Henslin James M. Sociology: A Down to Earth Approach

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Threats to Health 581

TABLE 19.1 What Drugs Have High School Seniors Used?

Source

By the author. Based on Johnston et al 2008a:Tables 2, 3.

In the past year?In the past month?

Alcohol 43.1% 66.5%

How many have been drunk? 27.6% 45.6%

Nicotine (cigarettes) 20.4% NA

Marijuana 19.4% 32.4%

Amphetamines 2.9% 6.8%

Barbiturates 2.8% 5.8%

Tranquilizers 2.6% 6.2%

Hallucinogens* 2.2% 5.0%

Cocaine 1.9% 4.4%

MDMA (Ecstasy) 1.8% 4.3%

LSD 1.1% 2.7%

Steroids 1.0% 1.5%

PCP 0.6% 1.1%

Heroin 0.5% 0.7%

Other than LSD.

Men MenWomen Women

In the past month? In the past year?

TABLE 19.2 What Drugs Have Full-Time College Students Used?

Other than LSD.

Alcohol 67.2% 66.2% 80.1% 81.4%

How many have 46.3% 47.1% 61.9% 66.7%

been drunk?

Nicotine (cigarettes) 21.8% 18.8% 32.2% 29.7%

Marijuana 20.2% 14.8% 35.8% 29.4%

Amphetamines 2.8% 3.2% 8.1% 6.2%

Hallucinogens* 2.2% 0.8% 7.3% 3.1%

Cocaine 1.8% 1.7% 6.3% 4.9%

Tranquilizers 1.6% 1.9% 1.3% 0.2%

Barbiturates 1.0% 1.6% 4.2% 3.2%

MDMA (Ecstasy) 0.5% 0.3% 1.4% 2.7%

LSD 0.7% 0.1% 2.2% 0.8%

Heroin 0.3% 0.1% 0.3% 0.1%

Source: By the author. Based on Johnston et al. 2008b:Tables 8-2, 8-3.

In Table 19.2, we turn to college students. Among them, too, alcohol is the most pop-

ular drug, and four out of five of all college students have drunk alcohol during the past

year, about two-thirds in the past month. About two of three have been drunk during the

past year, almost half in just the past month. As you can see, women are slightly more

likely to drink alcohol and to get drunk. In general, however, male college students are

slightly more likely to use drugs.

Is alcohol bad for health? This beverage cuts both ways. One to two drinks a day for

men and one drink a day for women reduces the risk of heart attacks, strokes, gallstones,

and diabetes (“Alcohol” 2009). (Women weigh less on average and produce fewer en-

zymes that metabolize alcohol.) Beyond these amounts, however, alcohol scars the liver,

damages the heart, and increases the risk of breast cancer. It also increases the likelihood

of birth defects. One-third of the 37,000 Americans who die each year in vehicle accidents

are drunk (Statistical Abstract 2011:Table 1109). Each year, 700,000 Americans seek treat-

ment for alcohol problems (Statistical Abstract 2011:Table 202).

Nicotine.

Let’s suppose that you are on your way to the airport to leave for a long-awaited vacation. You

are listening to the radio and thinking about the palm trees and ocean waves of sunny Hawaii.

Suddenly, an announcer breaks into your reverie with a flash bulletin: Terrorists have hidden

bombs aboard five jumbo jets scheduled for takeoff today. The announcer pauses, then adds:

“The authorities have not been able to find the bombs. Because they don’t know which flights

will crash, all flights will depart on schedule.”

Five jets are going to crash. On each jet will be 200 passengers and crew. They will plum-

met from the skies, leaving a trail of agonizing screams as they meet their fiery destiny.

What would you do? My guess is that you would turn your car around and go home.

Adios to Hawaii’s beaches, and hello to your own backyard.

Nicotine use—with its creeping side-effects of emphysema and several types of can-

cer—kills about 400,000 Americans each year (Centers for Disease Control and Preven-

tion 2009b). This is the equivalent of five fully loaded, 200-passenger jets with full

crews crashing each and every day—leaving no survivors. Who in their right mind

would take the risk that their plane will not be among those that crash? Yet this is the

risk that smokers take.

Nicotine is, by far, the most lethal of all recreational drugs. Smoking causes cancer of the

bladder, cervix, esophagus, kidneys, larynx, lungs, and other body organs. Smokers are more

likely to have heart attacks and strokes, and even to come down with cataracts and pneumo-

nia (Surgeon General 2005). The list of health problems related to smoking goes on and on.

Then there is secondhand smoke, which is estimated to kill 50,000 nonsmokers a year

(Surgeon General 2006). This is the equivalent of another fully loaded jet going down

every two days.

An antismoking campaign that stresses tobacco’s health hazards has been so successful

that smoking is banned on public transportation and in most offices, restaurants, and, in

some states, even bars. Figure 19.11 shows how this antismoking message has hit home.

In four decades, cigarette smoking has been cut by more than half among U.S. men, and

almost that among U.S. women. As you look at this figure, you might be surprised to see

that most men used to smoke.

Millions of Americans wouldn’t think of flying if they knew that even one jet were

going to crash—yet they continue to smoke. Why? The two major reasons are addiction

and advertising. Nicotine may be as addictive as heroin (Tolchin 1988). While this may

sound far-fetched, consider Buerger’s disease:

In this disease, the blood vessels, especially those supplying the legs, become so constricted that

circulation is impaired whenever nicotine enters the bloodstream.

If a patient continues to smoke, gangrene may eventually set in. First a toe may have to

be amputated, then the foot at the ankle, then the leg at the knee, and ultimately at the hip.

. . . Patients are informed that if they will only stop smoking, it is virtually certain that the

otherwise inexorable march of gangrene up the legs will be curbed. Yet surgeons report that

some patients with Buerger’s disease vigorously puff away in their hospital beds following a

second or third amputation. (Brecher et al. 1972)

The second reason is advertising. Cigarette ads were banned from television in the

1980s, but cigarettes continue to be advertised in newspapers and magazines and on

billboards. Cigarette companies spend huge amounts to encourage Americans to

smoke—about $13 billion a year. This comes to $43 for every man, woman, and child

in the entire country (Centers for Disease Control 2007b). Although the tobacco indus-

try denies it, they target youth, often by associating cigarette smoking with success, high

fashion, and independence. Despite these denials, Joe Camel, the industry’s most blatant

attempt to lure children to smoke, has been banned. (See the photo on the next page.)

With fewer smokers in the United States, the tobacco companies have turned to recruit-

ing victims in the least industrialized nations. Their efforts to increase nicotine addiction

there have been quite successful, making nicotine deaths a serious problem in countries

such as China (Gu et al. 2009).

582 Chapter 19 MEDICINE AND HEALTH

1965

1985

2008

Percentage

10%

20%

30%

50%

40%

60%

Women

Men

Year

FIGURE 19.11 Who

Is Still Smoking?

The Percentage of

Americans Age 18 and

Over Who Smoke

Cigarettes

Source: By the author. Based on

Statistical Abstract of the United

States 2011:Table 200, and earlier

years.

Disabling Environments

A disabling environment is one that is harmful to people’s health. The

health risk of some occupations is evident: Lumberjacking, riding rodeo

bulls, and training lions are obvious examples. In many occupations,

however, people become aware of the risk only years after they worked

at jobs that they thought were safe. For example, during and after World

War II, several million people worked with asbestos. The federal govern-

ment estimates that one-quarter of them will die of cancer from having

breathed asbestos particles. It is likely that many other substances also

cause slowly developing cancers—including, ironically, some asbestos

substitutes (Meier 1987; Hawkes 2001).

Industrialization increased the world’s standard of living and brought

better health to hundreds of millions of people. Ironically, industrializa-

tion also threatens to disable the basic environment of the human race,

posing what may be the greatest health hazard of all time. The burning

of carbon fuels has led to the greenhouse effect, a warming of the earth that

may change the globe’s climate, melt the polar ice caps, and flood the

earth’s coastal shores. The pollution of land, air, and water, especially

through nuclear waste, pesticides, herbicides, and other chemicals,

poses additional risks to life on our planet. We discuss these problems in

Chapter 22.

Medical Experiments: Callous and Harmful

At times, physicians and government officials behave so arrogantly that

they callously disregard people’s health. Harmful medical experiments,

though well-intentioned, are an excellent example. We can trace these ex-

periments to 1895, with an attempt to find a way to immunize people

against syphilis. In that year, Albert Neisser, a physician in Germany, in-

jected young prostitutes—one was just 10 years old—with syphilis. Many came down with

the disease (Proctor 1999). Let’s look at two notorious instances in the United States.

The Tuskegee Syphilis Experiment. To review this horrible experiment conducted by

the U.S. Public Health Service, read the opening vignette for Chapter 12 (page 329).

To summarize here, the U.S. Public Health Service did not tell 399 African American

men in Mississippi that they had syphilis. Doctors examined them once a year, record-

ing their symptoms, and letting the disease kill them.

The Cold War Experiments.

Assume that you are a soldier stationed in Nevada, and the U.S. Army orders your pla-

toon to march through an area in which an atomic bomb has just been detonated. Be-

cause you are a soldier, you obey. Nobody knows much about radiation, and you don’t

know that the army is using you as a guinea pig: It wants to see if you’ll be able to with-

stand the fallout—without any radiation equipment. Or suppose you are a patient at the

University of Rochester in 1946, and your doctor, whom you trust implicitly, says, “I

am going to give you something to help you.” You are pleased. But the injection, it turns

out, is uranium (Noah 1994). He and a team of other doctors are conducting an exper-

iment to find out how much uranium it will take to damage your kidneys. (U.S. Depart-

ment of Energy 1995)

Like the Tuskegee experiment, radiation experiments like these were conducted on unsuspect-

ing subjects simply because government officials wanted information. There were others, too.

Some soldiers were given LSD. And in Palmetto, Florida, officials released whooping cough

viruses into the air, killing a dozen children (Conahan 1994). In other tests, deadly chemical

and biological agents, such as sarin, were sprayed onto naval ships to see if they were vulner-

able. The sailors in these tests wore protective clothing, but were unaware that they had be-

come white mice (Shanker 2002). In 2003, Congress approved a bill to provide health care

for 5,842 soldiers harmed by these secret tests.

Threats to Health 583

Do you think that this magazine ad is designed to

make cigarettes appealing to male youth? Although

tobacco industry officials denied that they were

trying to entice youth to smoke, evidence such as

this ad is overwhelmingly against them. It took

pressure from the U.S. Congress to get R.J. Reynolds

Tobacco Company to stop its Joe Camel ads.

disabling environment an

environment that is harmful to

health

584 Chapter 19 MEDICINE AND HEALTH

The Department of Veterans Affairs never learned the lesson,

and they are still using veterans for testing drugs. But this time

they get permission—by offering $30 a month to down-and-out

veterans of Iraq and Afghanistan. When a drug turns out to have

serious side effects, they delay telling their guinea pig veterans (“VA

Testing . . .” 2008).

Playing God. To most of us, it is incredible that government of-

ficials and medical personnel would callously disregard human life,

but it happens. Those in official positions sometimes reach a point

where they think they can play God and determine who shall live

and who shall die. And, obviously, the most expendable citizens

are the poor and powerless. It is inconceivable that the doctors who

did the syphilis studies would have used wealthy and powerful subjects.

The elite are protected from such callous disregard of human rights

and life. The only way the poor can be protected against such abuse

of professional power is if we publicize each known instance of

abuse and insist on vigorous prosecution of those who plan, di-

rect, and carry out such experiments.

Do such things still happen? You can decide for yourself. Con-

sider how medical researchers developed fetal surgery. Surgeons

were intrigued with the idea of operating on unborn children. Not

only did such surgery hold the possibility of extending medical

knowledge but the pioneers would also get their names in presti-

gious medical journals and be applauded by their peers. Yet such

experimental surgery could cost lives. To reduce the risk, the re-

searchers first experimented on animals. Their next step in refining their skills was to op-

erate on pregnant Puerto Rican women. Now that the procedures are proven, the main

patients are the unborn of the white and affluent (Casper 1998). The steps taken in this

process expose an underlying assumption about the value of life—from animals to Puerto

Rican women to white women. It is almost as though the researchers viewed themselves

as climbing an evolutionary ladder.

The Globalization of Disease

The year was 1918. Men and women, seemingly healthy the day before, collapsed and were

soon dead. In the morning, men wheeled carts down the streets to pick up corpses that were

left on porches like last night’s trash. In a matter of months, a half million Americans died.

Worldwide, the death toll reached between 20 million and 40 million. (Phillips 1998)

What silent killer had so abruptly hit the United States and most of the world? Incredi-

bly, it was the flu. For some reason, still unknown, a particularly lethal variety of the com-

mon flu bug had suddenly appeared.

Medical researchers fear that something like this will happen again. If it does, today’s

global jet travel, unknown in 1918, may make the outbreak even more deadly. Global

travel has destroyed the natural frontiers that used to contain diseases. In a matter of

hours, today’s airline passengers can spread a disease around the world. The resulting

number of deaths could make the 1918 death toll seem puny by comparison.

Such are the fears. New diseases keep appearing on the world scene, and antibiotics

are ineffective against many of them. When the Ebola virus made its surprise appearance

in 1976, with its particularly hideous form of death, the only way it could be contained

was to isolate an entire region of Zaire (Olshansky et al. 1997). When SARS (Severe

Acute Respiratory Syndrome) appeared in 2003, the World Health Organization of the

United Nations called emergency meetings, as did the Centers for Disease Control in the

United States. The fear was that SARS would encircle the globe, killing millions of peo-

ple in a short time. Each person with SARS was isolated, and cities and regions were de-

clared off limits to visitors. The same thing has happened with outbreaks of Asian bird

flu (avian influenza) and the Marburg virus in Angola that causes death from fever, di-

This two-headed dog is the result of an experiment by

surgeons in Moscow. Do you think that grafting the puppy

onto the adult dog, intended to advance techniques for

transplanting human organs, is justified?

Treatment or Prevention? 585

Thinking CRITICALLY

How Will Your Lifestyle Affect Your Health?

Let’s contrast Utah (home of the Mormons, who disapprove of alcohol, tobacco, extramarital sex,

and even caffeine) with its adjacent state Nevada (home of a gambling industry that fosters rather

different values and lifestyles).Although these two states have similar levels of income, education,

urbanization, and medical care, Nevadans are more likely to die from cancer, car wrecks, heart at-

tacks, kidney disease, lung diseases, and strokes. (Statistical Abstract 2011:Table 121)

As you can tell from this example, your lifestyle is fundamentally important for your health.

Lifestyles can lead you down a road to disease and illness—or to health and wellness. Of

course, you know this. Our schools and the mass media publicize the message that healthy

living—exercising regularly, eating nutritious food, maintaining an optimal weight, not smok-

ing, avoiding alcohol abuse, and not having a lot of sexual partners—leads to better health

and a longer life. It doesn’t take much reading to know that fatty, low-fiber foods bring dis-

ease and that a diet rich in fruits and leafy, green vegetables stimulates health.Yet the mes-

sage of how greatly lifestyle affects health falls on many deaf ears.

Although millions of Americans exercise regularly and watch their diet and weight, mil-

lions more gorge on potato chips, cookies, and soft drinks during their mesmerized hours

of watching television and wielding joy sticks.A shorter life and the misery of sickness are

simply not on people’s minds while snacks, reruns, and video games beckon. Prevention re-

quires work, while illness requires only a doctor’s prescription.

Most doctors, too, are attuned to writing prescriptions for health problems instead of

focusing on preventive medicine and “wellness.” When patients see their doctor, they don’t

want to hear “Lose weight, exercise, and don’t forget to eat your vegetables.” Who wants to

pay for that? You can get that message from your mother free. Patients want to leave their

doctor’s office with the message,“You’ve got such-and such”—and a comforting prescrip-

tion in hand to cure such-and such. Frankly, doctors make money writing prescriptions for

sick people, and to get physicians to turn their focus to “wellness,” we will have to make

“wellness” profitable. Under our current fee-for-service system, if doctors and hospitals

prevent illness, they lose money. Perhaps, then as some have suggested, we can pay doctors

and hospitals a fee for keeping people well.“Wellness” programs can be profitable. Many

companies have found that their medical bills are lower if they help their employees stay

healthy so they don’t become patients (Conlin 2007).

For Your Consideration

First, place the focus on yourself. How can you apply this information to live a healthier life?

Second, consider the broader picture, comprehensive “wellness” and prevention. How can

we improve disabling environments, decrease the use of harmful drugs, and stop businesses

arrhea, vomiting, and bleeding (LaFraniere 2005). Officials are also fearful of a power-

ful new form of tuberculosis that appeared in South Africa (Wines 2007; Dugger 2008).

When such deadly diseases—for which there is no cure—break out, world health of-

ficials send out emergency medical teams to seal off the area. They have been successful

in containing these diseases so far, but they fear that they won’t always be so fortunate.

Treatment or Prevention?

Let’s turn our attention again to the U.S. medical system. One promising alternative to

the way U.S. medicine is usually practiced is to change the focus from the treatment of

disease to its prevention. Let’s consider this in the following Thinking Critically section.

586 Chapter 19 MEDICINE AND HEALTH

from spewing industrial wastes into the air and using our rivers and oceans as industrial sew-

ers? How can we eliminate ads designed to seduce youth to use deadly drugs? How about

ads designed to get adults to tell their doctors what drugs they want? Finally, since we live in

a global village, how can we establish international controls and cooperation so we can cre-

ate a global health-producing environment?

The Future of Medicine

What will the practice of medicine be like in the future? You can expect current issues to

remain, such as the financing of health care, the extent it should be an individual or

governmental responsibility. Other issues mentioned in this chapter will also remain, such

as social inequality, malpractice lawsuits, and depersonalization. Some, such as conflicts

of interest and incompetence, will scandalize the medical profession. New diseases will

also appear, for which we will have to find new treatments. Beyond such carryover issues,

two trends seem to be shaping the future of medicine, alternative medicine and technology.

Alternative Medicine

It is likely that despite attempts of the American Medical Association to enforce a con-

forming view of illness and health, competing views and practices will demand equal time.

An example is alternative medicine, also called nontraditional medicine. This term often

refers to medical practices imported from Asian cultures. From the perspective of tradi-

tional Western medical theory and practice, most alternative medicine makes no sense. Re-

garding it as the superstitious practices of ignorant people, Western doctors usually turn

a scornful and hostile eye at alternative medicine. They first ridiculed acupuncture, for ex-

ample, because it violated their understanding of how the body works. But with patients

reporting results such as pain relief, acupuncture has slowly been accepted in U.S. med-

ical practice.

Many U.S. patients have begun to demand alternatives, and the U.S. medical establish-

ment has started to listen. Although the change is slow, in some places the Western and East-

ern approaches to medical care are being combined. In two hospitals in Savannah, Georgia,

standard and alternative doctors work alongside one another. Patients are given traditional

treatment accompanied by yoga, meditation, and shirodhara, in which warm herbalized

sesame oil is slowly dripped onto the patient’s forehead. Patients may also choose polarity

therapy (to unblock energy), biofeedback, Chi-

nese face-lifting, and aromatherapy (Abelson and

Brown 2002). Hospitals affiliated with Stanford

University, the University of Maryland School of

Medicine, and Harvard Medical School have also

begun to offer a touch of alternative medicine

(Keates 2003; Waldholz 2003).

The change is just a trickle at this point, but

what is sociologically significant is that alterna-

tive medicine has begun to make inroads into

the exclusive club run by the U.S. medical es-

tablishment.

Technology

Technology is certainly destined to have pro-

found effects on medicine. Let’s close this chap-

ter with a look at just one aspect of these coming

changes, one that, with a strange twist, will

bring medicine closer to its roots, that of doctors

making house calls.

Using leeches, an old medical treatment, is making a come-back. Researchers have

found that the chemicals the leeches inject when they bite relieve symptoms of

arthritis and other conditions.

alternative medicine (also

called nontraditional medicine)

medical treatment other than

that of standard Western med-

icine; often refers to practices

that originate in Asia, but may

also refer to taking vitamins not

prescribed by a doctor

The Future of Medicine 587

SOCIOLOGY and the

NEW TECHNOLOGY

Making Virtual House Calls: Visiting

Your Doctor Online

No more taking time off of work, filling out

lengthy paperwork or spending hours to visit your

local Doctors office. Just visit one of our online

doctors today were available 24/7. Sign up and a

Doctor or Nurse will be with you in minutes.

—Quoted from an online medical site

(whose quality of English may or may not

be indicative of its doctors’ practice of medicine)

U.S. medicine is finally moving into the digital age. In

some places, you can log online and have a face-to-face

consultation (via Webcam) with your doctor. Not only

can you describe your symptoms, but you can also use

your computer camera to show you doctor what hurts.

After looking, listening, and asking questions—the

usual thing—the physician gives advice and writes a

prescription.The physician files the prescription with

your local pharmacy, which will deliver it to your door.

Great for rural areas, where there is a shortage of

physicians. And also great for people who want to

avoid traffic jams, germ-infested doctors’ offices, and,

of course, those outdated magazines.

Meg Young was running a 102-degree fever when

she arrived in Boston. She considered going to a

hospital emergency room, but instead she went to

her hotel room. There she went online and hooked

up with her primary doctor in California. After she

described her symptoms, he said she had a bacterial

infection. He prescribed an antibiotic, which she

picked up from a drugstore near her hotel.

“I couldn’t have been happier to not sit up in

some hospital half the night,” she said.

It is easy to see why some patients find virtual

house calls appealing. They also hold high appeal for

some doctors.

If you are an online physician, just like your patient

you don’t have to fight traffic. You don’t even have the

expense of running an office, paying nurses and utili-

ties. On top of this, you don’t even have to see pa-

tients in person. To avoid contact with all of those

germs is a nice side benefit. You get to sit at your

computer, talk to your patient, view some part of their

body, and write a prescription. This process also cuts

down on the boring chit-chat. And getting paid is no

problem. Patients don’t get to “see” you until after

their credit card has been approved.

Seeing the profit opportunity in this developing new

medical “specialty” of “online medical expert,” entre-

preneurs have already started to move in. Some com-

panies will arrange the online visits, maintain records,

and handle credit cards and insurance reimbursements.

Having a physician just a click away, around the

clock, seven days a week is just the beginning. Eventu-

ally, the virtual house calls will be made from mobile

phone to mobile phone. Talk about a time saver. Snap

an image of what hurts, and you will be able to visit

your doctor while you are driving your car.

Of course, if you get too involved in the house call,

after a crunching noise, you might be using your cam-

era phone to show more injuries than you intended.

Based on Costello 2008; Miller 2009; Song 2009.

For Your Consideration

Which would you prefer—visiting your doctor online

or in his or her office? Why? Do you think that virtual

house calls are the wave of the future or an experiment

that will disappoint and be discarded?

Well, not quite, but coming soon in some

form. Already, doctors can perform surgery on

patients who are in distant locations, even

thousands of miles away. Telesurgery is

performed through a combination of robotics

and live imaging.

New HIV/AIDS cases in a year

1993 NOW

Number of AIDS-related

deaths, per year, United States

1995 NOW

Americans who

are obese

NOW

Percentage of U.S. deaths

caused by heart disease

19 0 0

NOW

mber of AIDS related

. death

rt d

sease

Men age 18 and over who

smoke, United States

1965 NOW

Women age 18 and over

who smoke, United States

1965 NOW

Annual cost of medical care

to the average American

1970

450

NOW

7,000

588 Chapter 19 MEDICINE AND HEALTH

SUMMARY and REVIEW

Sociology and the Study of Medicine

and Health

What is the role of sociology in the study of medicine?

Sociologists study medicine as a social institution. As

practiced in the United States, three of its primary char-

acteristics are professionalization, bureaucracy, and the

profit motive. P. 558.

The Symbolic Interactionist Perspective

What is the symbolic interactionist perspective on

health and illness?

Health is not only a biological matter but is also intimately

related to society. Illness is also far from an objective con-

dition, for illness is always viewed from the framework of

culture. The definitions applied to physical and mental

conditions vary from one group to another. Pp. 558–559.

The Functionalist Perspective

What is the functionalist perspective on health

and illness?

Functionalists stress that in return for being excused from

their usual activities, people have to accept the sick role.

They must assume responsibility for seeking competent

medical help and cooperate in getting well so they can

quickly resume normal activities. Pp. 559–560.

The Conflict Perspective

What is the conflict perspective on health and illness?

Health care is one of the scarce resources for which groups

compete. In 1910, the education of physicians came

under the control of a group of men who eliminated most

of their competition and turned medicine into a monop-

oly that has become the largest business in the United

States. On a global level, health care follows the stratifica-

tion that we studied in Chapter 9. The best health care is

By the Numbers: Then and Now

available in the Most Industrialized Nations, the worst in

the Least Industrialized Nations. Pp. 560–565.

Historical Patterns of Health

How have health patterns changed over time?

Patterns of disease in the United States have changed so

extensively that of today’s top ten killers, four did not even

show up on the 1900 top ten list. Because most Americans

live longer than their ancestors did, we can conclude that

contemporary Americans are healthier. For mental illness,

we have no idea how the current rate of mental illness

compares with that of the past, for we have no baselines

from which to make comparisons. Pp. 565–566.

Issues in Health Care

How does treating health care as a commodity

lead to social inequalities?

Because health care is a commodity to be sold to the high-

est bidder, the United States has a two-tier system of med-

ical care in which the poor receive inferior health care for

both their mental and physical illnesses. Pp. 566–568.

What are some other problems in U.S. health care?

One problem is defensive medicine, which refers to medical

procedures that are done for the physician’s benefit, not for

the benefit of the patient. Intended to protect physicians

from lawsuits, these tests and consultations add huge

amounts to the nation’s medical bill. Other problems are

incompetence, depersonalization, conflict of interest, med-

ical fraud, and racism and sexism. Pp. 568–572.

What is the controversy over physicians helping

people end their lives?

People’s bodies can be kept alive by technology even when

they have no brain waves. This leads to questions about the

meaning of life and when to “pull the plug.” Doctors giv-

ing prescriptions to end life is also an issue, fueled by re-

search findings on euthanasia in Holland. Pp. 572–574.

What attempts have been made to cut medical costs?

Health maintenance organizations (HMOs) and diagno-

sis-related groups (DRGs) are among the measures that have

been taken to reduce medical costs. Proposals for national

health insurance have ended in controversy, but the most

controversial proposal is to ration medical care. Pp. 574–576.

Threats to Health

What are some threats to the health of Americans?

Threats to the health of Americans include AIDS, which

has stabilized in the United States but is devastating sub-

Saharan Africa; obesity and thinness; alcohol and nico-

tine; disabling environments; unethical experiments, of

which the Tuskegee syphilis experiments and the Cold

War radiation experiments are two examples; and the

globalization of disease. Pp. 576–586.

The Future of Medicine

What is the future of medicine?

Many present aspects of medicine will continue into the

future, but alternative medicine and technology are likely

to shape the future of medicine. Pp. 586–587.

THINKING CRITICALLY ABOUT Chapter 19

1. A major issue in this chapter is the tension between medi-

cine as a right and medicine as a commodity.What argu-

ments support each side of this issue?

2. How does lifestyle affect health? What does this have to do

with sociology?

3. Have you had an experience with alternative medicine? Or

do you know someone who has? If so, how did the treat-

ment (and the theory underlying the cause of the medical

problem) differ from standard medical practice?

Summary and Review 589

ADDITIONAL RESOURCES

What can you find in MySocLab? www.mysoclab.com

• Complete Ebook

• Practice Tests and Video and Audio activities

• Mapping and Data Analysis exercises

• Sociology in the News

• Classic Readings in Sociology

• Research and Writing advice

Where Can I Read More on This Topic?

Suggested readings for this chapter are listed at the back of this book.

Population

and Urbanization

Chapter