Medical Marketplaces Flashcards
What are the two uses of the term medical marketplace since the 1980s?
1) medical pluralism
2) commercialisation of medicine in the long eighteenth century
What is the advantage of the medical marketplace model
Allows us to see the patient as the agent by bringing them into the story, whereas the history of ideas and medical practices tends to leave them out.
How many medical practitioners were there in London 1580-1600?
50 official physicians
100 surgeons
100 apothecaries
At least as many again who were working illegitimately
Approximately 500 in a population of 200,00, about 1 in 400.
What are the three types of commercial medicine?
1) Advice
2) Contractual
3) Self-Prescription
What are the three ways of viewing medical exchanges?
1) Commercial Medicine
2) Domestic medicine
3) Spiritual medicine
What did Wallice and Jenner mean that the “early modern medical marketplace must be understood as socially embedded and historically specific”?
Rather than a concept written in the neo-liberal moment of 1980s free market economics, the use of the medical marketplace must move away from applications which are done in uncritical, generalized terms.
The “Friedmanite echoes” of the language of the market are misleading, and can obscure opportunities for cooperation as well as competition, or ignore social pressures and systems of obligation. Critically examine medical practice rather than use as a ubiquitous term.
Harold Cook “Decline of the Old Medical Regime in Stuart London” (1986)
- Emphasised how the power of physicians, despite their intellectual background and institutional organisation, was far from hegemonic.
- Argued that institutions such as the College of Physicians operated within a market system, one in which their competitors were in a position of considerable strength
- Crucial part of a wave of scholarship that focused on variable, market oriented nature of medical provision and its inherent economic aspects.
“historians have been mesmerised by the formal chartered pyramid of physic”
Roy Porter, “The Patients View” (1985)
How do Pelling and Webster define ‘Medical Practitioner’
Any individual whose occupation is basically concerned with the care of the sick.
Synchronic explanation of the marketplace
An exploration of medical pluralism- range of medical assistance, marketplace as a synonym for different groups
Diachronic explanation of the marketplace
Exploration of medical commercialisation- emergence of a market, part of a process
Qualitative explanation of the marketplace
Medicine as analysed as a service provided through the workings of market mechanisms
What is the impact of a ‘homogenous’ marketplace?
Disguises chronological change
What does the marketplace focus on economy not address?
Non monetarised forms of healing: charitable and lay physic.
Brockliss and Jones ‘medical penumbra’
A holistic model with trained, orthodox medical practitioners in the centre, and numerous other types of healer in the periphery
Why is the Brockliss and Jones model suited to France but not England?
Stressed the fundamentally corporatist nature of medicine in France, whereas England was more of a free market
What is Gentilcore’s alternative model?
different but intersecting healing communities: medical marketplace obscures religious and magical explanations and remedies: proposed instead a model of overlapping ‘healing’ communities [Italy]
Porter vs. Wallis -competition
Porter: medicine men of all sorts were competing for custom, recognition and reward
Wallis: Medical practice involved as much cooperation as competition- a practitioner’s success depended on their integration into social networks, not conflict with every potential rival.
What was the impact of the marketplace on medical theory?
Shift from Galenic medicine (treated the individual) to chemical treatment of disease aided by an influx of printed material for empirics pills and quacks cures.
What was the impact of print on the marketplace
Widened it, allowing for a larger audience for medical goods and services.
For Harold Cook, what was the aim of physicians?
[GA and LM, 1994]
Not to cure disease, but preserve health and prolong life: education focused on the practice of natural philosophy rather than medicine- ‘good advice’.
Andrew Boorde’s popular medical text 1547
the ‘pinnacle of early 16th-century medical writing’ contained 5 rules for health and healthy lifestyle, not a list of cures for various diseases, but a manual of advice about health
In the Brockliss and Jones model, what did Charlatans lack?
Formal qualifications and certifications- inaccurate to suggest a non-hierarchical marketplace where everyone operated on a level playing field- in France, Charlatans lacked the ‘passport into the corporative world of the orthodox medical community.
Pomata’s horizontal networks
A case study of Bologna: people choose their healer using horizontal networks of kinship, friendship and neighbours.
patients could seek advice from BOTH official and unofficial healers- not a choice between binary opposites.
What is the impact of an emphasis on a monetary transaction in medicine?
Ignores that for much of the medical marketplace, other types of things were transacted: favour, credit, social standing, relationships of exchange that cannot be easily reduced to discrete transactions.
Why does Andrew Wear believe that the medical marketplace model is inappropriate for understanding lay medicine?
If transactions occurred, they were social rather the economic: MMM was conceived in the mid-1980s when free market ideology was dominant, a model that shouldn’t be over-emphasised as its focus on economic imperatives rather than cultural forces (ie religion), is anachronistic.
