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While we may be used to looking at the anthropology of less developed countries, Lynn Payer turns her lens at European and American medicine. In England one keeps a stiff upper lip, as doctors give fewer tests, less medicine and lower doses, even when not rationed. West Germans use six times the number of heart drugs as the French or English, although the three countries have similar rates of heart disease, often using several at once due to the attitudes towards the heart. France looks more at the terrain than the pathological organisms attacking it, strengthening the immunological system with techniques Americans would consider fringe medicine. And French doctors would use a hysterosalpingogram instead of the D&C that German, English and Americans use to diagnose conditions because they are afraid of adhesions from surgery that might impair fertility. American doctors do excessive hysterectomies that would be considered unwarranted in England, France and Germany and, at least at the time of the book, radical mastectomies instead of lumpectomies.
The book also looks at how medical compensation affects the way medicine is practiced. German and American doctors who are paid fees for each procedure use far more than English doctors who are paid a straight salary. American doctors may raise their fees when they want more compensation while French doctors would need to perform more operations. American doctors whose insurance companies would require them to perform a cesarean section after fibroid removal are more prone to remove the uterus than French doctors who have no such pressure and feel that a woman could have six myomectomies before a C-section would be required.
And different organs are looked at as important.Read more ›
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19 of 20 people found the following review helpful
Readers of this excellent book will wait in vain for an update as some reviewers have requested -- Lynn Payer died of breast cancer on September 22, 2001. So this will be it -- the insights she brings to the comparative study of health systems are thus all the more precious. I've lived in two of the countries she studied (UK and US) and been treated in a third (France) and the book rings true. An excellent addition to the library of anyone wishing to understand the strengths and the flaws of our health systems, and more importantly, why each system has different flaws!
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13 of 13 people found the following review helpful
Written from the point of view of a journalist and not a social scientist, this book is nevertheless a must read for readers interested in medicine, culture, and sociology of science. If you are one of those persons who thinks medicine is a science, I think this book will make a very surprising read. In particular, if you like the epistemological side of scientific inquiry, you could try to extend many of the discussions of the book to other practices (social sciences, physics). My only regrett is that the author doesn't cover Latin American medicine. (Next edition?)
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In Medicine and Culture, Payer describes what she sees as the spirit of the medical system in France, Germany, England, and the US. I say spirit, because she writes about the feel she got for the medical system in each while doing business and living abroad. She doesn't detail how the medicine is financed and regulated, and statistics are presented sparsely to illustrate points, and not flung at the reader. She is very much writing about the feel of medicine and how it interacts with culture in each country. This makes the subject matter less dated, because culture changes slowly, unlike specific medical procedures or government regulations.
I read this a few years ago and I feel that it has given me some important perspective and insight into medicine, which helps me interpret other information that I get about medicine. It was a fast read and worthwhile, even if you came across the book while looking for a more concrete treatment of medicine in different countries.
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13 of 16 people found the following review helpful
Having experienced medical care in five different countries, according to my experience varieties in treatment in different countries are very common. Though former British colonies still retain lots of resemblance to British health system. My only objection to the book is that it needs an update - lumpectomies instead of radical mastectomies are getting more common in US. However, hysterectomy, often unjustified, is still far to common in US with no hope for change in near future. Also, doctors seem to be unable to understand that different countries have different disease statistics even after you bring them articles printed in medical journals proving that you are right. Medicine does not deserve to be called science, IMO.
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This is a well written text that is unusual in that it applies the anthropological methods we often see applied to developing countries to developed countries. This is very much a personal but well informed view of this area and it is an interesting read. The only criticism I would make is that this and other such texts occasionally verge into minimizing the effects of individual differences and demographic characteristics in health beliefs and action in favor of "cultural" explanations. Who we are and what we do can be viewed through a range of lenses.
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