Jonathan Gabe

Key concepts in medical sociology

Introduction PART ONE: SOCIAL PATTERNING OF HEALTH Social Class - Graham Scambler Gender - Ellen Annandale Ethnicity - James Y. Nazroo Place - Sally Macintyre and Anne Ellaway Material and Cultural Factors - Graham Scambler Psychosocial Factors - Antonia Bifulco Life Events - Antonia Bifulco Neo-liberal Globalization and Health Inequalities - Roberto De Vogli, Ted Schrecker and Ronald Labonte Ageing and the Life Course - Tarani Chandola Social Capital - Orla McDonnell PART TWO: EXPERIENCE OF HEATH AND ILLNESS Medicalization - Jonathan Gabe Illness and Health-Related Behaviour - Lee F. Monaghan Stigma - Lee F. Monaghan and Simon J. Williams Embodiment - Simon J. Williams and Lee F. Monaghan Emotions - Gillian Bendelow Chronic Illness - Mike Bury and Lee F. Monaghan Disability - Nicholas Watson Illness Narratives - Mike Bury and Lee F. Monaghan Risk - Jonathan Gabe The Sick Role - Mike Bury and Lee F. Monaghan Practitioner-Client Relationships - Alison Pilnick Quality of Life - Mary Boulton Awareness Contexts - Lee F. Monaghan PART THREE: HEALTH, KNOWLEDGE AND PRACTICE Medical Model - Mike Bury Social Constructionism - Orla McDonnell Lay Knowledge - Gareth H. Williams Reproduction - Jane Sandall Medical Technologies - Alex Faulkner eHealth - Michael Hardey Geneticization - Rebecca Dimond and Jacqueline Hughes Bioethics - Clare Williams and Steven P. Wainwright Surveillance and Health Promotion - Sarah Nettleton PART FOUR: HEALTH WORK AND THE DIVISION OF LABOUR Medical Autonomy, Dominance and Decline - Mary Ann Elston and Jonathan Gabe Trust in Medicine - Jonathan Gabe Nursing and Midwifery as Occupations - Abbey Hyde Social Divisions and Formal Health Care - Catherine Theodosius Health Professional Migration - Ivy Lynn Bourgeault Complementary and Alternative Medicine - Michael Hardey Emotional Labour - Catherine Theodosius Informal Care - Sue Hollinrake PART FIVE: HEALTH-CARE ORGANIZATION AND POLICY Hospitals and Health Care Organizations - Per Maseide Privatization - Jonathan Gabe Managerialism - Jonathan Gabe Consumerism - Jonathan Gabe Citizenship and Health - Gareth H. Williams Social Movements and Health - Nick Crossley Medicines Regulation - Jonathan Gabe Evaluation - Nicholas Mays Malpractice - Jonathan Gabe

The Sociology of the health service

Introduction Jonathan Gabe, Michael Calnan, and Michael Bury 1. Medical Sociology and Health Policy: an Historical Overview Margaret Stacey 2. Privatisation in the British Health Service: a Challenge to the NHS John Mohan 3. The Politics of Professional Power: Medicine in a Changing Health Service Mary Ann Elston 4. Health Service Management - A Sociological View Griffiths and the Non-Negotiated Order of the Hospital David Cox 5. Evaluating the Outcomes of Health Care Angela Coulter 6. Recent Developments in General Practice: a Sociological Analysis Michael Calnan and Jonathan Gabe 7. Knowledge and Control in Health Promotion: a Test Case for Social Policy and Social Theory Alan Beattie 8. The Confused Boundaries of Community Care Hilary Land 9. The Agenda for Sociological Health Policy Research for the 1990s Margot Jefferys

Introduction: Sociological perspectives on the new genetics: an overview

We are at the dawn of a genetic age. The Human Genome Project, the largest biological research enterprise in history, promises to have our entire genetic structure mapped by 2001. Our media report new scientific claims of genes associated with diseases, conditions, behaviours or personality traits so regularly that it seems that we are being provided with a gene-of-theweek. Scientists have identified or claimed genes for cystic fibrosis, Huntington Disease, Fragile X syndrome, breast cancer, Alzheimer’s disease, colon cancer, bipolar illness, obesity, homosexuality, alcoholism, ‘novelty seeking’, shyness, bed wetting; the list gets longer weekly. James Watson, so-discoverer of the double helix structure of DNA and founding father of the Human Genome Project has declared, ‘We used to think our fate was in the stars. Now we know, in large part, it is in our genes’ (cited in Horgan 1993). The history of genetics is long and complex, encompassing numerous strands. In 1859 Gregor Mendel, an Austrian monk, discovered the rules of inheritance by doing carefully controlled breeding experiments with garden pea plants. In 1883 British scientist Frances Galton coined the term eugenics as ‘the science of improvement of the human race germplasm through better breeding’ (cited in Haller 1963: 3). For several decades eugenics thrived as both a form of ‘science’ and as a social movement. With the ‘rediscovery’ of Mendel’s laws at the turn of the century, the eugenic movement adopted a scientific mantle and prospered in both the US and UK. Attempts at eugenic hygiene included identifying ‘genetic defectives’, and controlling their procreation or assimilation into society through marriage and immigration laws as well as sterilisation of ‘undesirables’. In addition, eugenicists offered incentives for those deemed more generally fit (i.e. the upper classes) to increase their reproduction in order to improve the genetic stock. Prior to World War II, scientists and eugenicists proffered hereditarian theories of various diseases, conditions and behaviours. The eugenics movement flourished through the 30s, but eventually began to wane. Geneticists moved to separate themselves from the pseudo-science of eugenics, social scientists criticised the eugenicists’ faulty underlying assumptions, and the Nazis’

Voice or Choice? Patient and Public Involvement in the National Health Service in England under New Labour:

Involving patients, caregivers, and citizens in health care and health policy has been recommended by international organizations for over a decade. This article focuses on developments in England under New Labour, places them in the context of broader health policy, and assesses them in the light of the limited empirical evidence. The authors consider a range of possible explanations for these developments. They suggest that we need to distinguish between individual and collective forms of patient involvement, and they chart patient and public involvement in England before New Labour and in three distinct phases under New Labour. There has been a significant extension of opportunities for individual patients and the public to communicate their views, albeit with twists and turns in the policy over time. The authors explain these developments in terms of New Labours ideological attachment to pragmatism and the Third Way, political calculations about the need to reinvigorate political culture, and attempts to enhance cost-effectiveness. Patient and public involvement seems to be here to stay, but whether this will result in greater equity and a real shift in power away from professionals to citizens and patients is another matter.

Living with asthma: the experiences of young people at home and at school

This study is concerned with how young people with moderate to severe asthma live with and explain the disorder and manage the resulting symptoms. Based on in-depth interviews with 55 young people aged 11-16 living in West London, it shows that asthma restricted their lives at school and recreationally but that they were actively involved with their condition and its management. The study reveals that while prescribed medicines in the form of inhalers were used as the primary means of coping with asthma episodes, the young people were concerned about being dependent on such medicines, in line with more general ambivalence in late modern cultures about the long term use of prescribed medicines. It also demonstrates how social relations in particular contexts help to determine the extent to which asthma episodes can be managed.

The sociology of pharmaceuticals: progress and prospects

This paper takes a critical look at progress and prospects regarding the sociology of pharmaceuticals over the years. Key themes examined include: (i) medicalisation and pharmaceuticalisation; (ii) regulation; (iii) consumption and consumerism; (iv) expectations and innovation. Papers in the monograph are also introduced and discussed in relation to these themes. The paper concludes with some further comments and reflections on progress and prospects in this field, emphasising the continuing importance of sociological engagement with these personal and political issues in the 21(st) century.

Tranquillisers as a social problem

This paper attempts to highlight the value of the ‘social problem’ perspective for the sociology of health and illness by applying it to the issue of tranquilliser use and dependence. The approach involves focusing on the emergence of benzodiazepine tranquilliser dependence as a social problem and the extent to which it has been legitimated by the media and by the state. In the conclusion we draw out the implications of our case study for the development of a ‘natural history’ of social problems.

From Consumerism to Partnership? Britain's National Health Service at the Turn of the Century

It has been argued that “consumerism” has been one of the main influences on health policy in many countries over the last decade or so. This article focuses on the role of consumerism in U.K. health policy during this period through the introduction of changes in National Health Service provision such as introduction of the quasi-market, creation of the new managerialism, and new organizational structures set up under the recent Labour government. It considers the consequences of these changes for the users of health care and for citizenship rights, in particular the extent to which the changes have empowered these users and citizens.

Halcion Nights: A Sociological Account of a Medical Controversy

This paper offers an analysis of the events surrounding the suspension of the licence for the widely used sleeping tablet Halcion (triazolam) by the British Licensing Authority in October 1991. It is argued that these events highlight a growing crisis in modern medical treatments and in the social relations of health care. This is illustrated by focusing on four elements which have contributed to Halcion becoming a public issue and to its suspension and subsequent banning, namely the claims-making activities of medical experts, the development of legal challenges to medicine, the role of the media and the response of the state.

The contribution of physician assistants in primary care: a systematic review

BackgroundPrimary care provision is important in the delivery of health care but many countries face primary care workforce challenges. Increasing demand, enlarged workloads, and current and anticipated physician shortages in many countries have led to the introduction of mid-level professionals, such as Physician Assistants (PAs). Objective: This systematic review aimed to appraise the evidence of the contribution of PAs within primary care, defined for this study as general practice, relevant to the UK or similar systems.MethodsMedline, CINAHL, PsycINFO, BNI, SSCI and SCOPUS databases were searched from 1950 to 2010. Eligibility criteria: PAs with a recognised PA qualification, general practice/family medicine included and the findings relevant to it presented separately and an English language journal publication. Two reviewers independently identified relevant publications, assessed quality using Critical Appraisal Skills Programme tools and extracted findings. Findings were classified and synthesised narratively as factors related to structure, process or outcome of care.Results2167 publications were identified, of which 49 met our inclusion criteria, with 46 from the United States of America (USA). Structure: approximately half of PAs are reported to work in primary care in the USA with good support and a willingness to employ amongst doctors. Process: the majority of PAs’ workload is the management of patients with acute presentations. PAs tend to see younger patients and a different caseload to doctors, and require supervision. Studies of costs provide mixed results. Outcomes: acceptability to patients and potential patients is consistently found to be high, and studies of appropriateness report positively. Overall the evidence was appraised as of weak to moderate quality, with little comparative data presented and little change in research questions over time.Limitations: identification of a broad range of studies examining ‘contribution’ made meta analysis or meta synthesis untenable.ConclusionsThe research evidence of the contribution of PAs to primary care was mixed and limited. However, the continued growth in employment of PAs in American primary care suggests that this professional group is judged to be of value by increasing numbers of employers. Further specific studies are needed to fill in the gaps in our knowledge about the effectiveness of PAs’ contribution to the international primary care workforce.