Medical Sociology in the 18th-20th Centuries
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What was the prevailing attitude toward illness in the 18th and 19th centuries in the United States?

  • Illness was seen as a purely biological phenomenon.
  • Illness was primarily attributed to supernatural forces.
  • Illness was understood as a consequence of environmental factors.
  • Illness was connected to individual morality and behavior. (correct)

    • Which event challenged the prevailing "moral concept of illness" in the United States?

  • The American Civil War. (correct)
  • The publication of the Flexner Report.
  • The rise of industrialization.
  • The development of germ theory.

    • What was the main impact of the rise of medical bacteriology and germ theory on the understanding of illness?

  • It shifted the focus from social environments to biological causes of illness. (correct)
  • It completely discredited the "moral concept of illness."
  • It led to the establishment of public health infrastructure.
  • It emphasized the role of social factors in the spread of disease.

    • What did Rudolph Virchow's work on typhus fever contribute to the development of medical sociology?

    <p>It demonstrated the importance of social factors in disease transmission. (A)</p> Signup and view all the answers

    What was the primary reason for the parallel rise of medicine and medical sociology in the 20th century?

    <p>The recognition of the social determinants of health. (A)</p> Signup and view all the answers

    What is a key difference between osteopaths and chiropractors, as described in the text?

    <p>Osteopaths are recognized by the AMA, while chiropractors are not. (B)</p> Signup and view all the answers

    Which of the following is NOT mentioned as a reason why patients might turn to alternative therapies?

    <p>A belief that alternative therapies are more effective for treating chronic conditions. (C)</p> Signup and view all the answers

    Why is the distinction between alternative medicine and biomedical approaches important?

    <p>It defines the power dynamics between the biomedical profession and alternative medicine. (B)</p> Signup and view all the answers

    What is the primary reason why most patients consult a general practitioner before seeking alternative therapies?

    <p>They are often skeptical of alternative therapies and want to seek a traditional medical opinion first. (B)</p> Signup and view all the answers

    Which of the following groups is most likely to utilize folk or faith healers?

    <p>Individuals from racial or ethnic minority groups. (B)</p> Signup and view all the answers

    What is the significance of the "Two Cultures" concept, as illustrated by the case of Lia Lee?

    <p>It demonstrates the importance of understanding cultural beliefs when treating patients. (A)</p> Signup and view all the answers

    What is NOT a reason why a patient might utilize Complementary and Alternative Medicine (CAM)?

    <p>A desire to be reimbursed for CAM treatments by their insurance company. (D)</p> Signup and view all the answers

    Which of the following statements regarding the use of CAM is supported by the text?

    <p>CAM is frequently utilized as a supplementary approach to traditional medical care. (D)</p> Signup and view all the answers

    Which of the following factors contributed to the rise of hospitals as a primary care setting in the early 20th century?

    <p>The emergence of medical technology and germ theory. (D)</p> Signup and view all the answers

    What was the primary reason behind the rejection of universal healthcare in the US?

    <p>Opposition from physicians who saw their autonomy threatened. (C)</p> Signup and view all the answers

    Which of the following is NOT a category within the US’s categorical healthcare system?

    <p>Private health insurance (C)</p> Signup and view all the answers

    How does the epidemiological transition impact the health of populations?

    <p>It contributes to a shift in mortality patterns, with chronic diseases becoming the leading causes of death. (B)</p> Signup and view all the answers

    What is the primary focus of social epidemiology as compared to risk-factor epidemiology?

    <p>Examining the social and environmental factors that influence health and disease patterns. (A)</p> Signup and view all the answers

    Which of the following is an example of a latent effect within the life course perspective in health demography?

    <p>The impact of early childhood nutrition on adult health outcomes. (D)</p> Signup and view all the answers

    What is the primary focus of an epidemiologist?

    <p>Conducting research on the causes and spread of diseases. (B)</p> Signup and view all the answers

    Which of the following best represents the primary role of a patient-provider interaction?

    <p>Collaborating to develop a plan and manage a patient's health condition. (A)</p> Signup and view all the answers

    In the early 20th century, what was the primary impact of the emergence of medical technology and germ theory on the healthcare landscape?

    <p>It shifted the focus of care from the home to specialized medical institutions. (D)</p> Signup and view all the answers

    How did the rise of germ theory in the early 20th century influence the image of medicine and physicians?

    <p>It increased the public's trust in physicians and medical institutions. (B)</p> Signup and view all the answers

    What is the primary difference between incidence and prevalence rates in epidemiology?

    <p>Incidence reflects the number of new cases while prevalence reflects the total number of cases at a given time. (A)</p> Signup and view all the answers

    John Snow's investigation of the cholera outbreak in London is considered a landmark in epidemiology because he demonstrated which key concept?

    <p>The use of statistical methods to identify the source of an outbreak. (B)</p> Signup and view all the answers

    What is a key characteristic of a case-control study, as demonstrated in the example of a study on disease exposure?

    <p>It compares individuals with the disease to those without the disease to identify potential risk factors. (A)</p> Signup and view all the answers

    Which of the following is NOT considered a key factor contributing to the epidemiologic transition from infectious diseases to chronic diseases?

    <p>Increased public health efforts to prevent disease outbreaks. (B)</p> Signup and view all the answers

    Which era of epidemiology is characterized by a focus on identifying risk factors for chronic diseases?

    <p>Chronic Disease Era (D)</p> Signup and view all the answers

    What is the primary reason for the decline in morbidity and mortality in the 20th century?

    <p>Improved sanitation and public health measures. (C)</p> Signup and view all the answers

    In the context of the evolving medical profession, what is the 'Golden Age of Doctoring' often referred to as?

    <p>The mid-20th century, characterized by dominance of the medical profession and fee-for-service payment structures. (A)</p> Signup and view all the answers

    Which of the following factors contributed to the end of the 'Golden Age of Doctoring?'

    <p>Emergence of managed care and the bureaucratization of medical services. (D)</p> Signup and view all the answers

    How did the evolving doctor-patient relationship contribute to the decline of the 'Golden Age of Doctoring?'

    <p>Increasingly, healthcare providers became part of larger systems, leading to a decline in the independent practice of medicine. (D)</p> Signup and view all the answers

    What is a key characteristic of the 'Eco-Epidemiology Era' as highlighted by recent outbreaks like Ebola, COVID-19, and HIV?

    <p>Recognizing the interconnectedness of human, animal, and environmental factors in disease emergence. (D)</p> Signup and view all the answers

    What is the main focus of the American Medical Association (AMA) in this context?

    <p>Promoting the interests of physicians and resisting policies perceived as undermining their autonomy. (D)</p> Signup and view all the answers

    What is a key feature of 'managed care' in the healthcare system?

    <p>Third-party payers, such as insurance companies, control the cost and delivery of healthcare. (B)</p> Signup and view all the answers

    How did the COVID-19 outbreak contribute to the evolving role of epidemiology?

    <p>It demonstrated the need for collaboration between different disciplines to address complex public health challenges. (C)</p> Signup and view all the answers

    Which of the following is NOT a key challenge faced by the medical profession in the 21st century?

    <p>Shortage of medical professionals, leading to longer wait times for appointments and procedures. (D)</p> Signup and view all the answers

    What is a key factor contributing to the “demystification of the body” in the evolving medical profession?

    <p>The increased reliance on technology, such as imaging and diagnostic tools, to understand the body. (A)</p> Signup and view all the answers

    What is a primary consequence of the fragmented physician’s union (AMA) as relates to universal healthcare?

    <p>Active lobbying against universal healthcare programs in the United States. (C)</p> Signup and view all the answers

    Flashcards

    Flexner Report

    A report that established the biomedical model as the gold standard of medical training.

    Sociology

    The scientific study of society, including social relationships, interactions, and culture.

    Moral Concept of Illness

    The belief that illness and poverty are results of immorality.

    Civil War Impact

    The Civil War challenged the moral concept of illness due to high mortality from disease.

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    Social Medicine

    Recognition that societal factors significantly influence health and disease.

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    Alternative Medicine

    Treatments not commonly practiced by the biomedical profession.

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    Osteopaths

    Trained to manipulate the neuromuscular system, similar to MDs, recognized as a medical specialty.

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    Chiropractors

    Focus on manipulation of the spinal column; not recognized as a medical specialty by AMA.

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    CAM Users

    Individuals turning to alternative therapies often due to dissatisfaction with biomedicine.

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    Why Patients Use CAM

    Patients often seek CAM due to dissatisfaction with biomedicine, wanting to control their health.

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    Folk Healers

    Healers separated from medical professions, often serving racial/ethnic minorities.

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    Faith Healers

    Provide spiritual-based healing, typically outside of formal medical training.

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    Two Cultures: Lia Lee

    Story of a Hmong child representing cultural differences in understanding illness and healing.

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    19th Century Health Care

    Characterized by a lack of privacy in hospitals and rapid transmission of diseases.

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    Early 20th Century Advancements

    Emergence of medical technology led to improved hospital care and increased trust.

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    US Health Care System Organization

    Categorized into employer-based, Medicare, Medicaid, and other systems.

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    Epidemiological Transition

    Shift from infectious to chronic diseases as main causes of death.

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    Life Course Perspective

    Focuses on age-graded trajectories and the conditions that affect individuals' lives.

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    Epidemiology

    The study of how diseases affect populations, often referred to as 'disease detectives.'

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    Demography

    Understanding health based on population characteristics like race and age.

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    Managed Care Organizations

    Health care plans that provide cost-effective services and better patient management.

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    Pathway Effects

    Influences on health that follow a broader trajectory across a person’s life.

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    Incidence

    Number of new cases of a specific health problem over a time period.

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    Prevalence

    Total number of cases of a health problem at a specific time.

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    John Snow

    The first epidemiologist known for his cholera study.

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    Case Control Study

    Compares cases with a disease to controls without it.

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    Odds Ratio

    Odds that exposed individuals develop a disease compared to non-exposed individuals.

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    Cohort Study

    Observes exposed vs. non-exposed groups over time.

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    Causal Agents

    Factors that contribute to disease, such as biological or chemical agents.

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    Sanitary Era

    Focused on sanitation programs to prevent diseases in the 19th century.

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    Chronic Disease Era

    Shift in focus towards risk factors in the second half of the 20th century.

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    Morbidity

    The condition of being diseased or unhealthy; illness rate.

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    Mortality

    The rate of death in a population; death rate.

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    Golden Age of Doctoring

    Period in the mid-20th century marked by physician power and autonomy.

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    Managed Care

    Health care system designed to manage cost and quality; involves third-party payers.

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    Changing Doctor-Patient Relationship

    Shift from independent care to patient-provider interactions in late 20th century.

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    Study Notes

    Flexner Report and Biomedical Model

    • The Flexner report established the biomedical model as the standard for medical training.

    Sociology of Medicine

    • Sociology is the scientific study of society, focusing on social relationships, interaction, and culture.
    • Auguste Comte first used the term in the 1830s, proposing a unified science of human activity.
    •  Medicine, medical sociology, and public health have historically overlapped.
    • The understanding of the causes of illness shifted from social factors to biological ones.
    • The 20th century saw the rise of both medical disciplines and medical sociology.
    • Industrialization negatively impacted health.
    • Moral reform had limited effect on public health.

    Institutional Settings and Healthcare Experience

    • 18th/19th century US viewed illness through a moral lens, believing sickness stemmed from immorality.
    • The Civil War highlighted the significant difference between combat mortality and illness mortality: challenging the moral concept of illness when soldiers fought for a cause and still succumbed to illness.
    • 20th century saw a reevaluation of illness causes, leading to the emergence of social medicine and a growing public health infrastructure.
    • Recognition of industrialization's negative impacts and the limited power of moral reform.
    • The social perspective on illness was temporarily set aside by the rise of germ theory.
    • Rudolf Virchow studied typhus, demonstrating medical researchers could study diseases in social contexts.
    • Hospitals (19th century): lacked privacy, had high disease transmission, payment was involved amongst all parties, and there was a lack of organizational structure.
    • Hospitals (early 20th century): became national institutions, accessible in communities, increased acceptability, improved training for physicians and nurses, increase in trust due to improved outcomes, and home-based care became secondary.

    Countervailing Forces and Why the US Rejected Universal Healthcare

    • The pursuit of medical knowledge as a social science was limited, instead favoring the germ theory.
    • The rise of medical knowledge, credentialing, and technology enhanced the medical institution's prestige.
    • Physicians feared a loss of autonomy by rejected universal healthcare, linking it to socialism using an advertising campaign.
    • Disenfranchisement of Black voters prevented sufficient political support for universal healthcare.
    • President Truman struggled to connect universal healthcare to economic success.

    Healthcare Systems in the US

    • The US healthcare system is categorized into various systems including employer-based, Veteran's Administration, Affordable Care Act (ACA), Medicare, Medicaid, and Children's Health Insurance Program (CHIP).
    • Access is tiered, and access is dependent on factors like employment status.
    • Medicare covers the elderly, disabled, and those with end-stage renal disease (ESRD).
    • Medicaid covers low-income individuals, people with disabilities, and pregnant women.
    • CHIP provides insurance for children in uninsured families.

    Patient-Provider Interaction

    • Direct patient-physician interaction was more common in the past but now involves multiple actors and insurance.

    Health Demography and Epidemiology

    • Health demography examines the relationship between population health characteristics and demographics like age, race, and gender.
    • Epidemiologists study disease patterns in populations rather than individuals.
    • Epidemiological transition: infectious diseases are replaced by chronic diseases as leading causes of mortality (heart disease and cancer). The shift is caused by advances in medicine and understanding germ theory.
    • Epidemiological transitions as mortality transitions, showing stages: pestilence & famine, receding pandemics, noncommunicable diseases, and delayed mortality.
    • The life course perspective considers transitions embedded in broader trajectories subject to changing conditions, future options, and immediate circumstances.
    • Epidemiology and demography have historically been at odds, particularly on risk-factor epidemiology, but are finding renewed alliance through social epidemiology.
    • Age pyramids show population distribution by age and sex.

    19th and 20th Century Epidemiology Example:

    • John Snow's study of the Broad Street Pump in London identified the source of a cholera outbreak.
    • Minnesota's team discovered a salmonella outbreak linked to uncleaned ice cream containers.
    • Modern epidemiology applies scientific methodology to track disease outbreaks, uncover causes and develop solutions.
    • Incidence rates focus on new cases, while prevalence considers existing cases.

    Causal Agents and Eras of Disease

    • Causal agents of disease include biological, nutritional, chemical and social factors.
    • Sanitary era, infectious disease era, chronic disease era and eco-epidemiology era are four major eras in epidemiology and public health.

    The Changing Medical Profession

    • The 1950s experienced increased prices, unnecessary medical procedures, and fee-for-service payment.
    • The latter half of the 20th century witnessed the corporatization of medicine, increased competition, global influences, and reliance on technology to demystify medicine.
    • The doctor-patient relationship shifted, moving from a more independent physician to a patient-provider model.
    • Insurance influenced care giving and billing, resulting in fragmentation of the American Medical Association.

    Complementary and Alternative Medicine

    • Alternative medicine uses treatments outside the biomedical model.
    • Patients choose alternative healthcare for various reasons, including skepticism or dissatisfaction with biomedical care, desire for control over their health, and a positive experience.
    • Osteopathic medicine is considered a biomedical field, whereas chiropractic medicine is separate.

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    Explore the evolution of attitudes toward illness from the 18th through the 20th centuries in the United States. This quiz covers significant events, contributions of key figures like Rudolph Virchow, and the impact of medical bacteriology and germ theory on societal understanding of illness.

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