Medicine and Sociology of Health

By Mbuso Mabuza

This book aims to critically examine the contribution of the discipline of sociology and a number of theoretical sociological perspectives, from classical to postmodern to our understanding of health, illness and medicine. Specifically, the broad areas covered in this book include: critical perspectives on key sociological theories and themes in the sociology of health and illness including the profession of medicine, doctor-patient relationships, medicalisation, challenges to biomedicine, lay perspectives and beliefs, contemporary aspects such as health promotion, the new genetics, and complementary and alternative medicine. It is my hope that this book will enable you the reader to reflect critically on the sociological perspectives and concepts to your own context and experience of health, medicine, illness and public health practice. The intriguing discussions are organised in the following chapters: introduction - the history and philosophy of medicine; key concepts in sociology - an introduction; sociological theory - from classical to modern; sociological theory - critical and contemporary perspective; doctors, nurses and patients - working for health; challenging the ;medical model' - lay perspectives and the contribution of sociology; health promotion and sociology; complementary and alternative medicine (CAM); Sociology and the "New Genetics".

• Language: English
• Publisher: Mbuso Mabuza
• Release date: Sep 1, 2022
• ISBN: 9798201700355

Mbuso Mabuza

Dr Mbuso Mabuza is a highly motivated and multi-skilled international public health professional who has served in the public and private sectors of different countries. He has served as a prevention specialist at the Johns Hopkins Bloomberg School of Public Health, and as a consultant at the World Bank, among others. His mission is to improve health outcomes and to expand quality healthcare experiences amongst all groups of people and influence change and innovation.

Book preview

Preface

This book aims to critically examine the contribution of the discipline of sociology and a number of theoretical sociological perspectives, from classical to postmodern to our understanding of health, illness and medicine. Specifically, the broad areas covered in this book include: critical perspectives on key sociological theories and themes in the sociology of health and illness including the profession of medicine, doctor-patient relationships, medicalization, challenges to biomedicine, lay perspectives and beliefs, contemporary aspects such as health promotion, the new genetics, and complementary and alternative medicine (CAM).

It is my hope that this book will enable you the reader to reflect critically on the sociological perspectives and concepts to your own context and experience of health, medicine, illness and public health practice.

This book will be a valuable resource for health professionals (both allopathic and complementary medicine), health programmers, health economists, researchers, policymakers, medical students, undergraduate and postgraduate students in population and public health, social science, political science, law, public policy and related disciplines, and the general public.

Dr Mbuso Mabuza

Global Health, Medicine and International Public Health Consultant

Chapter 1

Introduction: The History and Philosophy of Medicine

The philosophy of medicine is not a subject to which much attention is paid in medical schools. Medical students during their long professional training are required to assimilate and retain an ever-increasing number of facts about an extraordinary variety of diseases. Their time is more than fully occupied in acquiring enough knowledge to satisfy their examiners; and most accept the way that medicine is currently practiced without questioning the basic assumptions upon which that practice is based.

When students become qualified doctors, the majority will lead extremely busy lives in which practical problems of diagnosis and treatment will leave little time for reflection. Even if they go into research rather than clinical work, it is probable that their pursuit of knowledge will be governed by existing paradigms.

In Western countries, scientific medicine, during the 20th century and this first part of the 21st century, has been immensely successful. The majority of infections have been conquered by a combination of immunisation and antibiotics. Diseases which used to be fatal, like pernicious anaemia and diabetes, have become readily treatable. Infant mortality has been greatly reduced, and the hazards of childbirth diminished. Yet much remains to be done.

Genetic engineering holds out the promise that many genetic defects can be prevented or modified. There are still crippling, chronic diseases, like multiple sclerosis and rheumatoid arthritis, which can be neither prevented nor effectively treated. The mysteries of the body’s own protective immune system have yet to be fully unravelled. It is certain that the next fifty years will bring forth as many exciting scientific advances as the past fifty years have done.

With so much to do, and so much evidence to show that current methods of investigation are fruitful, it might be argued that preoccupation with the philosophy of medicine is otiose. One of the virtues of this challenging, clearly argued book is that it persuades one that the opposite is true. The author, a physician, bio-chemist, and international public health specialist believes that medicine has entered a new phase in which basic assumptions have been questioned.

The author affirms Thomas Kuhn’s observation that medicine has now entered upon a period of ‘paradigmatic instability’. That is, it is a period in which doctors need to look at what they are doing afresh, and to reconsider their roles and responsibilities toward their patients and society.

So when did the practice of medicine begin? And who were the first doctors? While there are no straightforward answers to these questions, there is evidence from primitive societies that ‘treatments’ were attempted for common conditions, although often superstition and religious beliefs would be intermingled with these. We do know that from ancient Egyptian times (from around 3000 BC) there were ‘doctors’ and in this context the medical practitioner Imhotep (around 2600 BC) produced a written work chronicling over 200 different medical conditions.

Hippocrates (born 460 BC) is widely credited as being the father of modern medicine. One of his huge contributions in advancing the field was the insight into the fact that diseases could have natural (rather than supernatural) causes. Also of enormous significance was his oath of conduct for physicians which is still used worldwide today. Famous doctors from the Roman world include Galen who dissected primates and attempted to extrapolate findings to the human body, although with limited success. Advances in public health were also important during this period, including some of the first sewage systems.

In medieval times, medical practices virtually unrecognisable today were commonplace. For example, bleeding those who were ill was seen as helpful in a wide range of conditions as was the administration of laxatives. Predominant in this time was the notion that the church had a duty to care for the sick with many hospitals being built.

However, the term ‘doctor’ itself did not arise until the 14th century in Britain and was typically used to refer to theologians and those who could ‘teach’. Leonardo da Vinci, working in the 15th century contributed greatly to our understanding of human anatomy, with detailed sketches produced after careful dissection of human corpses. An important discovery in the 17th century was made by the well-known physician William Harvey – (that the heart pumps blood round the body). The idea of the four humours in the body – blood, phlegm, yellow bile, and black bile still predominated however, with much illness attributed to an imbalance in these.

Moving forward, the 19th century saw many advances, although to current day thinking many common practices of the era seem barbaric. This was the age of the first uses of anaesthetics, of the ‘germ theory of disease’, the first vaccines and also the first woman to be awarded a medical degree.

Right at the turn of the last century blood groups were identified, paving the wave for improvements in transfusion. The introduction of vaccines for conditions such as diphtheria, tuberculosis and vitally the development of antibiotics has revolutionised medicine. With the decrease in conditions that had previously decimated populations came the rise in diseases more rooted in lifestyle – diabetes, heart conditions and cancer.

The genetic, and laterally genomic era, along with the developments in reproductive technologies (the first ‘test tube’ baby was born in 1978) promise to again revolutionise health care, although this may come at a high economic cost (University of Glasgow, 2020).

Where are we now?

Genetic discoveries are revolutionizing medicine today.

Research continues to move medical science forward. Some of the areas that scientists are working on now include:

Targeted cancer therapy: Doctors are starting to use a new class of drug called biologics to treat cancer and other diseases. Unlike conventional chemotherapy, which can destroy fast-growing healthy cells, these drugs target specific proteins on cancer cells and cause less damage to the whole body.

HIV treatment: The effectiveness of HIV treatment is now such that people who take the medication regularly will not pass on the virus. The amount of the virus in their blood, known as viral load, is almost zero.

Stem cell therapy: Scientists are working on making human tissue and even whole organs from stem cells. This technique could one day help in treatments ranging from wound healing to prosthetics and replacement livers.

Gene therapy: A type of genetic engineering known as CRISPR gene editing may make it possible in the future to prevent genetic and inherited conditions, such as heart disease, leukaemia, cystic fibrosis, and haemophilia.

Robotics: Robotics and remote-controlled tools can already help surgeons carry out certain types of procedure. One day, surgeons may carry out all operations by controlling the movements of a surgical robot while looking at a