Evan Willis

Introduction: taking stock of medical dominance

More than 20 years have elapsed since the book that is the subject of this special edition was published. The aim in this scene-setting introductory paper is to undertake a stock-taking of status of doctors, doctoring and professionalism as we head into the 21st century. It considers the various challenges to medical dominance of health systems including neo-liberalism and economic rationalism, a growth in consumerism and associated litigiousness, the change from a cottage industry basis to mass markets as medicine has been industrialised, the rise of complementary and alternative medicine (CAM) and changing roles of other health care professionals.

Gendered embodiment and survival for young people with cystic fibrosis

In the context of improvements in both longevity and the quality of life for people with chronic disease, this paper takes as its sense of problem the differential life expectancy for young men as against young women suffering from cystic fibrosis. From a qualitative study of the transition to adulthood for young people with the disease, a theory of gendered embodiment is proposed to explain this differential. The social construction of masculinity and femininity as social practices resulted in the former being more conducive to survival than the latter in this case. There were marked differences between the young women and young men in attitudes to: the meaning of life, death, career and body image; all of which affected adherence to medical regimen.

Explaining the Growth of Complementary and Alternative Medicine

Abstract In this analytic review, the authors consider the ‘boom’ in demand for the services of practitioners of modalities of complementary and alternative medicine (CAM). The evidence for the increase in demand for these services is reviewed and explanations for this phenomenon considered and evaluated. Two particular explanations are considered: the postmodern thesis and the gendered spirituality thesis, as well as more general changes in society. Finally the paper considers the role of the social sciences in the legitimation and increasing use of CAM. The paper concludes that the trend is likely to continue, as will the role of social scientists in observing and documenting CAM.

Positivism resurgent: the epistemological foundations of evidence-based medicine

Abstract The aim of evidence-based medicine (EBM) is to introduce scientific coherence into what clinical epidemiologists characterise as the unscientific practice of medicine and, in particular, variations in diagnoses, treatment and prescribing. This paper lays out the claims of EBM—its concept of scientific knowledge, its model of disease and its construction of the role of epidemiology in medicine—and analyses them in the framework of a sociology of medical knowledge. It argues that rather than a paradigmatic restructuring of medicine, EBM is an appeal to positivistic canons of scientificity which have been systematically challenged by both the philosophy and the sociology of medicine. The paper concludes by providing a brief account of sociological explanations of practice and diagnostic variation in modern medicine. Taking these sociological explanations into account would much improve the delivery of medicine.

State of the Art: A Decade of Health Sociology in Review

Abstract This paper reports on a review of health sociology in Australia from 1990 till present. The authors searched all the major databases for health social sciences including Medline, CINAHL, Sociological Abstracts and Australian Medical Index. Methodological difficulties in capturing all such work are outlined first. Examination of the citations revealed a significant increase in research and commentary in the discipline, and a continued (since the last review) movement away from the biomedical world views towards more inductive, qualitative research strategies and epistemological standpoints. This decade saw the emergence of AIDS, the body and complementary and alternative medicine (CAM) as popular themes in research, and the proliferation of risk as a conceptual tool. An important finding is the proportion of single-authored publications and the possible implications for communication and dialogue amongst those working in the discipline, and the seeming lack of collaboration, at least at the level of publication. It is concluded that although there are parallels with the findings of the previous reviews, there have been distinct methodological and paradigmatic shifts in health sociology over the last decade.

Technological innovation and the labour process in health care.

The process of technological innovation in health care is explored in this paper using labour process theory. Taking the specific case study of diagnostic imaging technology it argues for the utility of labour process theory for analysing the professional labour process as a means of delineating the social contexts in which technological innovation provides a means of empowering workers.

Public health and the 'new' genetics: Balancing individual and collective outcomes

This paper considers the consequences for public health of developments in the understanding of the genetic basis of disease associated with the Human Genome Project (HGP). It develops a sociological perspective on the main social policy issue that arises--that of maximizing any benefits that may arise and minimizing any drawbacks, especially as regards public health. Some opportunities and dangers are discussed, as are three case studies of the impact of the human genome project on specific public health issues.

The 'new' genetics and the sociology of medical technology

Advances in the understanding of molecular biology associated with the Human Genome Project are already having a considerable social impact. Assessing that social impact provides a number of challenges for sociology. Using the perspective of medical technology assessment, this article considers issues concerning genetic testing and screening, individual versus collective uses of these biotechnologies and the special case of pregnancy and prenatal screening. It concludes with the specification of a research agenda for sociologists interested in the field.

The Industrial Relations of Occupational Health and Safety: A Labour Process Approach

Abstract This paper explores the utility of labour process theory for analysing the industrial relations of occupational health and safety. It examines the relationship between the capitalist labour process (especially work organization), technological innovation and occupational health and safety. It argues that the ideological separation of occupational health and safety on one hand and industrial relations on the other has increasingly been overcome as the health and safety of working conditions has become a terrain on which contestation or resistance takes place.

The prostatic imperative and the social relations of medical technology.

A sociological approach to medical technology assessment is outlined in this paper, first in general and then with specific reference to controversies surrounding the use of prostate-specific antigen (PSA) testing to population screening for prostate cancer.