Sociology Of Medicine Research Articles

Ecks, S.Eating Drugs: Psychopharmaceutical Pluralism in India. New York: New York University Press. 2013. vii + 223pp £50 (hbk) ISBN 978‐0‐8147‐2476‐7

Pharmaceutical pluralism has been embraced in India, from biomedical to Ayurvedic and homeopathic treatments. In Eating Drugs: Psychopharmaceutical Pluralism in India, Stefan Ecks argues that different approaches alter popular perceptions of drug use and their effects. Based on several years of research on India's pharmaceutical markets, Ecks explores how medications, especially mood medications, are understood and used in Kolkata. The reader is taken on an illuminating journey from biopsychiatric treatments to popular health practices, and alternative medicines prescribed in Ayurveda medicine, before returning to a discussion concerning psychiatry. A fundamental argument reiterated throughout the book is that patient's suspicions of psychopharmaceuticals are based on cynicism towards biomedicine's ‘magic bullet’ (p. 7) model of drug effects. The book has been written from ‘a position of doubt about the immediate and long-term side effects of biomedical psychopharmaceuticals’ (p. 187). Mistrust of biomedical drugs focus on their expense, the possibility of toxic side effects, and their superficial, ‘quick-fix’ results. There is the perception that modernity has spoiled health, hence biomedical psychopharmaceuticals are viewed with great skepticism, whilst many non-biomedical treatments are adopted. Alternative treatments include Ayurveda, the grand tradition of Hindu medicine which has been integrated into the Indian National Healthcare system. This is built on the idea that health comes from a robust and balanced diet, which harmonises individual's constitutions with the natural and social environment. Homeopathy is noted as the second most popular type of medicine in Bengal, and is also linked with food and experiences of digestion. Pharmaceutical association with food is a key theme. This is a particularly animated analogy that is brought to life extremely eloquently by Ecks. Within popular notions of health in India there is a focus on the centrality of the belly as the somatic centre of good health, leading to pharmaceuticals being described as food: ‘It is like a kitchen where food is cooked and refined’ (p. 21). Eck's analysis of Ayurvedic practices in Kolkata evidences how in traditional Indian medicine food is medicine and medicine is food. However, it is noted that this is a one-sided argument. Though food is used to make sense of drugs, drugs are not used to make sense of food. Furthermore, there is the risk that equating psychotropic drugs with food might make them appear banal. However, though this possibility is acknowledged, the argument is not fully explored in the book. Ecks provides a captivating narrative encapsulating the plethora of persuasive procedures employed by doctors to encourage patients to take their prescriptions. He discusses how cultural metaphors, which speak to a globalised anxiety about medications such as ‘mind food’ (p. 3), are used. However, whilst potentially increasing public acceptance of treatments, they obscure critical awareness of drug efficacy. In India ‘mood’ drugs and treatments of ‘the mind’ are routinely prescribed in their millions, and with limited public debate on psychopharmaceuticals, patients are confused by the notion that drugs can cure disturbances of the mind. There is friction between the competing sets of assumptions about drugs and how a metaphor like ‘mind food’ can distort crucial disparities. Such mass prescribing is also paradoxical; though more people are consuming treatments, the disorders they treat are also increasing. In analysing how Kolkattans perceive mood medicines and their efficacy for treating sadness and depression, Ecks provides a persuasive argument in identifying the need to address public anxieties about drugs via ‘a dialogue between anthropology of pharmaceuticals and a critical pharmacology of adverse drug effects’ (p.188). He notes that psychiatrists are trying to counter non-biomedical perceptions of drug effects and the bio-medical model of short-term targeted action. Even they discourage patients from discussing moods and mental states, and instead favour conversations about physical symptoms which expedite consultations between doctors and patients. The usefulness of using food metaphors for drugs is thoughtfully considered by Ecks. In a society where prescriptions are rapidly rising, and pharmaceutical companies give doctors strong incentives to write as many prescriptions as possible, Ecks suggests that the obscuring of the effects of drugs by Bengali psychiatrists is actually a positive outcome, as this has ramifications upon the marketing of pharmaceuticals. This may limit the growth of psychopharmaceutical sales in the future. Filled with anecdotal, vivid, and lively tales, this unique ethnography of pharmaceuticals in India will be of key interest to those in a range of disciplines, including the anthropology and sociology of medicine, pharmacology, mental health, bioethics, global health, and South Asian studies. It is a valuable contribution to debates about perceptions and attitudes towards medicine, and the different approaches towards treating depression.

The Study of Professional Deformations of Doctors as Deviations of Their Professional Role

Improvement of medical care is the topical issue of the health care system; its solution requires significant economic investment, based on the results of sociological research. In this regard, the author conducted a comprehensive study of the social and psychological parameters of the doctor’s professional role with a view to explicate its possible deviations. The study was conducted within the sociology of medicine, using its qualitative and quantitative methods, as well as a number of psycho-diagnostic tests. The results showed that the discrepancy between the level of the neuro-emotional and physical stress of medical practice and the institutional and professional valuation parameters leads to deviations in the professional role of the doctor, which is explicated as professional deformations of two types: general professional and special.

‘Involved in every step’: how working practices shape the influence of physiotherapists in elite sport

This paper examines how the medical and non-medical skills of physiotherapists enable members of the profession to become central agents in the multidisciplinary teams (MDTs) which dominate sports health care. Drawing on empirical data derived from interviews with sports physiotherapists and doctors working in UK Olympic sport MDTs, this article argues that the role and influence of physiotherapy in elite sports health care can be explained in relation to physiotherapy’s working practice traditions and the degree to which these traditions correspond to their specific patients’ demands. Drawing on concepts such as medical dominance and relative practice autonomy drawn from the sociology of medicine, the paper argues that extended time, close physical contact and opportunities for experiential learning foster physiotherapist–patient mutuality, locate the physiotherapist as an inherent part of the recovery process and lead to trusting and collaborative health care relations. The practice traditions of physiotherapy enable these practitioners to respond flexibly to the particular demands of elite sports clients, intertwining athletes’ performance orientation with physiotherapists’ treatment through blurring the boundary between health care and sports training. Physiotherapists thus become seen as ‘useful’ in the eyes of the clients who shape the demand for health care delivery in elite sport.

Sport, health and medicine: a sociological agenda

This paper explores the ways in which social scientists should respond to the increasing prominence of health and medicine within sports science research agendas. It first reviews the research which has already been conducted on these themes, identifying core bodies of work on pain and injury, sport and health and the social organization of sports medicine. It then seeks to highlight the comparisons between the sociology of sport and the sociology of medicine, identifying existing areas of overlap and interchange between these two sociological sub-disciplines. Finally it develops a research agenda for the future, consisting of more differentiated and nuanced understandings of sportspeoples' illness/injury experiences, a development of critiques of the sport-health ideology which locate physical activity campaigns within public health more broadly, a scrutiny of the global inequalities which shape athlete health and illness, and an exploration of the impact of elite sports medicine on public health provision.

THE ANALYSIS OF SOCIAL INTERACTION THAT TAKES PLACE IN DISPENSARY HEALTH UNITS OF PUBLIC HEALTH SERVICES ON THE BASIS OF THE APPLICATION PARADIGM AGIL T. PARSONS

Purpose: development of recommendations for optimization the management system dispensary health units on the basis of the application paradigm AGIL T. Parsons. Methodology: theoretical analysis of the structural-functional theory T. Parsons. Results: recommendations formulated. Practical implications: management sociology, medicine sociology. DOI: http://dx.doi.org/10.12731/2218-7405-2013-2-4

Dual embedded agency: Physicians implement integrative medicine in health-care organizations

The paradox of embedded agency addresses the question of how embedded agents are able to conceive of new ideas and practices and then implement them in institutionalized organizations if social structures exert so powerful an influence on behavior, and agents operate within a framework of institutional constraints. This article proposes that dual embedded agency may provide an explanation of the paradox. The article draws from an ethnographic study that examined the ways in which dual-trained physicians, namely medical doctors trained also in some modality of complementary and alternative medicine, integrate complementary and alternative medicine into the biomedical fortress of mainstream health-care organizations. Participant observations were conducted during the years 2006-2011. The observed physicians were found to be embedded in two diverse medical cultures and to have a hybrid professional identity that comprised two sets of health-care values. Seeking to introduce new ideas and practices associated with complementary and alternative medicine to medical institutions, they maneuvered among the constraints of institutional structures while using these very structures, in an isomorphic mode of action, as a platform for launching complementary and alternative medicine practices and values. They drew on the complementary and alternative medicine philosophical principle of interconnectedness and interdependency of seemingly polar opposites or contrary forces and acted to achieve change by means of nonadversarial strategies. By addressing the structure-agency dichotomy, this study contributes to the literature on change in institutionalized health-care organizations. It likewise contributes both theoretically and empirically to the study of integrative medicine and to the further development of this relatively new area of inquiry within the sociology of medicine.

Seven warrants for qualitative health sociology

The biomedical and public health sciences have established a clear warrant for their existence. A warrant is a broadly shared justification for a research-based discipline (Katz, 1997). From the post World War II WHO proclamation aiming for “a state of complete physical, mental, and social well-being” to a recent reconceptualization of health as “the ability to adapt and self-manage” (Huber et al., 2011), thewarrant for the health sciences is to provide the knowledge base for the collective achievement of individual optimization. In spite of a diversity of interpretations about health priorities, the applied health disciplines have rallied around this mandate with research to prevent mortality and cure morbidity, and to alleviate the human, social, and economic costs of health or a lack of health. Articulated in grant proposals, enshrined in the notion of evidence-based medicine, and repeated in research institute’s vision statements, the broad purpose suggests a common interest beyond narrow disciplinary borders. The warrant to improve population and individual health offers a ready answer to the critic’s question of why we should bother with health research. Given that biomedical and public health research is united by the goal of optimizing the ability to adapt and self-manage, does health sociology need a separate warrant? Robert Straus (1957) famously distinguished two communities: researchers studying sociology in medicine and sociology of medicine. Sociologists in medicine would answer the question of the need for a separate warrant negatively. These social scientists have hitched their wagon to the broader health mandate: aiming to provide knowledge that directly benefits health and, more often, health care. They

Lo sviluppo della Sociologia della salute: rassegna dei contesti e delle fasi, dei temi e del suo futuro in India

Health is multi-dimensional and its determinants are not just bio-medical, but also socio-cultural and politico-administrative. Sociology of health developed in twentieth century as a specialized branch of sociology to address the widening health needs of human population. Sociology of health in India passed through several phases and complemented as well incorporated disciplines often identified as medical sociology and sociology of medicine. Parsonian system theory, interactionist perspective, conflict approach, phenomenological approach and empiricism have lasting impact on various researches conducted in India in last six decades. This paper is analytical in nature and focuses on four aspects: (i) development of sociology of health as an independent branch of sociology; (ii) three phases of its development in India; (iii) contexts and popular themes; and (iv) its future.

Development of Sociology of Health: a review of the contexts and phases, themes and future in India

Health is multi-dimensional and its determinants are not just bio-medical, but also socio-cultural and politico-administrative. Sociology of health developed in twentieth century as a specialized branch of sociology to address the widening health needs of human population. Sociology of health in India passed through several phases and complemented as well incorporated disciplines often identified as medical sociology and sociology of medicine. Parsonian system theory, interactionist perspective, conflict approach, phenomenological approach and empiricism have lasting impact on various researches conducted in India in last six decades. This paper is analytical in nature and focuses on four aspects: (i) development of sociology of health as an independent branch of sociology; (ii) three phases of its development in India; (iii) contexts and popular themes; and (iv) its future.

Sovereignty, Security, Psychiatry: Liberation and the Failure of Mental Health Governance in Iraq

This article examines how psychiatry has been used as a technology of security in post-‘liberation’ Iraq. Drawing on Foucault and Foucauldian work on the history and sociology of medicine, it begins by tracing how, from the 19th century onwards, psychiatry has instantiated its authority through a claim to provide social security within national spaces, both through methods of sovereign confinement and through liberation and governance. Arguing that the various ‘psy’ disciplines — and medicine more generally — are increasingly used as technologies of security internationally, the article examines psychiatric practice in Iraq, where patients in the Al Rashad psychiatric institution were accidentally liberated from their confinement by US Marines in 2003. Iraq’s ‘mentally ill’ were initially considered a manageable security threat and thus subject to liberal community governance efforts. Yet, after the so-called suicide bombing of two pet markets in 2008, reportedly by former Al Rashad patients, those deemed ‘mentally ill’ and others associated with them were once again made subject to sovereign confinement, marking a failure in liberal governance. Thus, this article seeks to explore some of the complex lines connecting sovereignty, security and psychiatry in post-‘liberation’ Iraq, and in global politics more generally.

SOCIAL PHARMACOLOGY: THE NEW INTERDISCIPLINARY SCIENTIFIC DIRECTION

Consideration of medical and sociological problems in the field of drug development and administration is expedient within the limits of a new interdisciplinary direction of a medical science on a joint of clinical pharmacology and sociology of medicine. Subjects of studying of social pharmacology are both interrelations of pharmacological activity and social factors, and set of medical and social processes by development, manufacture, turnover and utilization of drugs. On the basis of socially-pharmacological approaches probably creation of new tools for optimization of activity of authorities, scientific institutions, the medical and pharmaceutical organizations on perfection of drug development and administration.

Eliot Freidson: progression and constraints in the biography of an intellectual

Eliot Freidson (1923-2005) is considered one of the founders of the sociology of medicine. Both his critics and admirers in the sociological and medical fields recognize his work as an international benchmark. This paper analyzes Freidson's intellectual biography without concentrating on his ideas or their transformation over the course of time. The emphasis is on the personal constraints that marked his intellectual career within a broader context, with the many different opportunities and choices. It establishes the intersection between the singular trajectory of an intellectual, and the structures, processes and events in which he was immersed and which he changed by his actions.

Commentary: The appearance of new medical cosmologies and the re-appearance of sick and healthy men and women: a comment on the merits of social theorizing

Cosmology, 1770–1870’ 1 is something of a classic. A search using the Thomson ISI Web of Knowledge Service reveals that, within this database, the article has some 133 citations and rate of citations have remained consistent over time. Furthermore, the impact is not limited to sociology; the top six subject areas that return the highest citation scores are ‘history and philosophy of science’ (29.3%); ‘social sciences, biomedical’ (23.3%); ‘public, environmental and occupational health’ (21.1%); ‘sociology’ (20.3%); ‘health care sciences and services’ (12.8%); and ‘medicine, general and internal’ (6.0%). It is intriguing that this conceptual paper should have such an enduring and broad significance. But herein lies its merit; as the sociologist Bryan Turner notes: ‘Ultimately sociology can better serve the practical problems and needs of patients by formulating sociological rather than medical questions.’ 2 This statement reflects Strauss’s well-known distinction between ‘sociology in medicine’ and ‘sociology of medicine’. 3 The former refers to research agendas that are professionally and institutionally driven, whereas the latter implies a more critical approach, wherein the philosophical and epistemological underpinnings of medical knowledge and medical practice are open to scrutiny. Jewson’s analysis certainly scrutinises the content of medical knowledge and reveals how it is contingent upon socio-economic relations between the patrons and producers. At a time when health and social researchers are increasingly encouraged to undertake empirically-based and policyorientated research it is useful to reflect on the

Chiropractic Physicians: Toward a Synthesis of Electronic Medical Records and the Society, Culture, Personality Model in the New Millennium

Objective: The purpose of this paper is to synthesize the key concepts of electronic medical records and society-culture-personality relationship upon the educational practice as well as decision making of chiropractors in the new millennium. Discussion: It is essential for doctors of chiropractic to be cognizant of the fundamental core of the society-culture-personality model as an organizational tool to conceptualize key features of electronic medical records technology. The new form of socially meaningful interaction established through electronic medical records technology may augment communication among the healthcare team and thereby could expand the quality of care. Conclusion: Electronic medical records technology has the capability to provide the medium for chiropractors to foster improvements in the health care institution in regard to five components: availability, accessibility, affordability, continuity, and quality. (J Chiropr Humanit 2008;15:2-9) Key Indexing Terms: Chiropractic; Medical Records Systems, Computerized; Sociology of Medicine.

Chiropractic Physicians: A Functional Conceptualization of Electronic Medical Records Technology and the Society, Culture, and Personality Model in the delivery of Healthcare

Objective: The purpose of this paper is to provide a theoretical functional framework for chiropractic physicians on how the society, culture, and personality (SCP) model is an essential tool for enhancing the understanding of socially meaningful interaction through the use of electronic medical records (EMR) technology in the healthcare institution. Discussion: The numerous capabilities of EMR technology can provide many benefits currently unavailable with paper-based records; thus, EMR technology can create new communication opportunities to cultivate improvements through socially meaningful interaction. However, adoption does not guarantee EMR system operability or patient satisfaction with the care process. Successful migrations to EMR technology may possibly require healthcare organizations to incorporate concepts from SCP into the delivery of care. As technological advances occur, it is essential for chiropractors to remember that a patient is a distinct individual who happens to have an ailment, rather than simply the ailment. The SCP model will help to maintain the chiropractor-patient relationship amidst the changes within the social milieu. Conclusion: There is a need for chiropractors to re-examine how factors such as social class, age, racial, ethnic, family, religious background, and technical competency influence how they utilize electronic medical records technology to deliver care. These factors can help shape treatment strategies based upon the patient’s background and chiropractor’s technical ability to employ EMR technology to bring about greater socially meaningful interaction. (J Chiropr Humanit 2008;15:10-18) Key Indexing Terms: Chiropractic; Medical Records Systems, Computerized; Sociology of Medicine

Straus: as duas sociologias médicas

Robert Straus' pioneer work, "The nature and status of Medical Sociology," written in 1957, was reviewed. Straus, one of the founders of medical sociology, made major contributions to this field and created the first department of behavior sciences in a medical school. In the work reviewed, Straus establishes the differences between sociology in medicine and medical sociology. Comments are made on the current perspective of medical sociology and about the author.

Review Essay: Avoiding conventional understandings: the enduring legacy of Eliot Freidson

Review Essay: Avoiding conventional understandings: the enduring legacy of Eliot Freidson

Understanding genetic disease in a socio‐historical context: a case study of cystic fibrosis

In this article I present a socio-historical analysis of the definition and diagnosis of one particular genetic disease--cystic fibrosis (CF)--in an effort the better to understand its social context both before and after the advent of molecular genetics. I begin my analysis with some background on the history of CF, before moving on to consider the emergence of the notion of classic CF, the development of the sweat test, early approaches to mild or variant forms of CF, the concept of CF as a genetic disease, the concept of CF as a collection of related disorders, and developments in the understanding and diagnosis of CF which came about in the wake of molecular genetics. I highlight a range of technological, professional and patient developments and how these stimulated new research, typologies and clinical tools. I also consider how different notions of CF were mobilised, either to support or undermine a particular approach to diagnosis or treatment, and consider how the dynamic and contextual characteristics of CF were accounted for by scientists and clinicians with an interest in CF. I end by discussing the implications of my analysis for the contemporary sociology of genetics, and related studies in the sociology of medicine more generally.

Avoiding Cheap Grace: Medical Harm, Patient Safety, and the Culture(s) of Forgiveness

Dena Davis defines the job of the ethicist working on clinical issues as describing what real people really believe and how they really act. (2) If so, then insights from religion and related aspects of culture may help hospital administrators charged with meeting new standards for patient safety to recognize the restorative role that has long played between individuals and within communities and to incorporate into their systems for dealing with medical mistakes that lead to injury, death, or other trauma) What follows is a broad religious studies rather than a strictly theological or doctrinal perspective on forgiveness, one that incorporates insights from Jewish and Christian social ethics, ritual studies, sociology of medicine, and medical anthropology, as well as from clinicians themselves. That said, several concepts borrowed from Christian theologian Dietrich Bonhoeffer--cheap among them--are integral to my argument against what might be termed as self-interpreting principle. What mean here is a way of formulating so that its relational character--the actions that various actors undertake in relation to one another so can take place--is forgotten. This relational understanding of may be replaced by a cheap grace that, in formulating as automatic, either acknowledges no role for the injured person as agent of forgiveness, or assumes that this person should offer in the absence of disclosure, apology, accountability, compensation, or other goods that we might place under the principle of justice. In cases of medical harm, a cheap grace approach on the part of professional caregivers, including clinicians, chaplains, social workers, or pastors, may also place pressure on a patient and family to forgive automatically--by reminding them that good people are forgiving, or by assuring them that offering will bring them closure, or by telling them that, after all, nobody meant to harm them--even as the patient's and family's distress is prolonged because they do not know what really happened, or because there is no acknowledgment of their suffering by those directly responsible for it. In avoiding non-relational approaches to forgiveness, we must keep in mind that forgiveness is a Janus-faced word. It holds contradictory meanings--to engage and to detach--that are often conflated or insufficiently distinguished in everyday conversation as well as scholarly discourse. In the Jewish and Christian traditions, the deepest meaning of is detachment. Forgiveness as cheap grace, as entitlement rather than outcome, ignores this deep meaning by refusing to ask what those harmed through medical mistakes may need in order to achieve detachment, or by pressuring them into engagement or acquiescence, even into a divine, salvific role, instead of allowing detachment to take place over time--in what the Christian Bible refers to as kairos, the appropriate time, as opposed to chronos, chronological time--once justice has been secured. (4) Arguing for a definition of after medical harm that holds detachment as the ultimate goal of the process does not mean that injured patients--or clinicians who have made errors--should simply be encouraged to detach from incidents of medical harm, and from their feelings concerning these incidents. Forgiveness entails more than detachment. Even in mundane interpersonal situations, forgiveness-as-detachment can be unsatisfying: after we have succeeded in emotionally detaching ourselves from a painful situation, we may still hesitate to say I forgive you if we believe that, by doing so, we are excusing bad behavior rather than affirming changed behavior. One caution about the Jewish and Christian traditions is in order: while they are powerful if not always acknowledged influences upon Western culture and Western medicine, they are not universal. …

8. HEALTH CARE COMMUNICATION: A PROBLEMATIC SITE FOR APPLIED LINGUISTICS RESEARCH

In this chapter, we address, selectively, how applied linguists and those concerned with discourse analysis in particular, have recently approached the study of health care communication, especially in intercultural contexts, and relate these approaches to studies undertaken by researchers in other academic disciplines such as the sociology of medicine and by health care practitioners in the course of their own work. At issue will be questions concerning selected sites and themes, the degree of distinctiveness of research methodologies and different understandings of what counts as data, and questions concerning reflexivity and practical relevance in terms of the use to which findings can be put. Appreciating areas of difference and similarity is a necessary basis for establishing the desirable, but potentially problematic, partnerships among academic disciplines and between such disciplines and the work of professional practitioners, both in research and in professional development. As a sample site in the delivery of health care in the framework of cultural and linguistic diversity, we identify nursing, and use this site and its practices to advocate the collaboration of applied linguists, professional practitioners, and researchers from other areas of social science in the exploration of health care communication in multilingual/multicultural contexts and elsewhere.