What are the strengths and the weaknesses of using the 'medical marketplace' as an approach to the history of medicine - Essay Example

? The Medical Marketplace Model: Its Strengths and Weaknesses Essay 2,470 words of Introduction The field of medical history has gone through numerous changes over time. Today, the primary emphasis in human medicine is on how individuals identified, interpreted, and treated medical disorders. For numerous historians, this emphasis is situated in the context of a medical marketplace composed of a variety of medical items and healers. The medical marketplace model has ever since governed the field of the history of medicine. Harold Cook coined the term ‘medical marketplace’ to describe English medicine during the 17the century.1 This model involves the long-established tripartite differentiation of physicians, surgeons, and apothecaries, plus different kinds of quacks, herbalists, faith healers, midwives, and other less definite or ‘qualified’ healers.2 However, the medical marketplace model has also been criticized in various medical fields. This essay analyses the strengths and weaknesses of the medical marketplace model as an approach to the history of medicine. The Medical Marketplace Model Drawing on the assumption that ailing individuals have the capacity to make consumer decisions and are rational, numerous historians have expanded the history of medicine to encompass all forms of medical marketplace throughout the history of medicine. Thus, the history of the whole range of casual quacks and healers, of commercial products, and family prescriptions for different illnesses has become accepted and popular medical history.3 Historians have been particularly interested in being able to recreate the massive array of options or alternatives available to consumers of medical products and/or services. Over the recent decades, historians have given a great deal of attention to the hierarchy or division of medical professionals and in the knowledge, understanding, and experiences of patients. As an outcome of this wider approach, historians became adept at characterising the delivery of medical products/services in early modern North America and Europe as a medical marketplace.4 Furthermore, this tendency to adopt the medical marketplace model has also been observed among historians focused on the histories of ‘folk medicine’. In general, how the patients responded or did not respond to their sickness offered a measure of the degree to which the medicalisation processes progressed or regressed throughout time.5 Historians in the 1970s and 1980s were predisposed to situate medical professionals at the limelight in the medical marketplace of the past centuries, endowing early modern physicians an antiquated critical role in the delivery of medical services. More distinguishing attribute of later studies is the transition from physician-oriented academic interest to a more inclusive paradigm of the different sources of medical products/services provided.6 Past studies drew largely on the number of medical professionals as a measure of what several historians considered as ‘poor’ performance of healers throughout the 18th and 19th centuries, revealing the exaggeration of the value of physicians, who in reality were an outnumbered group among medical practitioners.7 Basically, the medical marketplace model demonstrates that insistent and educated or well-informed patients, or consumers, bought medical products/services as commodities in a disorganised, independent, and unchecked medical system. From the 18th to the 19th century, no ethical codes specific to the field of medicine presided over the relationship between health care providers and patients in early modern North America and Europe.8 Even though highly educated medical professionals produced essays on issues that are currently classified within the domain of medical ethics, the daily interactions between the ill and healers were influenced by two categories of broader social rules: (1) the system of the delivery of medical services during the early modern period has been associated with a medical marketplace; and (2) similar to other social relations during the early modern times, both healthcare providers and patients recognised the shared responsibilities of support and respect between individuals of dissimilar social groups.9 In a medical marketplace, medical products/services are commodities hence medical relationships and transactions were mostly governed by the norms of commercial transaction. Sometimes, the healthcare provider was the client, and the patient a practitioner, whilst on occasion these roles were overturned.10 Ever since the 17th century, patients were at times viewed as people needing particular care and protection because of their chronic or fleeting illness or impairment. Nevertheless, there is a disagreement over whether the medical marketplace model sufficiently illustrates the countless options offered. Numerous historians have claimed that this supposes a completely commercial setting dominated by ‘eligible’ providers. The English Common Law stated that any person could regard him/herself as a healer, recommend and carry out medical services.11 This led to a whole host of individuals who exchanged products/services for another product/service, or, at times, for supportive or generous purposes. These may comprise altruistic practitioners, such as clergymen, and commercial providers who provided free medications or supplementary consultations. Andrew Wear has claimed that the existence of healers who exchanged or provided their services at no cost makes the term ‘exchange market’ a more precise description than ‘medical marketplace’.12 Nevertheless, it may be assumed that supposedly ‘complimentary’ services in fact had a price tag fastened to them, and thus were ‘commercial’ dealings. Members of the clergy could have obliged a devotion to being ‘religious’ as payment for their services. Others could have been following established behavioural codes and medical professionals who offered complimentary services expected to have a paying client sooner or later.13 Historians have been more and more engaged in deconstructing documents or writings and fitting in readings of diverse narratives and chaotic interactions. Although the medical marketplace paradigm has been a valuable approach to the study of the history of medicine, there are numerous other narratives or experiences to be analysed and other interactions, besides that of supplier and consumer, to examine. Inopportunely, the medical marketplace approach at times restricts the perspective of historians to the seller-buyer relationship and impedes any regard for other activities-- such as the involvement of loved ones in medical care-- and interactions-- such as sponsorship-- that move away from the norms of commodification or consumerism.14 As a result, it becomes important to reassess the strengths and weaknesses of the medical marketplace model as an approach to the study of the history of medicine. The Strengths and Weaknesses of the Medical Marketplace Model The historiography of the medical marketplace has disclosed a highly diverse collection of theories, practices and treatments within which ‘alternative’ medicine was taken into account. All of these alternatives had its advocates and proponents. Essentially, they were not restricted to a specific social group, social class, or geographical setting and, as emphasised by Roy Porter, with regard to the likelihood of treatments in the 18th century, “the sick, given the opportunity, would shop around.”15 Harold Cook uses the term medical marketplace to describe not only the dominance of market forces and the diversity of healers, but also on the formation of a theoretical model of economic sphere that is ruled by consumerism and the commodification process. Cook tries to discover “how the physician of seventeenth century London tried to maintain the dignity of learned medicine by exercising the juridical authority of the College of Physicians and how they ultimately failed in the face of deeply felt economic, intellectual, and political changes”.16 Historians have accommodated the various types of healthcare providers into the medical marketplace model. It has been a somewhat valuable method of putting different medical providers on a similar or equal position. Quackery was denounced by educated or licensed physicians and it is their antagonistic written works that mostly lived on.17 By using the medical marketplace model as an approach to the study of the history of medicine, historians were able to present an idea of how different medical providers acted in response to the major developments in the medical field during the 17th century. They were also able to show how the political, intellectual, and legal tensions during this period pushed the development of medical innovations beyond the group of qualified physicians.18 As the medical marketplace created intricate networks within the political and social domains, the traditional medical system finally collapsed despite of profound changes in politics, education, and economy in the early part of the 18th century.19 Moreover, the medical marketplace model allowed historians to demonstrate that the emergence of consumerism that recognised medical condition as a commodity created a force to preserve and reinforce a self-motivated commercialism in the medical marketplace. Historians were able to show that the medical marketplace did not merely facilitated the growth of quackery, but also strengthened the process of professionalisation as a move towards a specific principle or reputation that professionals wanted to create.20 Even though interest in quackery ebbed and flowed alongside the condition of the medical marketplace, increasing demands from licensed professionals to form an elite medical profession by the 19th century became poorly influential. Thus, historians were able to explain that the dominance of professionals in the medical marketplace became critical to the medicalisation process as charitable hospitals and clinics became important to early modern Britain.21 In the latter part of the 20th century, a remarkable change in the medical marketplace recreated the established boundaries between traditional and unconventional medicine. Numerous alternative treatments that had been denounced and discarded as quackery by medical professionals were subjected to renewed investigation.22 The medical marketplace model has helped raised issues, topics, studies, and documents which had been overlooked or denounced as unethical, trivial, or irrational by historians. However, the medical marketplace model as an approach to the study of history of medicine also received quite a few criticisms. Andrew Wear is one of the scholars that exposed the weaknesses of the medical marketplace model. According to him, the model is historically biased because it relied on the surviving accounts of qualified physicians who denigrated quackery. Putting physicians, surgeons, and apothecaries in the medical marketplace revealed that, just like their despised rivals, they were also motivated by monetary concerns.23 Nevertheless, according to Wear, a reminder must be given. The medical marketplace model was formulated at Thatcher’s and Reagan’s time, particularly in the middle part of the 1980s, and bears out the cold-blooded free market philosophy of these policymakers. Just like the contemporary free market principle, the medical marketplace approach can be exaggerated. It highlights economic forces and disregards the cultural factors (e.g. religion) that influenced medicine.24 Moreover, the proponents of a free market discard any charitable tendencies or moral limitations in their pursuit of profit, but not all early modern professionals were like them. As mentioned earlier, some early modern practitioners helped sick people at no cost. In addition, the medical marketplace model is not suitable for analysing ‘folk medicine’, within which, if any exchanges or dealings took place, they were social in nature instead of economic.25 Furthermore, the model has a tendency to deviate emphasis from the realistic and cognitive features of medicine. How professionals treated and diagnosed illnesses have been devalued by historians determined to examine the diverse nature of the medical marketplace.26 Similarly, Brockliss and Jones believe that the medical marketplace model only reinforces and perpetuates the hostile line differentiating medical professionals from other healers and is a misinterpretation of how medical knowledge was distributed. They also argue that the medical marketplace is wrong in its assumption that medical professionals deride quacks because they were economic rivals, but because quacks embodied an insult or disrespect to social or moral order, or, more specifically, they weakened the cultural and social principles embraced by the people.27 Likewise, Roy Porter argues that there is an insufficient availability of credible documents about quackery in early modern Britain and that the medical marketplace model requires re-evaluation because of its weak historical grounding.28 Alongside an alternative interpretation of the medical marketplace model, the accounts of such historians mediate in a discourse of medical tradition classified within a ‘tripartite’ hierarchy of medical practitioners. Any overemphasis on the medical marketplace is hence appropriately questioned.29 As stated by Margaret Pelling: Selected institutions of the early modern period and before have been made to carry a considerable burden of interpretation. The reality of the tripartite division of medicine in England depends on the universal significance of certain well-known developments in the institutionalisation of medicine in London: the foundation of the College of Physicians... in 1518; the merging of the Barbers’ Company with the tiny elite of the surgeons in 1540; and the splitting off of the Apothecaries from the Grocers Company in 1617.30 (Pelling 235) The major impact of an emphasis on the tripartite division of medical practitioners-- which rarely encouraged or permitted female contributors-- is the notion that medicine is the exclusive arena of men. Basically, the medical marketplace model is fairly elitist and chauvinistic, disregarding the contributions of women in the field of medicine. But according to historical accounts, these women were in fact good herbalists and nurses.31 Conclusions The medical marketplace model had shown much potential in the field of medical history during the past decades. But just like any other historical models, the medical marketplace approach has strengths and weaknesses. The model helped historians explain a highly diverse collection of theories, practices and treatments within which ‘alternative’ medicine was taken into account. Furthermore, the model helped historians explain the emergence of consumerism as a force that preserved and reinforced commercialisms in the medical marketplace. And, ultimately, the medical marketplace model renewed the interest of historians in 19th-century quackery and lay medicine. However, the model also suffers from several weaknesses. First, it is historically biased because it largely relied on the accounts of medical professionals. Second, it highlights economic forces and disregards the cultural factors (e.g. religion) that influenced medicine. Third, how professionals treated and diagnosed illnesses have been devalued by historians determined to examine the diverse nature of the medical marketplace. And, lastly, the model devalues the contribution of women in the field of medicine. Bibliography Bynum, W.F. et al., The Western Medical Tradition, 1800-2000 (Cambridge: Cambridge University Press, 2006). Byrne, Georgina., Modern Spiritualism and the Church of England, 1850-1939 (UK: Boydell & Brewer, 2010). Cook, Harold John., The decline of the old medical regime in Stuart London (New York: Cornell University Press, 1986). Jackson, Mark., The Oxford Handbook of the History of Medicine (Oxford: Oxford University Press, 2011). Lindemann, Mary., Medicine and Society in Early Modern Europe (Cambridge: Cambridge University Press, 2010). Pelling, Margaret., The common lot: sickness, medical occupations, and the urban poor in early modern England: essays (UK: Longman, 1998) Wear, Andrew., Medicine in Society: Historical Essays (Cambridge: Cambridge University Press, 1992). Wear, Andrew., Knowledge and Practice in English Medicine, 1550-1680 (Cambridge: Cambridge University Press, 2000). Wilson, Peter., A Companion to Eighteenth-Century Europe (New York: John Wiley & Sons, 2009). Read More