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January 2, 2005
The quote below is from an article in the latest issue Monthly Review. The article by Anderson, Smith, and Sidel is entitled, What is social medicine?. The authors are connected to the Social Medicine Website.
Social medicine is what arises from the critique of a modernist biomedicine---the workings of power and culture in the biomedicine; illness as disease; the body-cure of biological medicine; and bio-medicine's power to define disease and the self and to manage relationships and lives. We live under this medical gaze, and we resist and rebel against it, even as we are shaped by it's knowledge/power.
In many ways this critique involves us beginning to grasp what is happening when it is almost over,and when it is difficult to change it.Social medicine is best seen a counter discourse to bio-medicine; one that recognizes the way that social and economic conditions profoundly impact health, disease, and the practice of medicine; that the health of the population is a matter of social and political concern concern and that society should promote the health of the population through both individual and social means.
Though the Anderson, Smith, and Sidel article refers to the US, its introductory paragraph gives a good account of the way that medicine is changing in Australia.
It says:
"The past two decades have seen a rapid expansion of the corporate agenda in the field of health and health care. Rather than moving toward a system of universal access to medical care in the United States, the access to and quality of clinical services is being turned over increasingly to the insurance industry. Patients are now "clients" and clinical services are "product lines." More clinical research is now funded by the pharmaceutical industry than the National Institutes of Health; pharmaceutical dollars pay the salaries of top academics and set the national research agenda. Clinicians and patients alike are wooed by sophisticated advertising campaigns (often disguised as education) that promote expensive drugs of dubious efficacy. The insertion of "market rationality" into health care has not brought the hoped for curbing of health care costs. The United States, despite spending more per capita on medical care than any other country in the world, continues to perform poorly on many health indicators, with a life expectancy at birth that ranks twenty-seventh in the world."
The idea that is increasingly gaining hold is one of a neo-liberal mode of governance using market instruments to provide the answer to our current healthcare problems.
Anderson, Smith, and Sidel say that two decades of market reform in U.S. health care have not given all Americans affordable, quality health care nor is it likely to do so. They say that United States’ health problems will not be solved by more of the same—more doctors, more medicines, more quality control initiatives, more computers, more audits, and faster discharge times.
They say a fundamental rethinking of the social role of medicine is required because the neoliberal mode of governing health is orientated to disease-specific understanding of health not social medicine.
What this article does show is the way that medicine, technology, and society, markets and subjects are connected together, thereby highlighting the importance of the governmentality approach.
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