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Analysing social reconstructions of health knowledge
Fran Collyer
Department of Sociology & Social Policy, University of Sydney, NSW
Abstract
At one level, my paper is a straightforward case study of the discovery of a tiny micro-organism, helicobacter pylori, by a couple of Australian scientists, and how this new piece of medical knowledge upset orthodox knowledge about the cause, and treatment, of stomach ulcers.
Basically, the story is that orthodox medical knowledge has long explained stomach ulcers as the consequence of overeating and over-indulgence of alcohol or drugs. When the two Australian's identified helicobacter pylori at the site of many stomach ulcers, they argued that ulcers are not caused by an excess of acid in the stomach, but by the action of a micro organism which infects the stomach, eats away at the mucosal lining, and causes the stomach to produce extra gastric acids. From their research observations, the Australian's recommended that antibiotics rather than antacids be given to treat patients with stomach ulcers.
Apart from being an interesting historical case study, the paper is also about social constructionism. It uses social constructionism to explain the widespread resistance to the acceptance of new medical knowledge, and the lack of change in the clinical treatment of ulcers. The paper then goes on to examine some of the limits of social constructionism.
All three papers in this symposium share a similar challenge of accounting for `material reality'. A few years ago, Bryan Turner argued that `the body' had been treated as a residual category in the development of sociological theory, and that there was a need for a `conception of the embodied actor which will transcend the all-pervasive Cartesian division of mind-body' (Turner, 1992:8,91). In my paper I argue that social constructionism is, at best, ambiguous in the way it takes into account material reality. In this, the paper does not disagree with the general thrust of Gillian Hatt's paper on low blood pressure, which argues for a social constructionism that acknowledges the embodied basis of medical knowledge (Hatt, 1996); nor with Catherine Garrett's paper on anorexia, which proposes that dualistic metaphors of the body - the socially constructed, `outward' body and the inward `natural', private body - can be used to further our understanding of anorexia and as a therapy to heal and overcome anorexia (Garrett,1996).
However, my paper diverges from the other two in two particularly significant ways. The first is that it is fundamentally a structuralist rendition of the historical shaping of medical knowledge. Both Catherine's and Gillian's papers offer cultural accounts of these processes. I have no quarrel with the idea that physicians use embodied knowledge in their clinical decisionmaking, nor with the idea that culture creates differences in the therapies used worldwide, nor even with the idea that people use cultural resources such as metaphors to provide strategies for recovery. However, I maintain that there are larger, more powerful forces at work that frame, limit, fracture, and structure these cultural resources.
My case study documents these social forces. It argues that the discovery of helicobacter pylori was not at all welcomed by the international drug companies, who's top selling medications were ant-acids. Antacid preparations were, and continue to be, a multi-billion dollar global industry. The pharmaceutical companies, even 16 years later, continue to maintain that stomach ulcers are biochemical disorders, and ulcers result from the overproduction of gastric acids and from bad dietary habits.
The case study goes on to identify other forms of resistance to the new theory, including the scientific community and the medical profession. I argue that the hierarchical organisation of medicine impeded the acceptance of the new knowledge, because it challenged the existing knowledge and practices of highly regarded specialists.
References
Collyer, FM. (1996) 'Understanding Ulcers: Medical Knowledge, Social Constructionism, and
Helicobacter Pylori.' Annual Review of Health Social Sciences, December, pp. 1-39.
Hatt, G. (1996) '"Feeling Low": The Emergence of a Concept of Low Blood Pressure and the
Representation of an Embodied Identity' Annual Review of Health Social Sciences,
December, pp. 57-80.
Garrett, C. (1996) 'Remaking The Self Through Metaphor: Recovery From Anorexia Nervosa'
Annual Review of Health Social Sciences December, pp. 139-56.
Moerman, D. (1983) 'General Medical Effectiveness and Human Biology: Placebo Effects in
the Treatment of Ulcer Disease' Medical Anthropology, Quarterly 14 (3) pp. 14-6.
Turner, BS. (1992) Regulating Bodies: Essays in Medical Sociology London, Routledge.
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