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Medical Dominance Then and Now
Critical Reflections
David Coburn
Professor Emeritus, School of Public Health Sciences, University of Toronto, Canada
Abstract
The publication of Evan Willis's notable book on medical dominance coincided with the appearance of similar Anglo-American accounts.
Now, there are retrospectives on medical power. Why then and why now? Professional power was central because health care was the focus of political discussion at the time but is now less important vis-a-vis political struggles over neo-liberalism. Freidson played a key role in bringing medical power into focus. Medicine is also less sociologically prominent now because, it is in fact less powerful than it was. There is a convergence between the power of the traditional professions and that of numerous other expert occupations.
Despite assumptions to the contrary it is noted that neither the linkages of knowledge / expertise / power nor the existence of putatively self-regulatory organizations is sufficient to ensure professional dominance or control. Closure theory, the pre-eminent approach in the area of the professions cannot adequately explain these changes in medical power. Rather, both challenges to medical power and the changing salience of medical dominance within sociology can be illuminated using the type of political economy approach which Evan Willis helped to pioneer.
Keywords
medical dominance, sociology of health, political economy
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