Medical dominance then and now: critical reflections.

ABSTRACT

The publication of Evan Willis' notable book coincided with the appearance of similar Anglo-American accounts. Now, there are retrospectives on medical power. Why then and why now? Professional power was central because health care was the focus of political discussion at the time but is now less important vis-a-vis political struggles over neo-liberalism. Freidson played a key role in bringing medical power into focus. Medicine is also less sociologically prominent now because it is in fact less powerful than it was. There is a convergence between the power of the traditional professions and that of numerous other expert occupations. Despite assumptions to the contrary it is noted that neither the linkages of knowledge/expertise/power nor the existence of putatively self-regulatory organizations is sufficient to ensure professional dominance or control. Closure theory, the pre-eminent approach in the area of the professions, cannot adequately explain these changes in medical power. Rather, both challenges to medical power and the changing salience of medical dominance within sociology can be illuminated using the type of political economy approach which Evan Willis helped to pioneer.

KEY WORDS

Medical dominance, sociology of health, political economy

Introduction

In 1983 Evan Willis wrote a book on medical dominance, ranked as one of the most influential books in Australian sociology. At about the same time writers in other countries were also analyzing the role of medicine. Paul Starr published The Social Transformation of American Medicine (1982), Gerald Larkin wrote Occupational Monopoly and Modern Medicine (1983) on British Medicine, and two colleagues and I published a much shorter historical description of 'the rise and fall' of Canadian medicine (Coburn et al, 1983; Coburn 1999). We are now faced, 20 years later, with various retrospectives on medical power. For example, the Journal of Health Politics, Policy, and Law in 2004 published a special edition of 20 comments on Starr's book. Now Health Sociology Review is publishing a re-visitation of the concerns that Willis had in 1983.

Why the coincidental publication of various analyses of medicine in the 1980s?