SOCIOLOGY G/290

 

“Sociology of Health, Illness, and Biomedicine”

 

Spring 2000

 

Wednesdays, 11:15 am – 2:15 pm

SSB 101

 

 

Professor Steven Epstein

Department of Sociology

University of California, San Diego

858-534-0489

sepstein@ucsd.edu

http://weber.ucsd.edu/~sepstein

 

Office hours: Mon & Tue, 2:00-3:00 pm

 

 

 

This course is intended to provide an introduction to central topics in the sociology of medicine, health, and illness. At the same time, an important goal is to suggest how that field is being redefined and reinvigorated by social and cultural studies of science and technology. Although many of the themes we will address have a long history, the emphasis will be on recent scholarship—most of it sociological, but some of it drawn from anthropology, history, and cultural studies. The course focuses more-or-less exclusively on the United States in the 20th and 21st centuries.

 

We will seek to understand biomedicine by exploring multiple domains: the market relations that commodify health care; the work sites in which medical practice is articulated; the research arenas that transform medical knowledge, practice, and technologies; the systems of cultural meaning within which ideas of health and disease circulate; the social inequalities that structure the experience of illness and access to care; the social movements that challenge biomedical authority and expertise; and the bodies and selves that experience and are remade by illness.

 

All readings are contained in a course reader which is available for purchase at Cal Copy in its new location:  3251 Holiday Ct. #103 (off of Villa La Jolla Drive between La Jolla Village Drive and Nobel Drive; phone 858-452-9949).

 

            Students are expected to submit a paper by Wednesday, June 14 on a topic approved by the instructor no later than the end of Week 5. In addition, each student (including auditors) will be asked to circulate discussion questions in advance of two class meetings.

 

SCHEDULE OF READINGS

 

 

WEEK 1 (April 5): Introduction

 

 

WEEK 2 (April 12): Health Disparities and the Embodiment of Inequalities

 

Read any six:

 

Bruce J. Link and Jo Phelan, “Social Conditions as Fundamental Causes of Disease,” Journal of Health and Social Behavior 1995 (extra issue): 80-94.

 

Richard G. Wilkinson, “National Mortality Rates: The Impact of Inequality?” in Perspectives in Medical Sociology, 2nd ed., ed. Phil Brown (Prospect Heights, IL: Waveland 1996), 76-82.

 

Chloe E. Bird and Patricia P. Rieker, “Gender Matters: An Integrated Model for Understanding Men’s and Women’s Health,” Social Science & Medicine 48 (1999): 745-755.

 

Will H. Courtenay, “Constructions of Masculinity and their Influence on Men’s Well-Being: A Theory of Gender and Health,” Social Science & Medicine 50 (2000): 1385-1401.

 

David R. Williams, “Race and Health: Basic Questions, Emerging Directions,” Annals of Epidemiology 7, no. 5 (July 1997): 322-333.

 

Nancy Krieger, “Embodying Inequality: A Review of Concepts, Measures, and Methods for Studying Health Consequences of Discrimination,” International Journal of Health Services 29, no. 2 (1999): 295-352.

 

Jennifer Terry, “Agendas for Lesbian Health: Countering the Ills of Homophobia,” in Revisioning Women, Health, and Healing: Feminist, Cultural, and Technoscience Perspectives, ed. Adele E. Clarke and Virginia L. Olesen (New York: Routledge, 1999), 324-342.

 

 

WEEK 3 (April 19): Constructing  Illness, Medicalizing Society

 

Read any six:

 

Peter Wright and Andrew Treacher, “Introduction,” in The Problem of Medical Knowledge: Examining the Social Construction of Medicine, ed. Peter Wright and Andrew Treacher (Edinburgh: Edinburgh University Press, 1982), 1-22.

 

Phil Brown, “Naming and Framing: The Social Construction of Diagnosis and Illness,” in Perspectives in Medical Sociology, 2nd ed., ed. Phil Brown (Prospect Heights, IL: Waveland 1996), 92-122.

 

Elizabeth M. Armstrong, “Diagnosing Moral Disorder: The Discovery and Evolution of Fetal Alcohol Syndrome,” Social Science & Medicine 47, no. 12 (1998): 2024-2042.

 

Paula A. Treichler, How to Have Theory in an Epidemic: Cultural Chronicles of AIDS (Durham, NC: Duke University Press, 1999), 11-41 (Chapter 1: “AIDS, Homophobia, and Biomedical Discourse: An Epidemic of Signification”).

 

Paul A. Martin, “Genes as Drugs: The Social Shaping of Gene Therapy and the Reconstruction of Genetic Disease,” in Sociological Perspectives on the New Genetics, ed. Peter Conrad and Jonathan Gabe (Oxford: Blackwell, 1999), 15-35.

 

Hilary Arksey, “Expert and Lay Participation in the Construc­tion of Medical Knowledge,” Sociology of Health & Illness 16, no. 4 (1994): 448-468.

 

Peter Conrad, “Medicalization and Social Control,” Annual Review of Sociology 18 (1992): 209-232.

 

Margaret Lock, “Anomalous Ageing: Managing the Postmenopausal Body,” Body & Society 4, no. 1 (1998): 35-61.

 

Eugenia Kaw, “Medicalization and Racial Features: Asian American Women and Cosmetic Surgery,” Medical Anthropology Quarterly 7(1991): 74-89.

 

Stuart S. Blume, “Histories of Cochlear Implantation,” Social Science & Medicine 49 (1999): 1257-1268.

 

 

WEEK 4 (April 26): Constructing Medical Objects and Subjects

 

Read any six:

 

Byron J. Good and Mary-Jo DelVecchio Good, “‘Learning Medicine’: The Constructing of Medical Knowledge at Harvard Medical School,” in Knowledge, Power, and Practice: The Anthropology of Medicine and Everyday Life, ed. Shirley Lindenbaum and Margaret Lock (Berkeley: University of California Press, 1993), 81-107.

 

Stefan Hirschauer, “The Manufacture of Bodies in Surgery,” Social Studies of Science 21, no. 2 (May 1991): 279-319.

 

Monica J. Casper, The Making of the Unborn Patient: A Social Anatomy of Fetal Surgery (New Brunswick, NJ: Rutgers University Press, 1998), 106-134 (Chapter 4: “Working on (and around) the Unborn Patient: Negotiating Social Order in a Fetal Treatment Unit”).

 

Stefan Timmermans, “Mutual Tuning of Multiple Trajectories,” Symbolic Interaction 21, no. 4 (1998): 425-440.

 

Marc Berg and Geoffrey Bowker, “The Multiple Bodies of the Medical Record: Toward a Sociology of an Artifact,” The Sociological Quarterly 38, no. 3 (1997): 513-537.

 

Danièle Carricaburu and Janine Pierret, “From Biographical Disruption to Biographical Reinforcement: The Case of HIV-Positive Men,” Sociology of Health & Illness 17, no. 1 (1995): 65-88.

 

Suzanne J. Kessler, Lessons from the Intersexed (New Brunswick, NJ: Rutgers University Press, 1998), 12-32 (Chapter 2: “The Medical Construction of Gender”).

 

Charis M. Cussins, “Quit Sniveling, Cryo-Baby. We’ll Work Out Which One’s Your Mama!” in Cyborg Babies: From Techno-Sex to Techno-Tots, ed. Robbie Davis-Floyd and Joseph Dumit (New York: Routledge, 1998), 40-66.

 

 

WEEK 5 (May 3): Trust, Authority, and Expertise in Medicine

 

**PAPER TOPICS DUE BY END OF WEEK**

 

Read any six:

 

Paul Starr, The Social Transformation of American Medicine (New York: Basic Books, 1982), 9-17 (“The Roots of Authority”).

 

Renée R. Anspach, Deciding Who Lives: Fateful Choices in the Intensive Care Nursery (Berkeley: University of California Press, 1993), 55-84 (Chapter 3: “Predicting the Future: Why Physicians and Nurses Disagree”).

 

Kathryn M. Taylor, “Physicians and the Disclosure of Undesirable Information,” in Biomedicine Examined, ed. Margaret Lock and Deborah R. Gordon (Dordrecht: Kluwer, 1988), 441-463.

 

Peter Conrad, “The Meaning of Medications: Another Look at Compliance,” in Dominant Issues in Medical Sociology, ed. Howard D. Schwartz (New York: Random House, 1987), 209-220.

 

Sue Fisher, In the Patient’s Best Interest: Women and the Politics of Medical Decisions (New Brunswick, NJ: Rutgers University Press, 1986), 29-58 (Chapter 2: “No More Uterus, No More Babies: How Language Functions in Medical Discourse”).

 

Richard Gwyn and Glyn Elwyn, “When is a Shared Decision not (Quite) a Shared Decision? Negotiating Preferences in a General Practice Encounter,” Social Science & Medicine 49, no. 4 (August 1999): 437-447.

 

Deborah Lupton, “Consumerism, Reflexivity and the Medical Encounter,” Social Science & Medicine 45, no. 3 (1997): 373-381.

 

 

WEEK 6: Standards and Protocols: The Art and Science of Medical Decision Making

 

**CLASS TO BE RESCHEDULED FOR MONDAY MAY 8 OR TUESDAY MAY 9. EPSTEIN OUT OF TOWN MAY 10-15.**

 

Deborah R. Gordon, “Clinical Science and Clinical Expertise: Changing Boundaries Between Art and Science in Medicine,” in Biomedicine Examined, ed. Margaret Lock and Deborah R. Gordon (Dordrecht: Kluwer Academic Publishing, 1988), 257-295.

 

Marc Berg, Rationalizing Medical Work: Decision-Support Techniques and Medical Practices (Cambridge, MA: MIT Press, 1997), 79-102 (Chapter 3: “Getting a Tool to Work: Disciplining a Practice to a Formalism”).

 

Stefan Timmermans and Marc Berg, “Standardization in Action: Achieving Local Universality through Medical Protocols,” Social Studies of Science 27 (1997): 273-305.

 

Monica J. Casper and Adele E. Clarke, “Making the Pap Smear into the ‘Right Tool’ for the Job: Cervical Cancer Screening in the USA, circa 1940-95,” Social Studies of Science 28, no. 2 (April 1998): 255-290.

 

Geoffrey C. Bowker and Susan Leigh Star, Sorting Things Out: Classification and Its Consequences (Cambridge, MA: MIT Press, 1999), 107-133 (Chapter 3: “The ICD as Information Infrastructure”).

 

 

WEEK 7 (May 17): Clinical Trials and the Politics of Ethics and Objectivity

 

Harry M. Marks, The Progress of Experiment: Science and Therapeutic Reform in the United States, 1900-1990 (Cambridge: Cambridge University Press, 1997), 129-163 (“Of methods and institutions, or the triumph of statistics”; and “Managing chance: Statistics and therapeutic experiments, 1950-1960).

 

Evelleen Richards, “The Politics of Therapeutic Evaluation: The Vitamin C and Cancer Controversy,” Social Studies of Science 18 (1988): 653-701.

 

Steven Epstein, “Activism, Drug Regulation, and the Politics of Therapeutic Evaluation in the AIDS Era: A Case Study of ddC and the ‘Surrogate Markers’ Debate,” Social Studies of Science 27, no. 5 (October 1997): 691-726.

 

Monica J. Casper, The Making of the Unborn Patient: A Social Anatomy of Fetal Surgery (New Brunswick, NJ: Rutgers University Press, 1998), 135-167 (Chapter 5: “Clinical Trials in Fetal Surgery: Making, Protecting, and Contesting Human Subjects”).

 

 

WEEK 8 (May 24): Risk, Uncertainty, Testing

 

Deborah Lupton, The Imperative of Health: Public Health and the Regulated Body (London: Sage, 1995), 77-105 (Chapter 3: “Taming Uncertainty: Risk Discourse and Diagnostic Testing”).

 

Susan Markens, C.H. Browner, and Nancy Press, “‘Because of the Risks’: How US Pregnant Women Account for Refusing Prenatal Screening,” Social Science & Medicine 49 (August 1999): 359-369.

 

Rayna Rapp, Testing Women, Testing the Fetus: The Social Impact of Amniocentesis in America (New York: Routledge, 1999), 53-77 (Chapter 3: “The Communication of Risk”).

 

Troy Duster, Backdoor to Eugenics (New York: Routledge, 1990), 37-57 (Chapter 3: “The Genetic Screening of ‘Target’ Populations”).

 

Dorothy Nelkin, “The Social Dynamics of Genetic Testing: The Case of Fragile-X,” Medical Anthropology Quarterly 10, no. 4 (1996): 537-550.

 

Stefan Timmermans and Valerie Leiter, “The Redemption of Thalidomide: Standardizing the Risk of Birth Defects,” Social Studies of Science 30, no. 1 (February 2000): 41-71.

 

 

WEEK 9 (May 31): Health Activism, Body Politics, and the Transformation of Biomedical Research

 

Mark A. Chesler, “Mobilizing Consumer Activism in Health Care: The Role of Self-Help Groups,” Research in Social Movements, Conflicts and Change 13 (1991): 273-305.

 

Judith D. Auerbach and Anne E. Figert, “Women’s Health Research: Public Policy and Sociology,” Journal of Health and Social Behavior (Extra issue, 1995): 115-31.

 

Steven Epstein, “The Construction of Lay Expertise: AIDS Activism and the Forging of Credibility in the Reform of Clinical Trials,” Science, Technology, & Human Values 20, no. 4 (Autumn 1995): 408-437.

 

Patricia A. Kaufert, “Women, Resistance, and the Breast Cancer Movement,” in Pragmatic Women and Body Politics, ed. Margaret Lock and Patricia A. Kaufert (Cambridge: Cambridge University Press, 1998), 287-308.

 

Diane E. Goldstein, “Communities of Suffering and the Internet,” forthcoming in Health 4, no. 3 (2000): 309-323.

 

 

WEEK 10 (June 7): The New Political Economy of Health: “Providers,” “Consumers,” and Corporations

 

Robert Kuttner, “The American Health Care System: Health Insurance Coverage,” New England Journal of Medicine 340, no. 2 (14 January 1999): 163-168.

 

Peter Conrad and Phil Brown, “Rationing Medical Care: A Sociological Reflection,” in Health, Illness, and Healing, ed. Kathy Charmaz and Debora A. Paterniti (Los Angeles: Roxbury, 1999), 582-590.

 

Carroll L. Estes, Charlene Harrington, and Solomon Davis, “The Medical-Industrial Complex,” in Health Policy and Nursing, ed. Charlene Harrington and Carroll L. Estes (Boston: Jones and Bartlett, 1994), 54-69.

 

Donald W. Light, “Countervailing Power: The Changing Character of the Medical Profession in the United States,” in Perspectives in Medical Sociology, 2nd ed., ed. Phil Brown (Prospect Heights, IL: Waveland 1996), 650-664.

 

Jerome P. Kassirer and Marcia Angell, “The High Price of Product Endorsement,” New England Journal of Medicine 337, no. 10 (4 September 1997): 700.

 

Alan F. Holmer, “Direct-to-Consumer Prescription Drug Advertising Builds Bridges Between Patients and Physicians,” JAMA 281, no. 4 (27 January 1999): 380.

 

Matthew F. Hollon, “Direct-to-Consumer Marketing of Prescription Drugs: Creating Consumer Demand,” JAMA 281, no. 4 (27 January 1999): 382.

 

David Shenk, “Money + Science = Ethics Problems on Campus,” The Nation, 22 March 1999, 11-18.

 

Daniel M. Fox, “Comment: Epidemiology and the New Political Economy of Medicine,” American Journal of Public Health 89, no. 4 (April 1999): 493-496.

 

Theda Skocpol, “The Rise and Resounding Demise of the Clinton Health Plan,” Health Affairs 14 (Spring 1995): 66-85.

 

 

**Papers due Wednesday, June 14**