Customer Reviews

Medicine and Culture: Revised Edition

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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!

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. The French place great stress on the liver, its ability to process food and to regulate the body while the Germans focus on the heart.

While we may consider medicine a science apart from cultural considerations, Payer shows us that the art of medicine is subject to cultural and economic biases even in the modern European-American context.

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?)

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.

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.

If you think conventional medicine is scientifically proven, read this book! Very enjoyable, easy to read and a must read for anyone who may ever need any medical treatment! The book shows some interesting facts, not speculation.

Very interesting book. I had no expectations at the beginning of the book and read with open interest. Since finishing the book, I have been more aware in my own experience of the agressive nature of some mainstream medical practices here in the United States. The "let's fix this before something might happen" approach is in some instances a real mindset of the establishment and no doubt Big Pharma is a great contributor to this approach. The different medical philosophies and treatments in France, England, and Germany are interesting to note (much less agressive). Enjoyed the book!

Is Medical science & technology really universal and the same around the globe?
The book shows how medicine is heavily influenced by culture.
Great book to learn about medicine thought processes in different countries.

This book gives a wonderful view of health care in several, seemingly similar, countries. The ideas that how we view pain, healing and the meaning that a physician has in our lives varies wildly from one country to the next. Are all of these examples equally true today as they were 15 years ago, perhaps not. What is very evident, and one can see this as plain as day when living abroad, is that our views about the purpose of medical care in our lives will be greatly dictated by where we are born. Another book that you should read that will greatly compliment Payer's book is Meaning, Medicine and the 'Placebo Effect' by Daniel Moerman. Interestingly, Moerman has a two-page section on Linda Payer's book. This shows how comprehensive a viewpoint this book, Medicine and Culture, had on the implications that culture has on medicine.

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.