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.
How does Roy Porter define quacks?
[1989 H4Sale]
those who:
- drummed up custom largely through self-orchestrated publicity
- operated as individual entrepreneurs rather than as cogs in the wheels of the medical community
- dealings with their clients were largely one-off
- depended heavily upon vending secret nostrums
When were authorities likely to interfere with disease?
when it 1) affected employment or 2) threatened public health
How many adverts did Kevin Siena analyse?
512
What did Kevin Siena’s analysis of adverts for the pox show?
A wide range of healers not only advertised that they could treat the pox, but that they would do so in a way that would meet patient demand for confidentiality, with a clear promise of privacy
-Patient need as shaping medical practice
What was the role of advertising in quack medicine?
Facilitating the success of marginal practitioners alongside traditional elites.
What does Gentilecore suggest about the EM Italian medical marketplace?
Surviving denunciations to the College of Physicians suggest that the practice of medicine in early modern Italy was policed from above; if medicine was a marketplace, it was a regulated one (however imperfect/ineffectual/prone to negotiation this policing may have been.)
Unfettered marketplace: favoure model for England
When does Gentilecore suggest was the golden age of medical pluralism?
c.1550-1700.
Influence of Enlightenment reason, break down of religious explanations of disease, commercialisation, professionalisation.
How did the College of Physicians describe Simon Forman?
‘ignorant, audacious, illegal, bold and wicked imposter: a quack’
-failed to curtail his medical practice
How did Simon Forman threaten the college of physicians?
-he infringed on their privilege, challenged their authority: in promoting his astrological methods, he denounced their learned medicine and administered remedies to thousands of people.
What event led to the success of Simon Forman as a medical practitioner?
Plague 1592-3
Most members of the College of Physicians fled the city
Forman- caught plague but survived- believed God had sent him to cure the plague
Describe the relationship between Forman and trust
Forman’s method meant that through his judgement, he won the patients’ trust, meaning he could exercise his authority.
‘in each consultation, he and his patients negotiated an exchange of trust for true judgements.
Describe Simon Forman’s medical method
A patient provided her name, age, address and question. Forman calculated the position of the stars and planets and made a judgement.
Katherine Park 15th century Florence
Cluster of small practitioners, influenced by non-economic factors such as social and political ties
Harold Cook 17th century England
- Increasing prevalence of medicine for payment
- Shift from medicine for maintenance of health to a more ad-hoc response to disease
Why does Cook argue physicians tried to control London medical trade?
1) commercial rivalry
2) stand against medical incompetence
What did charitable acts ensure?
healers place in heaven- eg. hospitals founded for the good of the founders soul.
Define medical economies
Systems of social encounter an exchange within which responses to illness were sought and provided
What was the use of association? [Wallis]
Relationships between medical practitioners served as an axis for profit, patients and medical products
Describe Wallis’s conception of 17th century London medical practitioners
Operated within and through commercial networks that linked them in diverse, mutually beneficial relationships.
Ian Mortimer’s rural medical marketplace
Move away from assumption that urban medicine served its immediate marketplace and nothing else; from the 1650s, practitioners regularly settled in rural areas
What could the College of Physicians do from 1541?
Began suing non-physicians for practising without a license [England]
What was the character of the learned physician important to?
Public trust: physicians had the right kind of character that quacks did not
What was the physicians role? [Cook]
to guide his advisee’s life through council, not to fight disease but preserve health and prolong life.
Why was the superiority of physicians deemed dubious?
They argued that classical education > practical experience, lost its authoritative purchase.
How did physicians conceptualise their task?
Offering good council about health and reform habits of the patient- a lifestyle prescription, not a cure
Why did the Council of Physicians need ‘correct moral character’?
King -> duty of care -> delegated COP to carry out that duty
What did the commoditization of medicine threaten?
Ideological supremacy of dietetics or advice about health
What changed to medicine do Brockliss and Jones highlight?
Long 18thc - ‘plastic and protean Galenism replaced by a diffident medical pluralism with a strong emphasis on empirical method
Which disease frequently went beyond the therapeutic reach of physicians?
venereal.
How did the Paris Faculty of Medicine ensure their hegemony over medical practice ?
Members of the Paris Faculty of Medicine deployed this colourful blueprint of the charlatan as a means of denigrating any medical practitioner who seemed to threaten their epistemological, corporative or moral standing.
Faculty had corporative precedence and ideological hegemony. Attacked any practitioner who could not live up to their exacting standards.
London medical marketplace
demand driven
What does Gentilecore argue about religious and secular therapeutics
Coexisted in the same culture, offering patients a choice of explanatory models in keeping with their own convictions about illness.
What did sick Neopolitans engage in medical services? [Gentilecore, Healers and Healing EM Italy]
moved between medical and ecclesiastical healers based on their own perceived needs, as opposed to choosing one distinct type of cure from a metaphorical marketplace
Why can domestic medicine not be overlooked
household was a key economic unit of production.
What does an over emphasis on montary transaction ignore?
that fo much of the medical marketplace, other types of things were transacted: favour, credit, social standing
What does Fissell argue
In the marketplac emodel, all EM medicine is condensed into a single marketplace lacking chronological change.
How was the medical marketplace initially conceived?
as a heuristic device explaining the behaviour of patients and practitioners.
What was the function of print on the marketplace?
catalytic function- permitted a range of practitioners to advertise and practice more intensively.
Historians have fit different kinds of medical practitioners into a model they have created - MM a useful virtual space for placing disparate groups of practitioners together on an equal footing
Challenge: Medical penumbra, charlatans excluded from corporate world. [Brockliss and Jones]
Local authorities
willing to hire a range of practitioners to minsiter to the poor, poor permitted to travel and beg to meet costs.
Advertising played a key part
in asserting the value of quack medicine, helped facilitate the success of marginal practitioners alongside traditional elites.
