Introduction

I was caught off guard when I began reading the introduction. It starts with "the dream of reason id not take power into account." Isn't this supposed to about the transformation of medicine? As I continued reading, I began to understand what Starr is trying to put across. Medicine probably began as a combination of different types of "reason"-- whether it is scientific knowledge or simply the intrinsic human empathy to help the sick. Yet, wherever there is reason, there comes power and authority. When knowledge begins to build, there is a need to control and regulate it before it goes out of control. Yet, even this process is complicated. As Starr states, "Its authority spills over its clinical boundaries into arenas of moral and political action for which medical judgment is only partially relevant and often incompletely equipped. Moreover, the profession has been able to turn its authority into social privilege, economic power, and political influence."(p.5)

So, some may assume that all medical professionals can use this power and authority to become powerful. Starr immediately states that this assumption is wrong. Many medical professionals, both of the past and present, have not held powers of position.

In the end, Starr states that there three problems with professional sovereignty in American medicine. First, it is historical -- there's no relation between social structure and caring for the sick. Second, to understand the organization of medicine in the United States, you have to delve further than simply looking at the doctor-patient relationship. Finally, you need to use an approach that "encompasses both culture and institutions" to understand this health care system.

Following these premises, Starr delves into what exactly authority is (it incorporates characteristics of legitimacy and dependence). What I find most interesting about this discussion is how he states medical authority came to be. He states that "the rise of professions was the outcome of a struggle for cultural authority as well as social mobility." To me, this makes perfect sense. In order to establish oneself as a medical professional, you have to have cultural authority to ensure that your patients and those related will listen to your professional opinion. Once a professional gains cultural authority, he will more than likely use this power for social mobility. If he is able to establish himself as a member of the "upper class," he will have the power to practice medicine as he wishes.

Starr states something similar to my assumption, "at a time when traditional certainties were breaking down, professional authority offered a means of sorting out different conceptions of human needs and the nature and meaning of events." Medical professionals could offer opinions if someone's medical request was due to his individual need or simply to help prove a point of a certain event.

The practical use of authority is greater than simply offering a medical opinion. Once medical professionals had established their authority, they were able to "control [...] the market, then [use it against] large organizations and government [that] threatened to intervene."