that today's problems are not new, and then skates across the surface of a wide variety of topical issues, from nurse education and remuneration, to regulation and the nature of management. It uses a series of case studies – on clinical grading, the NHS internal market, funding, waiting lists, devolution and local pay – to highlight the issues. The somewhat polemical and nurse-centric vision culminates in an eclectic selection of prescriptions for the future. One is left in no doubt about how some nurses view their predicament; but in this fierce and partisan struggle, the unaligned reader is left looking for convincing evidence and a wider focus than just nursing, particularly when generalisation and caricature occasionally substitute for objective description. Celia Davies and colleagues do take in such a wider canvas, and provide a more measured assessment. This collection of 12 essays looks at current trends and future prospects for various sections of the UK healthcare workforce, including patients (co-producers of care) and informal carers, healthcare assistants, nurses, general medical practitioners, public health workers, complementary and alternative practitioners and pharmacists. The focus here is on both the ‘internal’ concerns of the professions and on the patient. So, for example, Anne Williams describes how nurses’ roles are changing and blurring at the edges, and how the drive towards specialisation conflicts with the need for generalists. In an echo of Hart and Weinberg, her account of the substitution of nurses for doctors highlights just how difficult it is in practice to define (and therefore defend) the unique contribution of nursing, and to measure its value. Alison Blenkinsopp and Christine Bond look at how the pharmacy profession has sought to develop a strategic view of its place in the future, beginning with just such a succinct definition of the five things that pharmacists do, and then attempting to develop distinct but complementary roles for the various elements within the profession, including support staff. Rachel Lissauer, by contrast, argues that much of the change now sweeping through the professions still focuses on clinical diagnosis at the expense of the needs of an ageing population and the ‘continuing healing relationship’. Ailsa Cameron and Abigail Masterson argue that the sort of piecemeal, ‘muddling through’ change that has affected each profession hitherto is not enough to meet the challenges they all face. The time may now be ripe for a national, strategic and multi-professional reappraisal of established roles, with a view perhaps to the creation of entirely new categories of worker – maybe even new professions. Change – fundamental and fast-moving – is the common theme through each of these books, to which the response from the professions has generally been defensive, reactive and piecemeal. Much of the defining context of professionalism is under severe strain – the competing concepts of hierarchy and autonomy; professional and external accountability; the impact of organisational change on professions; different concepts of ‘evidence’ of benefit and harm; inter-professional rivalry – and through it all, the importance of power. On this evidence, there is still some way to go before a convincing new vision for the health professions can be developed and agreed. Perhaps the time has come to de-professionalise the argument – to take the debate out from the individual professional silos and engage the society they all profess to serve. The recent causes célèbre of medical malpractice in the UK – for example, the Bristol Royal Infirmary tragedy, the removal of cadaveric organs in Liverpool, the case of the GP mass murderer Harold Shipman – confirm that professions should not be left to manage their own affairs, and that society will not tolerate such a regime any longer. The political context of the ongoing debate about the regulation of the healthcare professions is complex and unpredictable, and politicians themselves are unsure about how far-reaching reform needs to be – each successive revelation of regulatory failure (such as the latest report about Shipman) tends to produce yet another twist of the regulatory ratchet. The core imperative is that society – patients, carers, relatives, taxpayers – should trust their professional servants. In the context of the active consumer, such trust has to be earned and continually re-earned. Periodic crises cast the spotlight again on the trusting relationship, and even though these crises are far from typical of the reality of healthcare (Shipman was not a typical GP, and most babies do not die unnecessarily from heart surgery) suspicion of opaque professional regulation is easily rekindled. There is something of a paradox: society wants to trust its professionals, but needs to impose control first. When this inherently difficult paradox is cast into the context of the sometimes perverse incentives of the market (Weinberg), or in a public-sector health service that appears to have lost sight of the pressures facing its professional staff (Hart), it is perhaps unwise for the professions to respond by re-iterating professional truisms about holistic care or the need for professional values to imbue management. A new discourse would be more helpful, which demonstrates (with evidence) the impact of different incentive systems and management styles on patient care and outcomes. As Charlotte Sausman describes in her chapter in The Future Health Workforce, there is a series of technological and scientific, demographic and disease-based, political and socio-economic drivers which will force change upon the health professions, and profoundly alter the discourse on their professional values and roles in the next few years. If the professions enter this period of change by trying to defend a series of traditional occupational divisions and unsupported nostra, they will do little to ensure an outcome which serves either their needs or those of society. Each of the books discussed here makes a useful contribution to this debate, although perhaps not always in the ways in which the author intended. The Future Health Workforce allows the reader to dip their toes into many of the key professional waters, and provides a reliable summary both of their individual differences and some of the common themes. There is also a useful Appendix which reproduces some key statistics about the UK health workforce from a 2001 survey. Weinberg's account of culture clash in microcosm is an engaging read, conveying not only the context and the cultures, but also something of the human costs and passions which form the substance of healthcare for the millions of committed staff which it employs. Chris Hart's cri de coeur over the state of his own profession may not always persuade, but it certainly leaves the reader with a strong impression of how some within nursing feel that what is precious about their profession – the legacy from future generations of nurses which must be defended and renewed for the 21st century – is being misunderstood, frustrated and even betrayed by non-nurses and even by some from within the profession. The stakes are high for all concerned, and especially for those who have yet to find their voice in this debate – the patients. Marcus Longley 1 1 University of Glamorgan Somerville, P. and Steele, A. (eds) ‘Race, Housing and Social Exclusion.’ London : Jessica Kingsley Publishers , 2002 £19.95 (pbk) 336pp. ISBN 1-85302-849-5 While this book examines social exclusion in the context of race, specifically in relation to housing, and while its authors claim to be examining social exclusion only in that context, it does makes a very useful contribution to our wider understanding of the significance of social exclusion in our society. Importantly, the book leads us to understand that there are a number of theoretical perspectives on the dynamics of social exclusion, and although the authors do not claim to adopt any one of them, they do reject Durkheimian functionalism and essentialism as two theoretical perspectives that are unhelpful in this context. They firmly reject objective categorisation of individuals and argue that social exclusion is founded in the categorisation of individuals by powerful others and, in so doing, those with the power to define, create labels such as race and ethnicity which become the social categories through which their power is exercised. In Chapter 2, Peter Radcliffe makes stimulating theoretical analyses of the dialectic between choice and constraint, and integration and inclusion; and in particular, provides an important discussion of the different levels that choice and constraint operate, the subjective, the institutional and the structural. In doing so, however, he leads us to appreciate that this does not provide a universal analysis and that different individuals and ethnic groups experience these phenomena differently. The book also shows us that nationalism itself is not a static phenomenon and that it is subject to change and modification in terms of identity and culture. In addition to sound theoretical underpinning, the book gives the reader general information about the housing experiences of black and minority ethnic groups in Britain, but goes on to analyse in greater depth, not only the experiences of specific groups, for example, women and young people, but also variations in experiences in different parts of both the UK and the EU. Bowes and Sim emphasise the significance of low income, high unemployment and poor health for sections of the minority ethnic and black population, and argue that more affluent groups have moved away from inner city housing where racial harassment is often a significant issue. On the other hand, Gidley, Harrison and Tomlins write that there is increasing complexity in the diversity of circumstances for ethnic minority groups in relation to housing needs but that, despite this, choice continues to be limited by constraints such as low pay and racism. However, Philips and Unsworth, and Robinson, examine the area of rented housing, arguing that while there is the potential for increased choice, there has been evidence of a perpetuation of institutional discrimination on the part of the local authorities and housing associations. Despite this, there is also some evidence of imaginative planning on the part of some agencies. Robinson, using Ginsburg's typology of racism, analyses the operation of racism in this context in greater depth, and provides a valuable insight. The book also provides a stimulating and informative analysis of the role of housing associations and goes further to consider the employment status of members of black and ethnic minority groups in social housing organisations. Somerville, Steele and Sodhi provide a pragmatic response by illustrating practical ways which registered social landlords might take in order to improve recruitment and retention of black people and those from ethnic minority groups. The authors consider in some depth the experiences of women, young people and older Asian people, emphasising the need to extend our understanding of the perceptions and needs of these groups. Gayle provides an insight into the processes by which people are able to influence and control their housing conditions. His concern with participation and empowerment, regional development and regeneration provide a positive view of the possibilities of change and future developments. This book provides a comprehensive description of the current trends in housing for black people and for members of ethnic minority groups, not only in England but in other parts of the UK and Europe. In one sense it provides us with a picture of the current circumstances, but it also draws the reader's attention to many of the institutional constraints which mitigate against such groups from either finding suitable housing or improving their housing accommodation and involvement in housing issues. It is an invaluable reader for third-level undergraduates studying housing. For post-graduate students, the chapters by Radcliffe and Robinson are a stimulating and instructive perspective on racism, exclusion and empowerment. Anthea Coghlan 2 2 Coventry University Bainham, Andrew, Day Sclater, Shelley, Richards, Martin. For the Cambridge Socio-Legal Group (eds) Body Lore and Laws . Oxford and Portland, Oregon: Hart Publishing, 2002 35 (hbk) 18 (pbk) xii + 346pp. ISBN 1-841113-197-0 (hbk) 1-84113-196-2 (pbk). Body Lore and Laws is an edited collection following a series of seminars held by the Cambridge Socio-Legal Group in 2000. Each chapter was originally presented as a paper for discussion by the Group before being edited for the book. The book contains an Introduction and 17 further chapters. The Introduction is written by one of the editors – Shelley Day Sclater – who writes that the book is about the relationship between law and the human body. She adds: As its [the book] title suggests, ‘law’ is not seen unambiguously, in isolation, but in its relationships to the diverse range of social discourses that make up ‘body lore’ and which also structures the narratives that rhetorically create law as a body of rational principles and practices. The essays tell tales of inevitable ambiguities – the body is in law, but law is also in the body – and both body and law are necessarily mixed up with our shifting cultural lore (p. 1). As such, bodies have ‘material, substantive realities’ but at the same time bodies are subject to cultural lore whose meanings are ‘provisional, multiple, ambiguous [and] shifting from context to context’ (p. 5). As Sclater notes the relationship between law and the human body is of interest to, amongst others, scientists, doctors, the lay public and many academics. With this in mind the contributors to the book come from a variety of backgrounds and disciplines, including sociology, law, reproductive medicine, criminology, psychology, philosophy and midwifery. The notes on the cover suggest that the book is divided into two parts; with Part One covering ‘Making Bodies’ and Part Two ‘Using and Abusing Bodies’, but this is not in fact the case within the book as the chapters are not grouped in this way. Perhaps the editors decided that the chapters did not fit neatly into these two categories? There are other ways that the book could be subdivided with, amongst others, the themes of gender; reproduction; the child; death; risk and/or emotion linking several of the chapters. But, given the range of topics covered, it is probably best that no such subdivision was attempted. The range of topics covered is diverse, and substantive issues considered include the law and ethics of the sale and donation of organs and other body parts (Chapter 3 Jonathon Herring); issues raised for male medical students when examining male genitalia (Chapter 6 Martin Johnson); the embodied gendered aspects of domestic homicide when women kill their abusive male partners (Chapter 7 Felicity Kaganas); the ‘hiring’ of a prostitute's body by a male client (Chapter 11 Belinda Brooks Gordon and Loraine Gelsthorpe); the mixed messages in law, policy and in lay discourse of gamete donation (Chapter 12 Rachel Cook); and whether genetic testing results in unique perceptions of the body (Chapter 17 Elizabeth Chapman). Some of the chapters (e.g. Chapters 2 and 8) feel explicitly theoretical, although all the chapter authors engage with theoretical issues, and most also take an historical approach with respect to the law and sometimes to their own disciplines’ consideration of the body. Body Lore and Laws is an exciting book. From the dramatic front cover (a pair of feet with a label attached to one big toe, presumably representing a dead body in a mortuary) through the Introduction and all of the chapters, the book represents a sophisticated critique of both the ‘natural’ and the ‘biotech’ body. At first, the range of topics covered feels overwhelming but there is something for everyone here. Anyone interested in the social scientific analysis of the body and/or in the relationship between the law and the body will find the whole of Body Lore and Laws a useful and interesting read but others with an interest, for example, in sex crime, human reproduction, death and dying may wish to read more selectively around themes and issues. The book will be useful for scholars and students in all areas of the social and health sciences both in terms of its theoretical and substantive considerations. In the preface to the book we are told that this collection of essays is the second that the Cambridge Socio-Legal Group has produced – the first being What is a Parent? A Socio-Legal Analysis (1999). I intend to find this first book and hope that maybe there will be a third. Gayle Letherby 3 3 Coventry University Riska, E. Masculinity and Men's Health: Coronary Heart Disease in Medical and Public Discourse. Lanham : Rowan and Littlefield , 2004 $70.00 (hbk) viii + 153pp. ISBN 0-7425-2900-2. In this book, Eliane Riska charts the rise and fall of three personality constructs historically connected to American men's coronary health in both medical and public discourses: Type A, the hardy executive and John Henry. Using a Foucauldian genealogical analysis of medical, scientific and popular texts, she argues that these categories, once perceived to be medical and psychological ‘facts’, are in fact cultural representations of class and ethnicity-bound masculinities within particular social and economic orders. Riska begins by discussing aetiological thinking that views the victimised male's personality as a medical risk factor. The book then moves on to a description of Friedman and Rosenman's famous ‘Type A’ behaviour pattern (and its alternatives, Types B and C) which was thought to increase coronary heart disease risk. The Type A man embodied characteristics representative of the hard-working yet economically threatened white middle-class breadwinner of 1950s America: tense, competitive and aggressive. Riska argues that the identification of this Type A personality was a process whereby traditional masculine values became medicalised and pathologised as cardiovascular risk factors. The fall from popularity of Type A by the mid to late 1980s is then illustrated, using a model of the stages of rise and decline in medical innovations. Type A behaviour was originally detected by a structured interview in which observation of the individual's behaviour was more important than the content of their answers. Subsequently, self-report instruments were developed in which content of response yielded a personality typification; this process of ‘psychologisation’ reified the personality categories as medical and aetiological facts. Riska illustrates that this process in fact led to the discreditation and downfall of Type A and its corollaries due to the lack of clear theoretical underpinnings to the psychological instruments being used in research. Subsequent chapters explore the personality types that supplanted Type A in medical discourse, such as the successful yet cardio-protected ‘hardy executive’ that came to prominence in the 1980s and restored a sense of masculine agency and mastery; and ‘John Henry’, the hardworking African-American man, who, by virtue of his marginal position in the social order, is at high risk of hypertension. A chapter is also dedicated to a description and exploration of the measurement of all three personality types, and a discussion of the validity of the measurement instruments used. Final chapters in the book explore the portrayal of social categories (types of masculinities embedded within class, race and larger institutional frameworks) as psychological categories; and reflect on the invisibility of gender in much health research. One of the book's strengths is its introduction of sociological thinking on gender into the medical discourse on coronary health, which has traditionally viewed men's health as gender-neutral. Riska argues that sociology has also been guilty of an under-theorisation of men's health and that future research requires a more gender-informed approach. As a non-sociologist but a social scientist with a background in ethnicity and cardiovascular health, the discussion of embodied masculinity was less relevant to me than the history and critique of theories of coronary heart disease aetiology, particularly in relation to the idea of the hypertensive black American man or ‘John Henry’. Riska notes that, before the development of this ‘John Henry’ construct, the ‘whiteness’ of men's personality types in relation to coronary health was taken for granted. Riska's book is a complex yet interesting account and analysis, if somewhat repetitive in places. In addition, I found her arguments occasionally unconvincing; for example, she suggests a relationship between the popular stories about boy detectives, The Hardy Boys, and the development of ‘hardiness’ as a key attribute of masculinity in American popular discourse. The book concentrates specifically on personality types that arose from, and are embedded in, North American culture. Riska emphasises that ‘Type A’ is a ‘uniquely American collective image’, in comparison with its relative absence from European public discourse, and notes that it continues to resonate within the American public collective memory. As a British social scientist, I was familiar with the concept of ‘Type A’ before reading the book, yet had not reflected on its culturally-bound emergence and evolution; whilst the author notes that the utility of these personality types is restricted by factors such as time, place, gender, race and class, I would have liked the book to have discussed whether they were used in research internationally and if so, what were their cross-cultural relevance or limitations. Overall, however, Riska's thesis is a well-developed and interesting one. Her book is likely to appeal not only to medical sociologists but to a range of people interested in men's health issues, ethnicity and health, and psychology and personality and their relationship to coronary heart disease. Lisa Hanna 4 4 University of Edinburgh Williams, S. J. Medicine and the Body. London : Sage , 2003 . £22.99 251 pp ISBN 0-7619-5639-5 (pbk) This is a book that both novice and expert readers will find interesting. In Medicine and the Body, Simon J. Williams offers an overview of medical sociology from the perspective of embodiment and the emotions. Readers will find, in this book, insightful re-visitations of long-standing debates (medicalisation, health inequalities, lifecourse, and chronic illness) as well as introductions to topics such as the new medical technologies, the ethics of care or the sociology of sleep. Throughout all these issues, Williams aims at producing a fair account of the different viewpoints in discussion. This book is also a positive evaluation of the contribution of the ‘sociology of the body’ to the sociology of health and illness, an approach that was initiated more than 20 years ago by, amongst others, Bryan Turner (who writes the supportive ‘blurb’ to the book). Williams sets the theoretical agenda of the book in the first chapter. Discussing the tension between biological reductionism and social constructionism, Williams suggests that the solution to this impasse might lie in a clear separation between ontological and epistemological issues, in an emphasis on the body as facilitator of action as well as constraint, and in a focus on the processual character of human organisms (p. 26). Such parameters guide the analysis offered in the rest of the book and find in the topic of the emotions their articulation. For Williams, the emotions represent the interface between biology and society, mediating between the knowledge and beliefs persons have about the world, their social context and their biological organisms. Such a mediating role of emotions is aptly illustrated in Williams's own research on health as transgressive performance (pp. 32–6). In the ‘rational hedonistic’ post-modern health behaviour, Williams argues that the body becomes emotionally attached to meanings closer to possibility and disorder rather than the calculative restraint that the theories of ‘healthicization’ would have us expect. The emotions are also given an important place at the boundary between materialist and psychosocial pathways in health inequalities (Chapter 3), in the boundary processes of ‘becoming child’ and aging (Chapter 4), and in the reformulation of the ‘ethics of care’ (Chapter 9). Such fascination with boundaries and their transgression is itself the main concern of chapters dedicated to the technological reparation and transcending of bodies (Chapter 8), in the labour of division that underpins, and, in Williams's opinion, undermines the sociology of mental health (Chapter 7), and in the organisation of the liminal ‘doing’ of sleep (Chapter 6). For me, this last topic is of considerable interest. Thus far neglected by most sociological theory and research, sleep is here given appropriate attention. To demonstrate the importance of sleep in the organisation of society, Williams explores the embodied temporal and spatial patterning of sleep as well as the way in which power and surveillance work through the rights and duties of sleepers in Western society – what Williams terms the ‘sleep role’ (pp. 116–22). Williams further explores the way in which sleep has recently become the object of medical discourse and surveillance and been ‘caught up in a tangled web of health and illness, morality and risk, safety and danger across the lay/professional divide’ (p. 126). For Williams, such processes have reached a point where it is impossible to predict whether the deployment of expertise will be used to protect or to eliminate sleep as we know it. Such reading of the socio-historical processes around sleep drives Williams's agenda for the sociological study of sleep (p. 136), which might be seen as uncritically accepting the intimate link between health and sleep (See Hislop and Arber, 2003, and Williams 2004). In this, Williams also seems to be attached to the lay/professional divide, thus neglecting the role lay people increasingly play in transforming and participating in the production of expert knowledges in contemporary technical democracies (an important contemporary boundary transgression). Structurally, Medicine and the Body bears a tension between theory and empirical analysis, in which the depth of the latter tends to be neglected in favour of the range and diversity of the perspectives discussed. How much this might be both the outcome of tendencies of the academic book market in the UK and Williams's own intellectual talents and affinities, this reader could not help but feel that the potential richness of some of the examples was not fully developed, allowing Williams's own middle ground position between constructionist and materialist medical sociologies to remain unchallenged. Tiago Moreira 5 5 University of Newcastle upon Tyne References Hislop, J. and Arber, S. (2003) Understanding women's sleep management: beyond medicalization-healthicization? Sociology of Health and Illness, 25, 7, 815– 37. Wiley Online LibraryCASPubMedWeb of Science®Google Scholar Williams, S.J. (2004) Beyond medicalization-healthicization? A rejoinder to Hislop and Arber Sociology of Health and Illness, 26, 4, 453– 59. Wiley Online LibraryPubMedWeb of Science®Google Scholar Volume27, Issue4May 2005Pages 541-550 ReferencesRelatedInformation