CH. 3

One of the most striking aspects of this chapter is the extent to which social inequity and class systems factored into the history of medical practitioners. On one level, you have the struggle of practitioners for legitimacy in their profession. With any physician being able to practice regardless of a standardized education or document, physicians as a whole were relegated to a lower class with the exception of those elite who managed to rope in high-paying clients. It is interesting that despite the fact that their lack of a unified standard kept them at a low scale of security and respect, physicians from the three distinct classes were divided on their support of formalizing one and with very different motivations.

As Starr described, the sectarian physicians and physicians without licenses or diplomas were against standardization for fear that it would exclude them. Elite physicians opposed it in order to maintain their social status by maintaining "lower" untrained physicians in the pool. But only physicians in the middle--those with legitimate degrees, but less clientele--fought for standardization. The objective is clear: only those in the middle would benefit by reducing competition for the average citizen by cutting out physicians without legitimate degrees while elevating their qualifications to the same level as their more successful colleagues.

But the irony of the social status debacle is not lost on me. On the whole, physicians were struggling to stabilize their standing socially and professionally. However, the fragmented social hierarchy within their profession was at odds, with most objecting to the one move that would secure the profession stability and legitimacy in the long run.

And yet, these divisions were masked form the public to maintain the facade of unified perspective in the field. In many ways, this is the perception that the public still has today about medical research and health provision. The interesting change in our current society seems to be that any division that might exist within the field is enjoyed less because of the actual debate on research or perspective, but because of its conflict. We live in an era where the existence of differing viewpoints is viewed as far more interesting than the actual viewpoints themselves. "Scientific" journalism (or what passes for it these days) seems to have trouble differentiating between legitimate differences in health perspectives and those that are on the fringe.

However, I wonder how one might categorize the division between the medical society and the homeopathic movement that Starr wrote about. In this instance, the fractured profession seemed unified in its derision of the homeopathic philosophy. Even these seem to be tied in subtle ways to class and social standing. As Starr points out, homeopathy emphasized above all else, the testimony of the patient and an empathetic attention and treatment. This support of the patient as an elevated individual rather than another patient to be quickly diagnosed highlights other ways in which social status of the physician (which had its own intra-level dynamics) interacted with the social status of the patient.

Very cool.