Buried in the pedantic pages of this book is a pointed challenge to medicine. Simply stated, Freidson's view is that the medical profession has become too autonomous and too powerful for the good of society, and that it must therefore be regulated. Like the prominent medical sociologist he is, the author develops his argument through an exhaustive theoretical analysis. He begins with the formal organization of the profession and proceeds to the ways in which the performance of its work is organized and regulated. He denies that the knowledge required for clinical practice is so esoteric that it cannot be questioned by lay persons. The "clinical mentality" he finds to be characterized by action orientation and pragmatism. Physicians, he concedes, do have a service orientation as well, but he believes it to be not prominent and not a sufficient basis for claims to professional autonomy. Physicians expect to be allowed

Profession of Medicine: A Study of the Sociology of Applied Knowledge

Mass childhood immunisation (MCI) is of primary importance to all modern public health systems and relies on high levels of uptake. Recent controversy in the UK about the safety of the MMR (measles, mumps, and rubella) vaccine has prompted widespread concerns and a government response that concentrates on providing more information to the public. This information has mainly adopted the language of risk, as exemplified in recent health promotion materials designed to persuade parents to choose the MMR vaccine. The paper analyses the key material and reveals three contestable assumptions; first, that individuals make decisions through a comparison of individual risk; second, that public concern about vaccination is due to a miscalculation of risk; third, that a policy of providing more risk statistics is the best response to the controversy. Through criticising these assumptions it is argued that some resistance to MCI is about alternative understandings of basic categories of health and disease. Further re...

Understanding vaccination resistance: moving beyond risk

Complementary and alternative medicine (CAM) occupations continue to struggle towards achieving professional status, especially in the form of statutory regulation. Many consider professional status a worthwhile goal for CAM occupations, yet it is a process fraught with tensions. In this paper we present in-depth interview data from the leaders of three CAM groups (naturopaths, traditional Chinese medicine practitioners acupuncturists, and homeopaths) in Ontario, Canada that demonstrate four main strategies used by these groups to professionalize. The strategies discussed are related to how the knowledge base of each group is organised and transmitted. These strategies include: improving educational standards, improving practice standards, engaging in peer-reviewed research and increasing group cohesion. At the core of these strategies is the demarcation of who is qualified to practice, and a signalling to 'outsiders', such as medicine and the government, that practitioners are qualified and legitimate. Across the three groups, the leaders referred to the inclusion of medical science as a basis for distinguishing between 'science' and 'non-science' as well as who should practice and who should not. We highlight how internal battles over the infusion of medical science into the knowledge base are part of the process for establishing legitimacy for the three CAM groups in our study. We end with a brief discussion of the implications of these internal battles over medical science knowledge for the future of CAM groups.

Moving forward? Complementary and alternative practitioners seeking self-regulation.

Table of Contents - 6[-]1 Policy, People, and the New Professional: An Introduction - 8[-]PART I POLICY - 18[-] 2 The Rise of Contractualisation in Public Services - 20[-] 3 Evidence-Based Policy: From Answer to Question - 35[-] 4 Societal Neurosis in Health Care - 49[-] 5 When Ideologies Bounce Back: The Problematic Translation of Post-Multicultural Ideologies and Policies into Professional Practices - 65[-]PART II PEOPLE - 80[-] 6 Safe Neighbourhoods - 82[-] 7 When Diversity Matters - 98[-] 8 From Residents to Neighbours: The Making of Active Citizens in Antwerp, Belgium - 110[-] 9 Authority, Trust, Knowledge and the Public Good in Disarray - 123[-]PART III PROFESSIONALS - 136[-] 10 Heroes of Health Care?: Replacing the Medical Profession in the Policy Process in the UK - 138[-] 11 Tensions in Medical Work between Patients' Interests and Administrative and Organisational Constraints - 153[-] 12 Empowerment of Social Services Professionals: Strategies for Professionalisation and Knowledge Development - 165[-] 13 Professional Management of Professional: Hybrid Organisations and Professional Management in Care and Welfare - 182[-]About the contributors - 195[-]References - 198[-]Index - 218

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Policy, People, and the New Professional : De-professionalisation and Re-professionalisation in Care and Welfare

Variations in provider conceptions of integrative medicine.

The purpose of this study is to assess the ways in which homeopathic physicians deal with the conceptual tensions between homeopathy and biomedicine The data-collection included twenty semi-structured interviews which were conducted with homeopathic physicians in Berlin Three distinct patterns of homeopathic practice emerged from the data: a) segregating the patients into categories of homeopathic and biomedical patients; b) complementing a predominantly homeopathic practice with a few biomedical strategies for diagnostics; c) focusing on homeopathy and condemning biomedicine with the exception of emergency medicine and surgery

 On the level of medical knowledge the physicians’ perspectives on the efficacy of homeopathy and some of its controversial concepts (opposition to vaccinations, miasm, vital force) are examined It also becomes evident that German homeopathic physicians do not sacrifice central aspects of homeopathic concepts in order to gain legitimacy

 Finally, it is argued that complementary medicine and alternative medicine are both rather unfortunate terms for studying homeopathy in micro-sociological settings Heterodox medicine is favoured

Robert Frank

Papers

Integrating homeopathy and biomedicine: medical practice and knowledge production among German homeopathic physicians