George Weisz

Social Science perspectives on medical ethics

I: Clinical Encounters of the Ethical Kind.- Clinical Trials and the Collective Ethic: The Case of Hyperbaric Oxygen Therapy and the Treatment of Multiple Sclerosis.- Biomedical Rituals and Informed Consent: Native Canadians and the Negotiation of Clinical Trust.- Moral Conflicts in a Psychiatric Hospital Treating Combat-related Posttraumatic Stress Disorder (ptsd).- Institutional Factors Affecting Psychiatric Admission and Commitment Decisions.- II: Ethics in the Public Arena.- Reaching Consensus About Death: Heart Transplants and Cultural Identity in Japan.- Ethics, Politics and Contraception: Canada and the Licensing of Depo-Provera.- III: The Institutions and Ideology of Medical Ethics.- The Origins of Medical Ethics in France: The International Congress of Morale Medicale of 1955.- The British General Medical Council and Medical Ethics.- Human Experimentation and the Origins of Bioethics in the United States.- The Evolution of American Bioethics: A Sociological Perspective.- IV: Medical Ethics and Social Science.- Medical Anthropology and the Comparative Study of Medical Ethics.- Morality and the Social Sciences.- Ethics and Ethnography in Neonatal Intensive Care.- Bibliography I / Book-length Works Reflecting or Relevant to Social Science Perspectives on Medical Ethics.- Bibliography II / Selected List of Book-length Works on or Basic to Medical Ethics.- Author/Name Index.

Hormone replacement therapy, cancer, controversies, and women’s health: historical, epidemiological, biological, clinical, and advocacy perspectives

Routine acceptance of use of hormone replacement therapy (HRT) was shattered in 2002 when results of the largest HRT randomised clinical trial, the women’s health initiative, indicated that long term use of oestrogen plus progestin HRT not only was associated with increased risk of cancer but, contrary to expectations, did not decrease, and may have increased, risk of cardiovascular disease. In June 2004 a group of historians, epidemiologists, biologists, clinicians, and women’s health advocates met to discuss the scientific and social context of and response to these findings. It was found that understanding the evolving and contending knowledge on hormones and health requires: (1) considering its societal context, including the impact of the pharmaceutical industry, the biomedical emphasis on individualised risk and preventive medicine, and the gendering of hormones; and (2) asking why, for four decades, since the mid-1960s, were millions of women prescribed powerful pharmacological agents already demonstrated, three decades earlier, to be carcinogenic? Answering this question requires engaging with core issues of accountability, complexity, fear of mortality, and the conduct of socially responsible science.

The Emergence of Medical Specialization in the Nineteenth Century

This essay reexamines the nineteenth-century origins of medical specialization. It suggests that by the 1880s, specialization had become perceived as a necessity of medical science as a result of the realization of two preconditions: First, a new collective desire to expand medical knowledge prompted clinical researchers to specialize; only specialization, it was believed, permitted the rigorous observation of many cases. Second, administrative rationality suggested that one could best manage large populations through proper classification, gathering together individuals belonging to the same class and separating those belonging to different categories. Both of these conditions emerged first and most powerfully in early nineteenth-century Paris. They were, in contrast, uniquely underdeveloped in the fragmented medical community of London during this period.

Biomedical Conventions and Regulatory Objectivity: A Few Introductory Remarks

This special issue of Social Studies of Science centers on the topic of regulation in medicine and, in particular, on the notion of regulatory objectivity, defined as a new form of objectivity in biomedicine that generates conventions and norms through concerted programs of action based on the use of a variety of systems for the collective production of evidence. The papers in the special issue suggest ways in which the notion of regulatory objectivity can be tested, extended, revised, or superseded by more appropriate notions. They insist on the need to examine more closely clinical-therapeutic (and not just clinical-research) activities, and to pay more attention to the activities of regulatory agencies such as the US Food and Drug Administration and to standard-setting organizations. They call attention to the professional and organizational activities surrounding the mobilization of conventions for regulating clinical practices. Finally, they provide material that can help us to think about how analytical notions such as regulatory objectivity may or may not inform interventionist research projects.

Spas, Mineral Waters, and Hydrological Science in Twentieth-Century France

This essay examines the survival of waters therapy in twentieth-century France with a view to understanding the conditions that make a therapy convincing in one national context and not in another. Part of the explanation for this survival has to do with the size and power of the spa industry. Where this industry was strong and economically powerful-as it was in France-its survival became a national priority. Of equal importance, however, was the role of the medical elite. In twentieth-century France, a small but influential group of elite physicians served as the chief architects of the continued survival and development of water cures. The primary mechanism for this process was a massive and successful campaign to introduce hydrology into the curriculum of medical schools. Once this was achieved, a large corps of academic hydrologists were in a position to produce significant amounts of convincing hydrological science that seemed to demonstrate the varied physiological effects of mineral waters. By the 1940s mineral waters had enough scientific visibility to ensure their inclusion without controversy in the national health insurance system that was being set up.

The biomedical standardization of premenstrual syndrome

This essay traces the history of premenstrual syndrome (PMS) in French, British, and American medical literature from 1950 to 2004. Aetiological theories, treatments and diagnostic criteria have varied over time and place, reflecting local conditions and changing notions of objectivity and evidence. During the 1970s researchers in each nation utilised different research strategies to overcome variation and contradictory results characteristic of PMS research. Since the 1980s, attempts have been made to standardise research internationally through prospective daily rating questionnaires that diagnose and measure PMS. Amidst controversy, a psychiatric reformulation of the syndrome was included in the Diagnostic and Statistical Manual of Mental Disorders (DSM). While the diagnostic criteria for this psychiatric category, now called premenstrual dysphoric disorder (PMDD), are widely accepted for research purposes, efforts to transfer them to medical practice have been less successful. PMDD remains a contested disease construct.

Historical reflections on medical travel

The terms ‘medical tourism’ and ‘health tourism’ cover many phenomena. Individuals able to afford the costs have frequently traveled great distances to consult with healers considered especially competent in their field. A reputation for expertise has, for the past century, been linked to technological capacity and those who can do so may prefer to travel to places such as the Mayo Clinic rather than relying on technology and expertise available locally. In Canada, there is something like a tradition that provincial Premiers with serious illnesses travel to the United States for their medical care. This is always controversial since Premiers are supposedly responsible for the quality of provincial health-care systems; if they don’t trust these institutions why should the rest of us? But despite occasional bursts of outrage, most Canadians understand the desire to obtain the best possible medical care even if it means traveling outside the country. What is unusual about the newest sort of ‘health tourism’ discussed in several papers in this issue is that technology and excellence are only some of the attracting features. Relatively low costs, desire to avoid waiting lists, access to procedures or facilities unavailable and possibly illegal at home, are often determining factors in individual decisions to travel for health care. One factor that is less than central is place. It just happens that the Mayo Clinic is in Rochester Minnesota, or the Cleveland Clinic is in Cleveland Ohio, or that the institutions discussed in these pages are located where they are. Location of course is not irrelevant. Not every locale can bring together the expertise, technology, capital, easy access and relative lack of political violence that turns a city into a medical destination. But there is nothing about these places that is intrinsically healthy or good for you. In many ways, ‘tourism’ is a catchy misnomer that simply means traveling long distances for medical care not dissimilar to what is available at home. While this phenomenon has relevance for medical care and global health and for the ways social scientists study them, such practices can best be seen as yet another example of the expanding global economy, another form of ‘offshoring’ goods and services, whose consequences have yet to be fully understood. It in no way diminishes the significance of this phenomenon to note that its application to health care is too recent for historians to have much in the way of a contribution to make to its discussion.

Epidemiology and Health Care Reform: The National Health Survey of 1935-1936

The National Health Survey undertaken in 1935 and 1936 was the largest morbidity survey until that time. It was also the first national survey to focus on chronic disease and disability. The decision to conduct a survey of this magnitude was part of the larger strategy to reform health care in the United States. The focus on morbidity allowed reformers to argue that the health status of Americans was poor, despite falling mortality rates that suggested the opposite. The focus on chronic disease morbidity proved to be an especially effective way of demonstrating the poor health of the population and the strong links between poverty and illness. The survey, undertaken by a small group of reform-minded epidemiologists led by Edgar Sydenstricker, was made possible by the close interaction during the Depression of agencies and actors in the public health and social welfare sectors, a collaboration which produced new ways of thinking about disease burdens.

Scientists and Sectarians: The case of psychoanalysis†

The early pioneers of psychoanalysis often behaved more like followers of a religious sect than like scientists. The author attempts to view sectarian tendencies as a behavioral pattern that tends to emerge among scientists under certain types of conditions. First, the early psychoanalytical movement is used to isolate the specific factors that encourage scientific groups to develop sectarian tendencies. Then, the history of the movement is analyzed in terms of the effect of these sectarian tendencies. The author argues that certain unique features and events in the history of the movement resulted from the interaction and conflict between sectarian characteristics, the norms of science and the institutional imperatives of scientific life.

Reviews : Gerald L. Geison, ed., Professions and the French State 1700-1900, Philadelphia, University of Pennsylvania Press, 1984. x + 319pp. £33.25:

by Sergio Moravia (1968, 1974), Utility and Liberty takes its place among the studies of Condorcet by Keith Baker (1975), Destutt de Tracy by Emmett Kennedy (1978), Cabanis by M. S. Staum (1980), and Roederer by Kenneth Margerison (1983). Pleasantly written, carefully structured, and well grounded in primary documents, Welch’s book is a significant contribution to our understanding of early Liberal ideas, on both sides of the English Channel.