ABSTRACT
This chapter explores some of the basic assumptions of the theoretical position that considers the medical profession the dominant force in medicine. It argues that the medical profession is not only losing the power it once had in medicine, but that it was never the dominant force shaping the production of medical knowledge or the practice and organization of medicine. The most strategic and treasured characteristic of the profession— its autonomy— is therefore owed to its relationship to the sovereign state from which it is not ultimately autonomous. Capitalism was being established, changing society from a mercantile to an industrial system. The establishment and development of the edifice of mechanistic medicine was not the result of the piling up of scientific discoveries like bricks in that construction. Science and technology are not the motors of history. The power of the professions is subservient to more powerful forces such as the dominant classes that have an overwhelming influence in medicine.
