STUDY GUIDE FOR EXAMINATION #4
SOC. 393, Medical Sociology 
SUNY College at Buffalo
Dr. ZHANG Jie, Ph.D.

 Chapter 11

The Profession of Medicine
American Medicine in 19th Century
Regular doctors (allopathic): forerunners of contemporary doctors
Irregular practitioners (homeopathic): patent medicine makers, botanic herbalists, midwifes
Allopathic Doctors: cure by opposites
Homeopathic Doctors: cure by similars (dilute solutions of drugs)
Most of them had less than one year of training, primarily through lectures
Very informal education: more than half of Harvard’s medical students were illiterate; any student who regularly attended the lectures received a diploma
Major Medical Advances
1860s    Anesthesia
1847    American Medical Association             (AMA)
1900    Allopathic doctors gained control             over health care
1910    Flexner Report (to regulate                 medical schools)
1920    Doctors a profession (Quality of             medical training had improved)
1940s    Antibiotics
Medical Profession
The three conditions for a occupation to become a profession
Autonomy to set its own educational and licensing standards
Technical, specialized knowledge
Following a code of ethics with a sense of service rather than profits
Medical Dominance
Medical profession, power, and dominance
Medical errors
When doctors endanger their patients’ lives through errors, their colleagues generally downplay the importance of the errors
Decline of Medical Dominance (Page 331)
Changes in public attitudes
Deprofessionalization
Defensive medicine (extra cautions)
Technological imperative (useless tests)
Proletarianization of doctors: becoming workers rather than autonomous professionals
The rise of corporatization
The growth of government control
The decline of the AMA

Becoming a Doctor
Education: 4+4+5
Graduating medical students can expect an average debt close to $100,000
Racial categories and medical schooling (Page 341)
Professional socialization: Learning skills, knowledge, and  medical values
Building a Medical Career
Sponsorship
Achieved status
Ascribed status
Gender difference in medical salaries (page 350)
Some Negative Medical Socialization
View patients as enemies
Depersonalize their patients
Believe patients’ feelings are not important to their treatment
Doctor and Patient Relationships
Activity-passivity
Guidance-cooperation
Mutual participation

Ethical debate: Truth Telling in Health Care (Page 352)
Autonomy: patients decide
Paternalism: the doctor controls
Medical Norms
Emotional detachment
Clinical experience
Medical or surgical intervention
Working with rare or acute illnesses rather than common or chronic illnesses

Decreased quality of health care
Increased doctors’ paternalistic value systems

Chapter 12

Other Mainstream and Alternative Health Care Providers
Other Mainstream Health Care
Nursing
Nurse-midwifery
Pharmacy
Osteopathy (parallel profession)
Alternative Health Care
Chiropractic
Lay midwifery
Curanderismo (Mexican folk medicine, typically trained through apprenticeships)
Christian Science practice (curing by praying)
Traditional acupuncture
Chinese herbal medicine
Occupational Prestige (Page 363)
Doctors (M.D.)
Lawyers
Dentists
Pharmacists
RNs
Legislators
Chiropractors
LPNs
Dental hygienists
Real estate sales
Waiters
Lay midwifes
Nursing
Almshouses
In early 20th century, nurses were cheap labor
The doctor-nurse game (subtle communication)
Gender roles
Florence Nightingale (1820-1910)
Founder of modern nursing system
Men and women should occupy separate spheres
Nursing needed a hierarchical structure
Caring is inherently women’s role
Difficulties to raise the status of nursing
The ethic of caring and duty
Women’s lack of political power
Ideas about women’s proper role and character

Hierarchical Nursing System
RN     (Registered Nurse)
LPN     (Licensed Practical Nurse)
NA     (Nursing Assistants)
Different Levels of RNs
Graduate degree (Nurse Practitioners)
Bachelor
Associate
Diploma

Nursing as semi-professionals, because they have considerable autonomy, status, and training, but remain subordinate to medicine
Gender in Nursing
Men find it easy to enter administrative work
The glass ceiling for women: Discrimination and social expectations that limit women’s career progress
Pharmacy
Profession (meeting all three requirements)
Clinical pharmacy
Pharmaceutical care

Osteopathy: A Parallel Profession
Founder: Andrew Taylor Still in 1864, allopathic
Combining magnetic healing and bone-setting
To gain professional status, osteopaths increased educational requirements for becoming an osteopath

Alternative Health Care Providers
NIH Office of Alternative Medicine
Chiropractics
Founder: Daniel David Palmer in 1895
Spinal problems foster disease by restricting nerves
Hand practice
Back and spinal care
Lower income 82k vs. 130k
Improved their status by increasing educational standards for entry into the field
Chiropractors’ Beliefs
Immunizations are unnecessary
They should serve as primary care providers
Spinal manipulation can cure most health problems
Acupuncture
Chinese chi (air, spirit, energy)
Balance of yin and yang in the body
NIH and WHO on Acupuncture
NIH Consensus Development Panel on Acupuncture in 1998
Acupuncture definitely alleviates nausea and some types of pain
Definitely does not help in stopping smoking
Has fewer harmful side effects
WHO
Acupuncture effective for treating about 50 disorders, including common cold, asthma, etc.

Chapter 13

Issues in Bioethics
Bioethics
The study of ethical issues in biological sciences and health care
The Emergence of Bioethics
AMA in 1848: the code of ethics established
Dr. J. Marion Sims, the father of modern obstetrics 1840s: testing on black slavery women
Nazi doctors: experiments on Jewish prisoners and murders of those the doctors judged genetically unfit
Nazi doctors: Eugenics (the Nazi philosophy) through sterilization and killing Jews, Gypsies, and others whom they considered racially inferior
In the Nazi Regime
Doctors sterilized persons considered genetically inferior
The marriage of persons with certain diseases was prohibited
Doctors supervised the killings of state mental hospital patients
Doctor decided which concentration camp inmates would be killed immediately
The Nuremberg Code (Page 401)
After WWII, Allied countries prosecuted 23 Nazi doctors after the Nuremberg Trials
Nuremberg Code: a set of internationally recognized principles regarding the ethics of human experimentation
The Patients’ Rights Movement
Gained strength and energy from the
Civil rights movement
Women’s rights movement
Publication of On Death and Dying
Dr. Elizabeth Kubler-Ross Book in 1969
Denouncing the dehumanizing aspects of modern medial treatment of the dying
Publication in the NEJM
Professor  Henry Beecher in 1966
Described 22 research studies
Top journals published articles that used unethical methods

Important Organizations of Bioethics
Hastings Center for Bioethics
Society for Health and Human Values
Center for Bioethics at Georgetown U.

The modern bioethics movement started to fully develop in 1960s
Classical Cases (Pages 403-406)
The Willowbrook Hepatitis Study (1971)
The Tuskegee Syphilis Study (1972)
Karen Quinlan and the Right to Die (1975)
The Willowbrook Study
The Willowbrook State School
Doctors purposely infected children with hepatitis
Researchers obtained consent from the parents of their subjects, but that consent was neither informed nor voluntary
The Tuskegee Syphilis Study
To investigate the long-term effects of untreated syphilis in African-American men
The study lasted about 40 years
The Karen Quinlan Case of Right to Die
21 year old woman fell into a comma after ingesting some drugs at a party
Brain damage and would never regain normal functioning
Parents asked that she be removed from life-support and allowed to die
The doctors refused
Courts for one year
Parents won, and the Karen was let die
Recent Cases (Pages 406-409)
Reproductive technology:
The first test-tube baby in 1978: Louise Brown
Surrogate pregnancy
Postmenopausal birth
Enhancing Human Traits: Enhancing drugs, plastic surgery, and cosmetic psychopharmacology.
Setting priorities: e.g. kidney dialysis with scarce resources
Still Debatable Cases (Page 409)
Human cloning
An unfertilized egg
Removing its nucleus
Replacing it with nucleus of cell taken from another person
Artificially stimulating the egg (no sperm)

Supporters: such research might lead to cures for some diseases
Protecting Human Subjects
IRB
The Board is charged with reviewing all federally-funded research projects involving human subjects
Limited by the Board’s reliance on unpaid volunteers