ABSTRACT
In 1984, Sociology of Health and Illness published an article by Philip Strong on ‘The academic encirclement of medicine’. This continued his attack on sociologists’ uncritical adoption of the thesis of medical imperialism (Strong 1979a). On the contrary, he argued, medicine occupied such a large space in contemporary society that it had become a major target for jurisdictional entrepreneurs in other fields. Law was a newcomer to this enterprise. The 1980 Reith Lectures by Ian Kennedy (1981), a prominent academic lawyer, had staked a public claim to legal jurisdiction over large areas of health care. Kennedy has repeatedly returned to these themes, most recently as Chair of the inquiry into perioperative deaths in paediatric cardiac surgery at the Bristol Royal Infirmary during the early 1980s (Bristol Royal Infirmary Inquiry 2001). Dingwall and Strangleman (2005) note how the final report repeats his earlier criticisms of medicine for persistent paternalism, hierarchy, excessive clinical freedom, undermanagement and lack of accountability, and urges that it should become more open, accountable, quality-oriented and patient-centred, using National Health Service (NHS) employment discipline to achieve these goals. Much the same might be said of the report by Dame Janet Smith, a senior judge, on the implications for the regulation of health care professionals arising from her inquiry into the murderous practice of Dr Harold Shipman, who is believed to have killed more than 500 elderly patients between 1974 and 1998 (Shipman Inquiry Fifth Report 2004). As Eliot Freidson (1982: 97) remarked, however, in a contemporary review of Kennedy’s Reith Lectures:
Merely attacking the pathologies of medical authoritarianism . . . does not help because it does not give us a sensitive and informed understanding of how and why they are so persistent even in the face of their massive cost . . .The broad public too has colluded with medicine, capital and the state in preserving the system . . . Are [there dangers in] merely
substituting. . . ‘professional’ laymen for professional ‘experts’ . . .becoming at least as coercive and elitist as what [is] replaced?
