Social Science & Medicine (1967)最新文献

The purpose of the present study was to investigate an indirect marketing method of drug industry: the associations between the leading physicians and the drug industry. 337 Finnish physicians were defined as key-physicians on the basis of their formal positions in 1974. Their associations with the drug industry in 1974 were investigated. 41% of the key-physicians had some associations with the drug industry. Those physicians who held many positions as key-physician had more relationships than those having fewer positions. The medical teachers had the highest frequency of relationships. But also those in the National Board of Health who had control functions over the drug industry or distributed drug information, had relationships. The most common form of connection was a membership in the administrative or scientific board of a drug company. The frequent connections between the medical elite and the drug industry may have important influences on the medical practice and health policy.

This paper examines the relationship between the components of infant mortality and social class by analysing the data available from infant mortality studies undertaken in Western Europe and the United States. A full set of data are given in the Appendix. It was found that although infant mortality has declined dramatically in the past century, the inverse relationship between social class and perinatal, neonatal and postneonatal mortality has not narrowed, in spite of the advances in medicine and surgery, sanitation and housing conditions, and the overall rise in living standards which were presumed to be of special benefit to the lower classes. The large influence of perinatal mortality, and especially stillbirths, on the infant loss rate is discussed.

Several hypotheses to explain the persistence of the social class gap are presented: the “capital assets” thesis; the “time-lag” argument; and the differential social mobility pattern. Finally, data on variables linking social class to infant mortality are briefly reviewed.

Two conclusions are reached. First, that there is a continuing, but unheeded, need for data on class and infant mortality. Second, that the important focus of action, as well as of further research, if the social class gap is to be closed, is less the traditional medical techniques and more the broader issues of social change in education, welfare as well as health services.

This study explores the factors associated with participation in a screening program for Tay-Sachs Disease among Jewish university students. Tay-Sachs Disease is an always fatal recessive genetic condition found primarily among Jews from central and eastern European backgrounds. Baseline data regarding knowledge and attitudes towards health, genetic disease, and Tay-Sachs was gathered by a mail questionnaire of a random sample of Jewish students at UCLA. One month later an intensive four week educational campaign about Tay-Sachs was mounted on campus. This was followed by three days of free Tay-Sachs screenings for anyone at UCLA. One hundred (23.8%) of the students in the baseline study were among the 1845 people who elected to be screened. Those students choosing to be screened were significantly different from those not so choosing by their increased desire to have children, their knowledge about Tay-Sachs Disease and their strength of identity as Jews. Discriminant analysis shows that Jewish identity is by far the most important variable. However, the three variables together account for only a small portion of the variance in explaining which students were tested. The major variables of the Health Belief Model, perceived susceptibility and perceived seriousness, were found not to be related to engaging in this particular health behavior. Some practical implications for increasing participation in genetic screening programs are discussed.

In recent years there has been a great deal of debate and controversy about the management of childbirth, among both the medical profession and the lay public. Perhaps related to this public debate, and to the increasing concern with “women's issues”, there has also been a growing interest among British sociologists in this topic. Unfortunately, this sociological interest may not always be welcomed by obstetricians and policy-makers who may be unaware of the scope of sociology and regard sociological contributions as over-simplified or biased. This paper outlines possible sociological approaches, reviews debates about home versus hospital confinements and the active management of labour, and formulates research questions to which the sociology of reproduction might address itself.

This paper discusses the sex differential in the provision of health care in the United States. Although women are the overwhelming majority of the health labor force, the key medical functions are controlled by men. This male domination of the division of labor in the medical sector reflects the political, economic and social power structure of American capitalist society.

The consolidation of “scientific medicine” as the dominant mode of medical practice at the turn of the century legitimated and institutionalized the differentiation of occupation by sex. “Scientific medicine” is oriented toward specialized, acute, in-patient hospital treatment with priority given to high-level technology, surgery and drug therapy. These particular functions are primarily controlled by the physician, the vast majority of whom are white, male and upper, or upper-middle, class.

The paper concludes by calling for an examination of the practice of “scientific medicine” as well as for a change in the sex, race and class division of labor in the medical sector.

The politics of health reform in the southern European countries are mixed with the interests of the pressure groups. Among these, the most important ones are the medical profession in the case of non-democratic countries (such as Portugal before 1974) and the programs of the political parties (as in Italy between 1964 and 1975). In the last decade southern European countries have developed health reform processes that have been substantially changed by the different pressure groups. We will begin with a theoretical framework on the relationship between socio-economic development and health reform. In the second part we study two cases: Portugal (1961–1974) and Italy (1964–1975).

In the case of Portugal we analyze the influence of the medical profession on health planning and social reform before 1974. In contrast to other southern European countries the Portuguese medical profession has been one of the most important factors advocating health reform in the country; it has been a basic proponent of change towards a global health reform in the '60s. The reasons are various: the relationships of the medical profession with the regimes of Salazar and Caetano; the poor economic situation of most of the physicians; the criticism of the Ordem dos Médicos; and the influence of specific medical leaders (such as Miller Guerra or Gonçalves Ferreira). The lack of political parties before the revolution, allowed both the medical association and the medical leaders to have a considerable importance as health pressure groups. This has decreased with the creation of political parties and the participation of the people in the organization of health structures.

In Italy, the design of a health reform (the riforma sanitaria) has been an important task of the political parties since 1964, and specially of the Christian Democrats, the Socialist and Communist Parties; other important groups have been: trade unions, medical profession, and other pressure groups. All these health reforms have crystallized in the project of the Servizio Sanitario Nazionale, its main goal being the linkage of local health units and regional hospitals. The most important contributions are those of the health leaders of the political parties: Bruni (from the DC), Seppilli (PSI), and Berlinguer (PCI). We analyze the relationship between the ideological stands of the Italian parties and their health reform models. Most of the parties, and other interest groups, recognize the same problems, namely: the regionalization of services, the expansion of preventive medicine, the role of the private physician, the power of the pharmaceutical industry, the cost of the health reform, the democratization and control of the Servizio Sanitario Nazionale, and the timing of its implementation. These problems are also common to Portugal, Spain, Greece and Yugoslavia, although the lack of competitive political parties in some of these countries leaves t