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Medical sociologists have much to gain by bringing in global health. In this article, I make the case for expanding our field by furthering sociological perspectives on global health. I reflect on my career, the influence of scholar-activist mentors, and my contributions to the development of scholarship about medicalization, narrative, and global health in medical sociology. First, I focus on medicalization, its relationship to biomedicalization and pharmaceuticalization, and critiques of the medicalization of global health. Second, I analyze the narrative turn in studies of illness experiences and the inclusion of visual materials as an integral part of narrative studies of illness. Third, I explore global health and show examples of bodies of knowledge that medical sociologists are building. Although I present each as a distinct area, my discussion illustrates how the three areas are intertwined and how my contributions to each traverse and build connections among them. [ABSTRACT FROM AUTHOR]

This paper reviews the author's experience in becoming a medical sociologist before the field had become formalized. The contributions to medical sociology of sociologist Selden D. Bacon and physician and medical educator William R. Willard are described. The relationship of medical sociology to medical behavioral science, as experienced at the University of Kentucky, is discussed. Finally, the thesis of the author's 1957 paper on the nature and status of medical sociology is re-examined. [ABSTRACT FROM AUTHOR]

This paper addresses current contentions that medical sociology is handicapped as both a scholarly and a policy science by its subordinate relationship to the more powerful field of medicine. An analysis of all research articles published in the JOURNAL OF HEALTH AND SOCIAL BEHAVIOR which focus upon patients reveals the following: (1) the presence, in the majority, of implicit and explicit medical value assumptions influencing all stages of the research process, from the definition of problems and variables through the application of findings to health policy; (2) a tendency for cases of "medical bias" to be associated with collaborative research in which the sociologist is wholly or partly dependent upon medical sponsorship and definition of the research situation. Consequences of this situation for the human subjects of research as well as for the field are discussed. A conclusion is that both our subjects' interests and the theoretic and political integrity of the field are best served by maximizing professional autonomy vis-à-vis medicine. A proposal for studying the structure of working arrangements concludes the paper. [ABSTRACT FROM AUTHOR]

The term patient noncompliance emerged in the 1970s as a tool for analyzing why people do not follow medical directives. Despite its early popularity, the term has languished in sociology while flourishing in biomedical arenas. It seems flaccid in a contemporary healthcare context as it overestimates physician authority and is tone-deaf to biomedicalization. I draw from sociological and anthropological traditions, as well as qualitative interviews with terminally ill patients ( N = 26) and their caregivers ( N = 16), to consider facets of a biomedicalized health experience and implications for an updated vision of compliance. First, pathways to care have proliferated under biomedicalization. With increased pathways comes increased need for understanding how treatment plans are socially constituted and assessed. Finally, increased complexity demands a more diverse vocabulary for understanding health related decisions. This paper is a call to sociologists to take the lead in transforming and updating this consequential concept. [ABSTRACT FROM AUTHOR]

This paper utilizes a social constructionist perspective to examine the widespread belief among physicians during the early 1980s that an oversupply of doctors was either present or imminent. It was found that the timing and growth of physician beliefs in a "physician glut" during this period could not be adequately explained by net increases in the physician supply, either on an absolute level or relative to the growth of the general population. Rather, this "fact" of a physician surplus was found to be more fruitfully explored as an emergent social phenomenon grounded in the historical evolution of physician-supply themes and the particular clinical practice environment in which physicians found themselves in the late 1970s and early 1980s. [ABSTRACT FROM AUTHOR]

The field of medical sociology has developed rapidly in recent years in sophistication of conceptualization and research techniques. Nonetheless, there remains a considerable amount of "unexplained variance" in knowledge about health and illness behaviors. This paper asserts that to grow further, medical sociology should become more interdisciplinary in conceptualization and design of research projects. The application of research findings from the field of psychoneuroimmunology to explain the effects of placebos as a form of magic is used as an illustration. [ABSTRACT FROM AUTHOR]

This paper examines the social construction of diagnosis and illness in several ways. First, I discuss the centrality of social construction in medical sociology. Next I discuss the major role of diagnosis in social construction, leading to the need for a sociology of diagnosis. I emphasize controversial and conflictual diagnoses, as a first step toward a more general sociology of diagnosis. Then I put forth a typology of social construction, involving four combinations based on whether a condition is generally accepted and whether a biomedical definition is applied. Next I detail a series of stages in the social construction of a condition. In that process, my primary concern is the initial social discovery, which is essentially a matter of diagnosis, with a secondary emphasis on illness experience. This is followed by stages of treatment and outcome, which recursively affect social construction. I conclude by noting the health policy implications of the social constructionist perspective. [ABSTRACT FROM AUTHOR]

This paper is a revision of an address given upon receipt of the Leo G. Reeder Award for Distinguished Scholarship in Medical Sociology. It was presented on August 24, 1991, to the Medical Sociology Section of the American Sociological Association during its annual meetings, held in Cincinnati, Ohio. [ABSTRACT FROM AUTHOR]

This paper is a revision of an address given upon receipt of the Leo G. Reeder Award for Distinguished Scholarship in Medical Sociology. It was presented on August 14, 1990 to The Medical Sociology Section of the American Sociological Association during its annual meetings, held in Washington, DC. Herein I reflect on the structured silence of personal bodily experience and on the unfinished paradigmatic challenge of feminism as a way of leading to a new praxis in medical sociology. [ABSTRACT FROM AUTHOR]

This paper is a revision of the address given by Professor Bloom in connection with his receipt of the Leo G. Reeder Award for distinguished scholarship in medical sociology. The address was given August 12, 1989 to the Medical Sociology Section of the American Sociological Association during its annual meeting, held in San Francis. co. [ABSTRACT FROM AUTHOR]

This paper is a revision of the address given upon receipt of the Leo G. Reeder Award for distinguished Scholarship in Medical Sociology. It was presented on August 19, 1987 to the Medical Sociology Section of the American Sociological Association during its annual meeting held in Chicago. [ABSTRACT FROM AUTHOR]

This paper is a revision of the address given upon receipt of the Leo G. Reeder Award for Distinguished Scholarship in Medical Sociology. It was presented on September 1, 1986 to the Medical Sociology Section of the American Sociological Association during its annual meetings, held in New York City. [ABSTRACT FROM AUTHOR]

Recently interest has shifted from the fact of a relationship between social stressors and health outcomes to factors that may buffer the impact of social stressors. Many forms of the stress-resource-adaptation model are possible. This paper argues that there is not one, but at least two distinct versions of the stress-buffering argument. Statistical models corresponding to each of these versions are developed with an emphasis on the interpretive logic of each model. Three other models described are not consistent with the notion of stress-buffering, but are sometimes thought to be. If more than one form of stress-buffering exists, then it ix possible that some coping resources play a "dual" buffering role. An illustration of how dual stress-buffering works suggests the importance of searching for such resources. Criteria for delimiting and distinguishing cases of stress-buffering from non-cases are discussed in the final section. [ABSTRACT FROM AUTHOR]

This paper is a revision of the address given by Professor Elinson upon receipt of the Leo G. Reeder Award for distinguished scholarship in medical sociology. The address was presented on August 29, 1985 to the Medical Sociology Section of the American Sociological Association during its annual meeting, held in Washington, DC. [ABSTRACT FROM AUTHOR]

This paper is a revision of the address given by Professor Fox in connection with her receipt of the Leo G. Reeder Award for distinguished scholarship in medical sociology. The address was given August 29, 1984, to the Medical Sociology Section of the American Sociological Association during its annual meeting, held in San Antonio. [ABSTRACT FROM AUTHOR]

Data from health surveys typically s/tow higher rates of morbidity among women than among men, while mortality data show the opposite pattern. Medical sociologists have formulated several key hypotheses to explain this female excess in morbidity-particularly as it occurs in milder forms of illness and disability. In this paper we examine one such hypothesis, using data from (lie Los Angeles Health Survey. According to the 'fixed role obligations" hypothesis, inflexible role obligations contribute to male/female differences in reporting illness and disability. As hypothesized, we find that controlling for such role obligations (particularly employment status) reduces male/female differences in reporting disability days, but that self- reports of chronic conditions continue to show significant male/female differences independent of these roles. These findings suggest that the fixed role obligations hypothesis is most appropriate for explaining male/female differences in sick-role behaviors that compete directly with fixed role obligations. [ABSTRACT FROM AUTHOR]

In this thoughtful paper, Mechanic discusses the differences between quantitative and qualitative researchers, focusing on health-related issues. It should, of course, be evident to readers that the issues he discusses have applicability far beyond medical sociology. The same issues arise in all kinds of social research and the excellent examples he gives can be expanded easily to examples in areas including education, criminology, industrial relations, social stratification, and others. In my reading of his paper, Mechanic discusses both differences between methods at a single point in time and differences in measuring process across time. As a quantitative survey researcher, I will comment on my perceptions of the similarities and differences between observational and survey methods for cross-sectional research. I then discuss some methods for bridging the gap that do not involve diaries. Finally, I discuss procedures for measuring process using observational and diary methods. [ABSTRACT FROM AUTHOR]

The study of social networks is increasingly central to health research for medical sociologists and scholars in other fields. Here, we review the innovations in theory, substance, data collection, and methodology that have propelled the study of social networks and health from a niche subfield to the center of larger sociological and scientific debates. In particular, we contextualize the broader history of network analysis and its connections to health research, concentrating on work beginning in the late 1990s, much of it in this journal. Using bibliometric and network visualization approaches, we examine the subfield's evolution over this period in terms of topics, trends, key debates, and core insights. We conclude by reflecting on persistent challenges and areas of innovation shaping the study of social networks and health and its intersection with medical sociology in the coming years. [ABSTRACT FROM AUTHOR]

When biomedical knowledge and technology create the capacity for humans to avoid disease and circumvent early death, sociological factors become more, not less important for population health. The transformation of disease causation from cruel fate, accident, and bad luck to circumstances that are under some degree of human control facilitates a powerful social shaping of disease and death. When humans have control, it is their policies, their knowledge, and their behaviors that shape the consequences of biomedical accomplishments, and thereby extant patterns of disease and death. I propose a "social shaping approach" that can frame our understanding of these processes and allow us to take action to optimize population health. Support for this approach is garnered from evidence of dramatic improvements in population health and in the uneven distribution of those improvements across persons, places, and times. Health improvements suggest that humans have gained control of disease whereas the uneven and very slow spread of such improvements underscores the critical importance of social factors. But the evidence presented represents a stick figure at best, one that needs to be filled in by a well-supported "epidemiological sociology" that uses a wide range of sociological concepts and theories to elucidate the social shaping of disease and death. Absent a robust societal investment in epidemiological sociology, population health will reside below its optimal level and the maldistribution of health-enhancing innovations will continue to create health disparities. [ABSTRACT FROM AUTHOR]

Research on the social determinants of health has increasingly sought to understand the relative importance of different features of socioeconomic status. Much of the ensuing debate has wavered between education and income, with recent research leaning increasingly toward income. This research has not, however; consistently explored interactions between different features of socio economic status and, in trying to understand the independent effects of different components of socioeconomic status, may have missed important features of socioeconomic position. With an eye toward examining how features of socio economic status combine and coalesce, this paper examines variation in the income-health association by level of education. Theories derived both from medical sociology and health economics suggest synergistic interactions between income and education, but they are unclear as to the direction and magnitude of these interactions. Results from two large and nationally representative data sets (the 1996-1997 Community Tracking Study and the 1972-2000 General Social Survey) indicate that the positive relationship between income and health varies substantially in both its strength and shape by level of education. Education improves health, and its effects are larger at lower levels of income. Moreover; education reduces the strength and curvature of the income-health relationship. Consequently, those with more education have better health for all levels of income, and fewer income-based disparities exist among the well educated than among the less well educated. The linear "gradient" relationship between income and health is, thus, more characteristic of groups with higher levels of education. Additional analyses indicate that these interactions existed in the United States in each of the last three decades. The results are discussed in light of theory regarding the perpetuation of health disparities, as well as current debates regarding the apparent incompatibility of distributive versus aggregative goals in health policy. [ABSTRACT FROM AUTHOR]

Cross-functional teams (CFTs) play an increasingly important role in health care. However, despite their potential, CFTs often fail to function effectively. This paper contributes to the literature in medical sociology by examining how the steep and well-defined hierarchy characteristic of the health occupations proves to be dysfunctional in the CFT setting. Previous research has shown that status differences among members of work teams negatively affect their functioning. Yet the specific mechanisms that connect variations in status to poor team functioning remain unclear. We hypothesize that it is the suppression of participation among low status team members that leads to poor CFT functioning. Our theoretical model integrates status characteristics theory and the value attainment theory of job satisfaction to link team members' statuses to participation in team decision-making and, ultimately, to their attitudes about the job. We use causal modeling to test our hypotheses. Our results indicate that relationships between health professionals defined in broader social contexts affect status, roles, and functions within CFTs, and these, in turn, affect the team's interpersonal processes. We suggest changes in organizational structure and in team leadership styles that might make CFTs more effective. [ABSTRACT FROM AUTHOR]

While there is little doubt that sociological theory and research has had an important impact on the way people think about health and health care, mental health and medical sociologists are often confronted with challenges concerning the utility of the work that they do. Among the doubters are deans, funding agencies and family members. We are challenged by the ascendency of biological interpretations of human behaviors, by the incompatibility between the con- textual view we prefer and the very strong individualistic orientation of our culture, and by the fact that we do not have an applied arm that trains the professionals who treat health and mental-health conditions. How do we respond to this challenge? The title of this paper gives a short answer: "The Production of Understanding." I propose that a powerful but under-recognized value of our work is the generation of explanations about health and mental health matters that help people understand the other side of an "us "/ "them" divide. We produce understanding in a context in which misunderstanding is regularly constructed by powerful people who offer victim-blaming explanations for the circumstances experienced by people with less power The production of understanding serves as an important counterbalance to this tendency Our work shapes the way people think about problems related to health and mental health, limits the power of inaccurate victim-blaming accounts and provides under- standing about why health and mental health are mal-distributed among people from deferent social circumstances. [ABSTRACT FROM AUTHOR]

The 2010 special issue of Journal of Health and Social Behavior, titled "Fifty Years of Medical Sociology," defined the contours of the medical sociological perspective. We use this as a backdrop to outline and assess the continued integration of genetics into medical sociology research. We contend that the explosion of genetic and epigenetic data in population health data sources has made the medical sociological perspective increasingly relevant to researchers outside of sociology, including public health, epidemiology, and quantitative genetics. We describe vast, underappreciated, and mostly unsolved challenges that limit the scientifically appropriate interest in incorporating genetics into existing paradigms. It is our hope that medical sociologists continue this integration but redouble efforts to maintain the core insights in social science research, such as the importance of environmental and structural (i.e., nonbiological) factors in determining health processes and outcomes and the use of rich, integrated, and rigorous empirical analyses. [ABSTRACT FROM AUTHOR]

The medical research institution is analyzed within a sociology of science framework and from a social psychological perspective. As an exemplar, a published study by Bierman (1976) concerning a treatment for genital herpes is explored in detail. Despite serious methodological flaws and ambiguities in the Bierman study, there has been widespread acceptance of the findings within both the medical and lay communities. Societal, medical, and personal implications of such practices arc discussed. [ABSTRACT FROM AUTHOR]

Using data drawn from interviews and observations with 18 families whose children were diagnosed with life-threatening, often rare diseases, I examine how families accessed and negotiated medical care at a top 10–ranked university research hospital. Access to highly specialized and technologically advanced care was essential in these critical cases. Combining analysis of these high-stakes cases with recent work highlighting the interactional dynamics of care delivery, I show how families followed different paths to elite care and used different illness management strategies throughout the treatment process depending on their ability to mobilize what Janet Shim terms cultural health capital. These diverging illness management strategies reproduced inequality even at the top of the U.S. healthcare system by allowing some families to secure microadvantages throughout the illness experience. These findings suggest a complex interplay between structures of care delivery and families’ illness management strategies and point to the need for broader conceptualizations of healthcare advantages. [ABSTRACT FROM PUBLISHER]

This article reviews the personal and professional processes of developing an interdisciplinary approach to understanding the complex issues of environmental health in their community, political-economic, social science, and scientific contexts.  This interdisciplinary approach includes a synthesis of research, policy work, and advocacy.  To examine multiple forms of interdisciplinarity, I examine pathways of integrating medical and environmental sociology via three challenges to the boundaries of traditional research: (1) crossing the boundaries of medical and environmental sociology, (2) linking social science and environmental health science, and (3) crossing the boundary of research and advocacy.  These boundary crossings are discussed in light of conceptual and theoretical developments of popular epidemiology, contested illnesses, and health social movements. This interdisciplinary work offers a more comprehensive sociological lens for understanding complex problems and a practical ability to join with scientists, activists, and officials to meet public health needs for amelioration and prevention of environmental health threats. [ABSTRACT FROM PUBLISHER]

A robust and very persistent association between indicators of socioeconomic status (SES) and the onset of life-threatening disease is a prominent concern of medical sociology. The persistence of the association over time and its generality across very different places suggests that no fixed set of intervening risk and protective factors can account for the connection. Instead, fundamental-cause theory views SES-related resources of knowledge, money, power prestige, and beneficial social connections as flexible resources that allow people to avoid risks and adopt protective strategies no matter what the risk and protective factors are in a given place or time. Recently, however, intelligence has been proposed as an alternative flexible resource that could fully account for the association between SES and health and thereby find its place as the epidemiologists' "elusive fundamental cause" (Gottfredson 2004). We examine the direct effects of intelligence test scores and adult SES in two data sets containing measures of intelligence, SES, and health. In analyses of prospective data from both the Wisconsin Longitudinal Study and the Health and Retirement Survey, we find little evidence of a direct effect of intelligence on health once adult education and income are held constant. In contrast, the significant effects of education and income on health change very little when intelligence is controlled. Although data limitations do not allow a definitive resolution of the issue, this evidence is inconsistent with the claim that intelligence is the elusive fundamental cause of health disparities, and instead supports the idea that the flexible resources people actively use to gain a health advantage are the SES-related resources of knowledge, money, power, prestige, and beneficial social connections. [ABSTRACT FROM AUTHOR]

Calls have been issued for understanding the "contexts" or "environment" shaping the causes and consequences of health and health care. Existing efforts raise concerns about how a panorama of influences can be considered simultaneously. Sociology's view of contexts as social network structures that shape and are shaped in social interaction offers one key to resolving this dilemma. Because social networks have become central in the social, natural, and physical sciences, this perspective provides a common platform for bringing in sociology's rich theoretical and methodological insights. Yet, to do this well, three conditions must shape our response. First, all levels relevant to health and health care must be considered, separated out, and linked by network mechanisms. The genetic-biological level, perhaps the most foreign level to sociologists, represents the greatest need and best prospect for advancing a sociologically based solution. Second, room must be made to tailor models to populations, whether defined socially or medically. Third, sociologists must find a voice within "big science " to address problems from social construction to social causation that contribute to basic social processes as well as health. I trace developments in the Network-Episode Model as one theoretical starting point. [ABSTRACT FROM AUTHOR]

The development of social epidemiology and medical sociology over the last half of the 20th century, in which Leo Reeder played a central role, transformed scientific and popular understanding of the nature and causes of physical health and illness. Viewed in the early 1950s as shaped almost entirely by biological processes and medical care, physical health and illness are now understood to be as much or more a function of social, psychological, and behavioral factors. Utilizing a stress and adaptation conceptual framework, social epidemiology has identified a broad range of psychosocial risk factors for health, most notably: (1) social relationships and support; (2) acute or event- based stress; (3) chronic stress in work and life; and (4) psychological dispositions such as anger/hostility, lack of self-efficacy/control, and negative affect/hopelessness/pessimism, with new risk factors continuing to be identified. However, proliferation of risk factors must be balanced by conceptual integration and causal understanding of the relationships among them, their causes, and consequences. One source of such integration and understanding has been the rediscovery of large and persistent socioeconomic and racial-ethnic social inequaldisparities in health. Socioeconomic position and race/ethnicity shape individuals' exposure to and experience of virtually all known psychosocial, and well as many environmental and biomedical, risk factors, and these risk factors help to explain the size and persistence of social disparities in health. Improving the socioeconomic position of a broad range of disadvantaged socioeconomic and racial-ethnic strata constitutes a major avenue for reducing exposure to and experience of deleterious risk factors for health, and hence for improving the health of these groups and the overall population. This in turn requires better understanding of the macrosocial forces that influence the socioeconomic position of... [ABSTRACT FROM AUTHOR]

For the past two decades, evidence-based medicine (EBM), or the reliance on current scientific evidence to reach medical decisions, has been embraced as a new paradigm to standardize clinical care. Drawing from in-depth interviews with seventeen pediatric residents in two residency programs, we evaluate the extent to which the medical sociology scholarship on uncertainty analytically elucidates the recent influx of EBM during residency training. Our findings suggest that residents interpret EBM in varying ways to match their work practices: "Librarians" consult the literature while "researchers" evaluate it critically. For both groups, EBM might generate new uncertainties due to the increased reliance on information technologies and epidemiology. Whether EBM reduces uncertainty depends upon the residents 'understanding of standardized knowledge and consequent incorporation of EBM in their clinical practice. Contrary to the predictions of some sociologists, EBM does not lead to a diminishment of humanitarian values in medical care. Nor does EBM lead to a science-based meritocracy on the patient ward, as claimed by some EBM advocates. Our conceptual updating of uncertainty emphasizes the continuous management of uncertainty during the medical socialization process. We argue that managing uncertainty develops along with what we term evidence-based clinical judgment. [ABSTRACT FROM AUTHOR]

Three case histories show how work in the medical social sciences--to the extent that such work reveals the origins of health problems in social structures of wealth and power--can become dangerous enough to threaten one's livelihood and in some instances one's very life. In this presentation, I encourage critical and engaged scholarship by referring to examples of dangerous work that should receive more attention: social medicine in Latin America and the critique of managerial ideology in the United States. Although social medicine has become a widely respected field of research, teaching, and clinical practice in Latin America, its accomplishments remain little known in the English-speaking world. For centuries, indigenous cultures in Latin America have held belief systems linking social conditions to patterns of illness and death. Latin American accounts of social medicine's history emphasize its European origins, especially in the contributions of Rudolf Virchow. In the United States, with the impact of the Flexner Report (1910) and its supporters, Virchow's vision of social medicine went into decline. On the other hand, in Latin America, social medicine flourished as a focus of education and research. Since social medicine's "golden age" during the 1930s, teachers, researchers, and practitioners have produced major achievements despite the dangers of this work, which in several instances have included torture, imprisonment, or death. An ideology favoring managerial decision making in the United States has influenced crucial policy decisions, and the justifications for these decisions have manifested symbolic politics in addition to the evaluation of factual evidence. With ambiguous empirical support, managerial ideology has fostered the general growth of managed care, the implementation of Medicaid managed care by state governments, the expansion of managed care in rural areas, and the impact of "evidence-based medicine" on policy and ... [ABSTRACT FROM AUTHOR]

The attempt to assess the impact of medical sociology on health policy encounters operational difficulties regarding what should be counted. After reviewing these difficulties, we argue that there is potential interest among policymakers for sociological contributions to policy debates, but that policy impact has been limited by sociologists' ambivalence, academic career considerations, and by health research becoming a distinct field of research. Suggestions for increasing sociologists' policy impact include attending to policy relevance in both the design of studies and the dissemination of results and by sociologists' becoming more oriented to the field of health policy research. [ABSTRACT FROM AUTHOR]

Over the past 40 years, the mental health care system has been radically transformed from one focused on institutionalized care to one centered on treatment in community settings. While medical sociology has played a prominent role in the study of psychiatric hospitalization and the deinstitutionalization process, the systematic exploration of the sociological dimensions of community-based mental health care is only just beginning. This essay reflects on past disciplinary contributions and explores some important empirical and theoretical directions in the field of mental illness research that could benefit from more extensive sociological analysis. The central argument is that the shift to a community-based mental health system has increased the need for the sociological perspective and that medical sociologists, in particular, have the theoretical and analytical perspective essential for developing a more complete understanding of the current conditions impacting the lives of people with severe mental disorders. Drawing on recent work in medical sociology, we illustrate some important topical areas at the center of controversies over treatment, social change, and public policy regarding severe mental illness. We conclude with a discussion of the barriers to this type of sociological research and suggestions for ways medical sociologists might contribute to the study of severe mental disorders in the future. [ABSTRACT FROM AUTHOR]

The current situation in health care organizations, among providers and for people, dramatically challenges the "business as usual" roles of medicine, government, insurance companies, the community, and the university. Health care reform marks the first attempt in a century to consider a reconstruction of the social contract between society and medicine. While sociology stands as one of the earliest social sciences to systematically study the health care arena and create a health-focused subfield, there is a perception, not without support, of a desertion of identity from within, an encroachment by other areas from without, and abandonment by the parent discipline. We argue that these situations in medical arenas and in research fields require serious rethinking. The key lies in understanding how these phenomena are related to each other and to larger social forces, and how they offer opportunities, rather than signal limitations, to medical sociologists. We turn to the theoretical tools of sociology to help unravel the complicated challenges that face both policymakers and researchers. After framing these issues in a sociology of knowledge perspective, we use the case of "utilization theory" to illustrate the connections between society and systems of care (as well as studies of them) and to create a future agenda. We end by raising three basic questions: (1) Why is a sociological perspective critical to the understanding of change and reform in health care? (2) Why is medical sociology critical to the survival of the general sociological enterprise? and (3) Why is general sociology critical to the research agenda in medical sociology? [ABSTRACT FROM AUTHOR]

Why is it that quantitative and qualitative researchers on health issues often have divergent findings and conclusions? Exploration of such differences can be a useful way of bringing separate intellectual enclaves in medical sociology together and also can stimulate future inquiries. Some differences can be resolved by more precise definitions, by comparable frequency and timing of measurement, and by careful evaluation of meaning contexts. The triangulation of methods, using diaries as a bridge between surveys and qualitative measurement, offers particular promise. Improved theory on the relationships of method to data, and more attention to behavioral sequences and the social context of measurement, can serve as a stimulant to innovative solutions. [ABSTRACT FROM AUTHOR]

The concept of care, integral to medical sociology and to the sociology of health and illness, suggests new challenges in two key areas of this field: 1) within professional socialization, an examination of socialization to ethical thinking, behavior, and identity among professional caregivers, building on the substantial literature already accumulated; 2) in the arena of hidden or informal care providers, an analysis of male and female informal providers and the productive work, other than care, done by these individuals. In both analyses, as well as in all medical sociology and sociology of health and illness, gender, race, and class require more attention. Both analytic endeavors influence the substance and the contours of the field. [ABSTRACT FROM AUTHOR]

The emphasis of this analysis is on the social institutional history of medical sociology. This subfield is described as (1) closely connected with the patterns of development in its current discipline, (2) as containing a dual thrust between applied and basic science, and (3) as struggling with "insider-outsider" ambiguity involving the work of subgroups working either in medicine or from roles external to medicine but studying the sociology of medicine. Tracing a detailed historical fragment from the decade following World War II, it is predicted that the continuity of an accepted position for medical sociology is assured even though the style and quality of its professional life are full of uncertainty. [ABSTRACT FROM AUTHOR]

What patients understand from medical consultations and the processes by which they understand are of considerable clinical and theoretical interest. Empirical research about patients' understanding has been restricted, however, by measures which are inadequate when compared with the depth and complexity of sociological and social anthropological theories of medical consultations. One consequence has been that sociological and social anthropological ideas have been considered largely inappropriate for practical application. A "third party" method of defining the information universe which patients might be expected to grasp from the consultation and of assessing three levels of patient "understanding" is proposed. The method involves judgments about the content of what doctors actually say to patients and what it might mean. Such methods inevitably involve specifying values and therefore make apparent problems of validity which are only implicit in methods where such judgments appear to be avoided. Evidence is presented to show the approach can be reliably conducted. Moreover, the measures described discriminate groups of patients in interesting and predictable ways and help to deepen our ideas about the determinants of cognitive outcomes in medical consultations. [ABSTRACT FROM AUTHOR]

Drawing from a variety of perspectives on deviance, we offer a general theory and specific hypotheses for why some people become regular users of marijuana. We estimate a path model that explains escalation of marijuana use using 23 variables modelled in four stages. Subjects (N = 1,229) are young adults who reported using marijuana at least once. The analysis uses data provided at two points in a panel study: in the seventh grade, by self-administered questionnaire, and as young adults (23-25 years old), by household interview. Results of the path analysis provide support for many of our theoretical expectations. Demographic controls have significant effects but do not negate a variety of psychosocial effects. Seventh-grade measures of peer acceptance and avoidant defensive tendencies directly predict escalation of marijuana use, while other seventh-grade measures have indirect effects on escalation of use through age of first trying marijuana and through the circumstances and consequences of first trying marijuana. Specifically, the later one tries marijuana, the less likely one is to increase use. Also, trying marijuana at a time of psychological distress and trying it without peer motivation predict escalated use. Moreover, consequences of initial use (i.e., weakening of ties with significant others and adverse physical or psychological outcomes) further affect increased marijuana use. [ABSTRACT FROM AUTHOR]

Despite the predominance of drug treatment within psychiatry and public policy debates surrounding psychotropic drug use, American medical sociology has largely neglected the study of psychiatrists' medication prescribing practices. The present study examines the influence of patient clinical and social characteristics, as well as physician and treatment-setting factors, on the prescription of PRN ("as needed") antipsychotic drugs by a sample of psychiatrists practicing in 2 North Carolina state mental hospitals in 1979. Two aspects of prescribing PRN drugs are analyzed: the initial decision to prescribe (or not prescribe) PRN antipsychotic medication for a patient; and. if medication is prescribed, the determination of daily PRN drug dosage. Patient clinical characteristics, including diagnosis, psychiatric impairment level, and concurrent non-PRN antipsychotic drug treatment, were found in a multivariate analysis to be the major determinants of PRN drug prescription. This finding suggests clinically appropriate use. Some researchers have suggested that the influence of patient social characteristics on psychiatric treatment is greatest when patient symptomatology is less severe; however, when the conditional effect of patient social factors on PRN drug prescription was examined by levels of patient impairment, no differences were noted. Finally, when PRN drug dosage was examined. only non-PRN antipsychotic drug employment was found to be related to the dependent variable in the analysis. Thus it appears, in contrast to the initial decision to prescribe medication, that clinicians' determination of PRN antipsychotic drug dosage is largely idiosyncratic. Study implications and limitations are discussed, with the need for further sociological study of psychiatrist drug prescribing emphasized. [ABSTRACT FROM AUTHOR]

Data from the 1984 Illinois Comparative Health Survey are used to examine whether the poor have adopted a consumer orientation toward professional health services in view of the reduction of financial barriers and clear signs of increased physician utilization. It was found, however, that lower-status persons stand as more or less passive recipients of such services. with a significantly greater tendency to invest responsibility for their own physical health in the health-care delivery system itself. Yet there was a general lack of difference with respect to health lifestyles involving food habits, emphasis on appearance, sports and exercise, smoking, and alcohol use. A culture-of-medicine thesis was found to provide a stronger explanation of this situation than a culture-of-poverty perspective. Medicine and the mass media have promoted the practice of a healthy lifestyle, but have not encouraged consumerism in the physician-patient relationship. Consequently, it appears that where social institutions provide positive sanctions, self-management and consumerism seems to grow for the poor; but where negative sanctions exist, consumerism does not seem to flourish. [ABSTRACT FROM AUTHOR]

The article discusses the author's plans as incoming editor of the "Journal of Health and Social Behavior". To prepare for upcoming editorial duties, the author tried to determine whether, within recent years, the periodical has had desirable breadth. Using a category system for mapping the field, a tally of issues since 1978 was conducted. From the survey, two conclusions were made. The first conclusion is that every important corner of the field has been covered. There have been articles on social factors in mental illness, the health effects of stress and multiple roles, health professional education and many other topics. The second conclusion is that there ahave been some strongly accented categories and others which, through present, are heard in a fainter voice. The author also highlighted the importance of medical sociologists in various parts of the field to the continuing soundness of the periodical.

The social construction of illness is a major research perspective in medical sociology. This article traces the roots of this perspective and presents three overarching constructionist findings. First, some illnesses are particularly embedded with cultural meaning—which is not directly derived from the nature of the condition—that shapes how society responds to those afflicted and influences the experience of that illness. Second, all illnesses are socially constructed at the experiential level, based on how individuals come to understand and live with their illness. Third, medical knowledge about illness and disease is not necessarily given by nature but is constructed and developed by claims-makers and interested parties. We address central policy implications of each of these findings and discuss fruitful directions for policy-relevant research in a social constructionist tradition. Social constructionism provides an important counterpoint to medicine’s largely deterministic approaches to disease and illness, and it can help us broaden policy deliberations and decisions. [ABSTRACT FROM PUBLISHER]