Humans form societies to satisfy needs which they cannot meet on their own. The most basic definition of a society, therefore, is a pooling of individuals’ abilities and resources. Just as individuals contribute unequally (some will be faster or stronger, for example), individuals receive unequally. Control of this distribution is given the name ‘power.’ Use of power forms the basis of human conflict.
Medicine, while ideally an impartial discipline motivated solely by a desire to do no harm, is no more exempt from conflict than any other area of human activity. The power dynamics in play include practitioner-patient, racial, religious, sexist, and other forms of discrimination, and public perception of certain diseases (for example, of STDs as ‘immoral’), among many others. As the most popular perception of the appropriate exercise of these power dynamics evolves, the popular perception of appropriate medical behavior changes commensurately. For example, the rise and fall of eugenics laws in the United States, or the shift from considering homosexuality a mental illness that appeared in the DSM.
What remained constant in this evolution is the belief that the appropriateness of the manner in which power is wielded in the medical field is a matter of public, moral concern. However, public opinion is not a monolith—there are conflicts within the non-medical public, and between society’s many power strata and interest groups over the morality of specific medical procedures, such as euthanasia or abortion, or the treatment of various groups of patients, for example African-Americans or women.
The primary focus of this class was examining some of these power dynamics, the public opinions that informed and influenced them, and the groups marginalized or victimized by them.
The two readings that I thought discussed this theme in the most interesting way in were The Doctor Who Fooled the World, by Brian Deer, and The Modern Period, by Laura Freidenfelds.
Brian Deer is British investigative journalist, responsible for the withdrawal of several drugs through work exposing conflicts of interest, fabrication of evidence, and plagiarism. His most famous work is the exposure of Andrew Wakefield, the fraudulent doctor who claimed that the MMR vaccine caused regression into autism. Deer published a series of reports detailing Wakefield’s conflicts of interest, manipulations of observations, and outright fraud. These findings led to the longest inquiry ever conducted by the UK’s General Medical Council, which found Wakefield “dishonest, unethical, and callous,” and struck him from the UK medical register.
The author structured his argument as a piece of investigative journalism. His narrative—chronicling the rise, fall, and surprising durability of Andrew Wakefield—is written as a story. The author’s diction is very informal and makes frequent use of flamboyant words that, while useful for ensnaring a skimmer of a newspaper into fully reading his articles, eventually begin to detract from his argument. For example, in describing one of Wakefield’s initial ideas to gain fame, the author writes “That’s bigger than you think. In fact, it’s epic.”
I couldn’t decide how I felt about the author’s structure. On one hand, it is probably true that such “journalistic writing” captures attention, is more accessible to a broader range of readers, and is therefore useful for propagating the author’s necessary warning against the appallingly damaging claims he helped uncover. However, it is hardly scientific. I felt that this point is important because such a conversational, non-scientific tone “brings down” his counter-argument to the sensationalistic level of Wakefield, and his large contingent of associated or unassociated followers. This, of course, becomes potentially harmful, as the fear of vaccines and their link to autism or a host of other supposed side effects is emotional. Parents who fear vaccinating their children deserve to be patiently engaged with, and thoroughly taken through as much impartially-presented proof as they require to convince them their worries are misplaced. If they have attached such psychological significance to vaccines (colloquially referred to as being a “conspiracy theorist”), then they may be impossible to convince, but it is nevertheless extremely important for those who are truly unconvinced not to see those advocating for scientific fact sharing behaviors with those peddling conspiracy theories. It is very important that the evidentially-supported position behaves, writes, and advocates for itself with the professionalism such a position requires. Otherwise, it runs the risk of being equated with its opponents, when the two sides are in no way equal.
I thought this raised interesting overall questions about how to convince people of important facts. Not everyone is equipped to evaluate medical research (one of the many reasons why people seek the advice of doctors), and so such research has to be condensed into more-readily explicable forms. This creates opportunities for undue informality that may have the opposite of its intended effect, and convince patients that they are being talked down to, or even lied to. Such difficulty and lack of trust in the medical realm was already an urgent problem before the coronavirus pandemic, as there were outbreaks of measles in the United States caused by, as the WHO terms it, “vaccine hesitancy.” The practitioner-patient power dynamic, and more broadly, the power dynamic between those who are expert in a field and those who have no education in it, can serve in this situation to guide people away from or drive them toward acceptance of dangerous misinformation.
Lara Freidenfelds writes on the history of American health, reproduction, and parenting. Her Ph.D. is in history of science from Harvard University, and she teaches on the history of reproduction, sexuality, and gender. The Modern Period investigates the history of menstruation in the changing landscape of twentieth-century America, a time period that included the drastically different years of 1900 and 2000.
The author’s main argument is that the evolution of the current, or “modern” method of managing menstruation in America was driven by and an expression of the wider social movement towards “modernity” or “progress.” She supports this by, in the interviews she conducted, focusing on the social aspects of learning about, managing, and talking about menstruation. She begins by outlining the great stigma initially attached to a woman’s “monthly,” which was considered an indecent, even Biblically unclean condition. Under the specious understanding of health in the nineteenth century, women were advised to avoid swimming or even bathing while they were bleeding, as they could more easily catch cold as the body divested itself of blood, and that it was critically important that they maintain regular cycles and not obstruct the flow of “bad blood” leaving the body.
As the twentieth century dawned, an extremely pervasive social movement of “Progressivism” arose in America. Its animating belief was that, as the country had closed the frontier and was beginning to make its own technological advances (the Wright brothers would fly in 1903), the “modern” disciplines of science and technology were rightfully expanding to include and improve every facet of life. Medicine was now to be based upon scientific inquiry, and this included the medical phenomenon of menstruation. In addition, women were beginning to enter the workforce (especially in white- or pink-collar jobs) in larger numbers, and they had to be able to do their jobs all month without the significant disruption of their periods. As a result, the market began to supply “modern” menstrual products designed to enhance the comfort and capability for physical activity of the wearer. Freidenfelds quotes interviews to describe the new products available for women, in addition to the gradually more medical and open way menstruation was discussed in those product labels and advertisements. The trend that would continue for the rest of the century was a greater variety of products, to enable a greater variety of activities, and a greater erosion in the taboos both around menstrual technologies and around menstruation itself. The author believed that this trend, which she saw as flying in the face of traditional morality and management practices, was driven largely by a capitalistic desire to be able to earn wages all month.
However, this trend was not uniform. Freidenfelds’s interviews showed that girls of Chinese immigrant descent were much more likely to view tampons as immoral, for example, than white Protestants from the Northeast. The author argued that this split was due to the center of the Progressive movement (the impetus behind the changing landscape) being in white, middle-class urban areas, making it more likely that those raised outside of those areas would view its trends with a certain skepticism, as a movement not really theirs and not aligned with their values.
I had one significant critique of the author’s method. She discussed menstruation as though it was not, at its root, a medical issue. She frequently spoke of “managing” menstruation as an almost unnecessary intervention, and stated that the goal of doing so was to produce a “body that could work and play at full efficiency all month,” as part of capitalistic brainwashing (193). I thought that this was an unbalanced view to take. For many women, conditions such as uterine fibroids, endometritis, or simply heavy bleeding make periods excruciatingly painful. The desire to manage one’s pain has less to do with a capitalist desire to be able to continue producing, and more to do with the human desire for relief. Additionally, blood in all its forms is potentially unsanitary; wishing to control it may include patriarchal stigma, but that is not the only motivation. Though she notes that for many women, the greater ability to control one’s period through menstrual products and the more factual and open way menstruation was discussed were liberating, her tone came across as fundamentally negative.
I thought this view of the “management” of menstruation illuminated an interesting power dynamic: between patients with the same condition. White Protestants from the Northeast, as previously noted, drove the Progressive movement, and as such had more power to shape the dominant narrative about the condition of menstruation. However, other groups or individuals who did not conform to that narrative were left out: people who should have been united were fighting each other. This conflict points to the underlying theme that there is always tension between individuals having power over themselves, and the program of the group to which they belong. Power can be granted by numbers, and therefore groups seeking to wield power must enforce a certain degree of compliance upon their members, and shun those who do not comply.
Ultimately, both readings had a lot of room for considering the abilities and limitations of an individual–both in attempting to navigate the medical world, and the world in general. How their lessons can best be applied, each reader will have to judge.
