The Social Transformation of American Medicine: The rise of a sovereign profession and the making of a vast industry

The Social Transformation of American Medicine: The rise of a sovereign profession and the making of a vast industry

Paul Starr

Language: English

Pages: 528

ISBN: 0465079350

Format: PDF / Kindle (mobi) / ePub


Winner of the 1983 Pulitzer Prize and the Bancroft Prize in American History, this is a landmark history of how the entire American health care system of doctors, hospitals, health plans, and government programs has evolved over the last two centuries.

"The definitive social history of the medical profession in America....A monumental achievement."—H. Jack Geiger, M.D., New York Times Book Review

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relation of knowledge and power and the nature and uses of authority. The opening theoretical passages, I recognize, may be a barrier rather than an invitation to some readers. I ask their patience. My aim in the Introduction is to place the analysis in the context in which I think it belongs; to define my terms; and to provide an analytical map that may serve as a guide through the chief turns of the argument, at least in Book One. But should the reader find this map too sketchy and abstract, I

of treatment. Very few people can discover whether or not your diagnosis and treatment are correct. . . but if you say a patient will recover and he dies, or that he will die and he gets w e l l . . . everybody will see that you are w r o n g . . . and they will naturally seek out some one with more experience or deeper thought." 27 For the same reason, a doctor had to be bold and prompt. Simulated spontaneity helps to dramatize social performance. "The public," Cathell wrote, "love to see a

point of leverage with physicians, it failed to gain entry. The AMA's gesture of accommodation toward its old adversaries, the homeopaths and Eclectics, was part of a more general effort around the turn of the century to unify and strengthen the profession. As of 1900 the AMA had only eight thousand members. The total membership of all medical societies, local and state as well as national, was approximately 33,000; another 77,000 physicians belonged to no association whatsoever. As a writer who

first listing of internships in 1914, and by 1923, for the first time, there were enough openings to accommodate all graduates.109 The profession grew more uniform in its social composition. The high costs of medical education and more stringent requirements limited the entry of students from the lower and working classes. And deliberate policies of discrimination against Jews, women, and blacks promoted still greater social homogeneity. The opening of medicine to immigrants and women, which the

formula or any private appropriation of medical knowledge or techniques, which it maintained ought to belong collectively to the profession. However, the AMA was powerless to enforce these views. In 1849 the association resolved to create a board to evaluate nostrums but proved unable to do so for lack of resources. In the late nineteenth century, proprietary drugs became more widely used, and professional concern about them intensified. Advertisements for such drugs filled the medical journals

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