Medicine and Society: Sociology 130, Fall, 2009

 (CRN 14261), MWF 10-10:52; Coleman 221

Prof. Carl Milofsky  Office: Coleman 204, ph: 73468,

 Office Hours W 11:00-12:00 milofsky@bucknell.edu;

website: http://www.facstaff.bucknell.edu/milofsky/ and on Blackboard

 

This course examines the relationship between the experiences of health and sickness, the structure and culture of society, and those professions and institutions that provide health care. The social causes of health and illness are fundamental attributes of society. As building blocks of society they are as important as those things that cause economic inequality, cultural values, and bureaucratic organizational structures. While this course attempts to inform you about some critical issues in health care institutions, its primary goal is for you to understand how physical wellbeing is related to the politics, economics, and social structures of society.

There will be three short writing assignments in the first part of the semester.  Together the papers will count for 10% of your grade. Without permission in advance, papers may not be turned in after class time.  Turn in a paper version of each assignment.  I will return comments via email. Make sure you have a copy since papers sometimes are lost.  There also will be six quizzes on the readings made available on Blackboard.  Each quiz will cover approximately three classes and must be completed before class on the days they are listed.  These will be included in your class participation grade (which is explained below). 

At the end of the term you will participate in a debate.  This is a team project and your contribution to the team and the overall effectiveness of your group will count in the grade.  As a result of the research you do for your debate project, you must prepare a five-page research paper.  The five-page paper should include an annotated bibliography and it should demonstrate that you have done some significant research.  Your performance in the debate will count for 10% and your paper will count 20% so that together the debates will make up 30% of your grade. 

Although this will be a group debate project you ought to think of this work as a personal research paper.  The debate is an oral report of your work.  Often I grade the verbal performance in the debate more easily than I grade the final paper.  You must to think of them as separate pieces of work.  Students often just hand in a written report that they have read during the debate.  This is a mistake.  In the debate your presentation ought to be relatively unscripted and related to the context and the interaction that is going on in the debate.  The paper is more formal and it is a research paper.  It will be graded as such.

50% of your grade will be determined by two midterm exams.  Each of these exams will cover readings, lectures, and other assignments during the time period covered by the exam—the second exam will not cover the entire course.  Exams will be on line and they will be made up of a random selection of the quiz questions, a random selection of terms to be defined (from lists provided at the top of each day’s class notes that I place on Blackboard), three short essay questions (chosen from a list of five alternatives) and one long essay question (chosen from among two alternatives).  Each of these sections will be set up as a separate test on Blackboard with the total of your score on the four subtests making up your exam grade.  You must take the short essay portion of the exam on Blackboard during the designated class period.  The other three portions of the exam will be available for 35 hours, from midnight the day before the in-class exam is scheduled to the end of the exam class period (11 am on that day). A week before the exam day, you can find on Blackboard the pool of 60 quiz questions, the pool of 60 terms to be defined, and the pool of 5 long essays from which Blackboard will randomly select the questions for the parts of your exam. If you have learning disabilities or other problems that make it hard for you to take an on-line exam, let me know and we will work out special arrangements for you to take the tests.

10% of your grade will reflect your participation in class. Participation is based on the subjective perception of the instructor.  It includes the following: attendance (after 3 absences your grade will be lowered); asking questions during debates; being an active and helpful member of your debate team; participating in class discussions which includes being civil (showing up on time, not sleeping in class, and so on), completing and getting high grades on reading quizzes, and doing a consistently good job over the course of the semester.  You will have one chance to take each reading quiz but the whole set of 60 quiz questions that will be used for each midterm will be made available a week in advance of the exam.  It will be set up as a quiz that you may take as many times as you wish.  Failing on any of these dimensions can cause your participation grade to drop one or two full grades.

As I said in the last paragraph I start taking off grade credit if students miss more than three classes.  Actually, I expect students to be at every class.  The three class allowance comes because religious holidays, sickness, or some important off campus events can’t be avoided.  We sometimes have controversy over these “excused” absences, however.  These absences count towards your three allowed free days.  If you take two days off for football games and then you get sick and have three excused medical absences you are over the limit.

If you go over the absence limit you must do extra work to make up for missed class time.  However, giving these extra assignments as make up work is at my discretion.  If you just choose to miss many classes I will not give you make up work.  If you are going to miss classes during the semester let me know that early.  Then if you get sick or otherwise must miss more classes we can work together to help you make up your work.

Please check on Milofsky's Web site for information and advice about the exams as well as for other materials related to the course. You can find it at http://www.facstaff.bucknell.edu/milofsky/SocMed/.  You also will find helpful material, like class notes for each day’s class, on Blackboard.  Class notes include terms from the day’s reading that will comprise the terms used in the definitions portion of the midterm exam.

In summary, the components of your grade are the following:

Three short papers                                                      10%

Participation including six readings quizzes       10%

Debate                                                                             10%

Paper on debate topic                                                 20%

Two midterm exams                                                  50%

Early in the term we will have a class library session with a librarian whom you may consult about your debate topic over the course of the semester.  Your other team members depend on your being responsible to others and on your doing your fair share of the work. In grading you, I pay attention to how much work individuals do and I am prepared to penalize those who do not do their share. Start early on your research and help your team members!

The main focus of writing instruction in this course is on how to offer arguments that defend a particular point of view, that are logically consistent, and that make good use of information. There are guidelines about how to do the short writing assignments on the course website and there also are specific suggestions for doing each of the assignments.  I expect you to read these materials and to use them in preparing your responses.  If your response does not show that you have read and understood this material on the web your grade is likely to suffer. 

The debates will give you a chance to demonstrate orally as well as in print whether you can convince an audience of your point of view. Earlier assignments in the term are designed to help you formulate arguments as well as to get you started early on the research required for a successful debate performance.

Some readings for this course involve accessing scanned copies of articles that are located in the “Course Materials” section of Blackboard.  If you cannot open assigned reading materials send an email to me (Prof. Milofsky) and I will send you an email copy of the reading.  You’ll need to do this a couple of days in advance of class since I will not usually be monitoring email at night.  Exams, quizzes, writing assignments, and study materials for exams will be located in the “Assignments” section.  The current (and updated) version of the course syllabus will be located in the “Course Information” section of Blackboard.

Two publications will be in the bookstore:

Peter Conrad, The Sociology of Health and Illness, 8th ed. (New York: Worth Publishers, 2009)  ISBN: 10: 1-4292-0558-X

Eric Klinenberg, Heat Wave.  A Social Autopsy of Disaster in Chicago (Chicago: University of Chicago Press 2002)  ISBN 0-226-44322-1

Course Schedule

The following is a detailed schedule of assignments for the semester. This schedule is likely to be changed as we go along. The correct and updated version of the syllabus will be maintained in the Course Information section of Blackboard.  The schedule will tell you the specific reading requirements you must do, the order in which they will occur, and what the writing assignment and examination schedule is. Reading and writing assignments are to be completed on the date they are listed. Whenever possible, bring assigned readings to class. Also, pay attention assignments listed in this syllabus that may not be specifically covered in class. You are responsible for doing them if they are listed here.

 

I.              Sickness

 

Aug 26    The medical model versus the social system model

                   **Read**  On Blackboard:  Andrew Twaddle and Richard M. Hessler, A Sociology of Health 2nd ed. (NY: MacMillan 1987), pp. 144-148, pp. 125-129

Aug 28    Sickness as deviance and the social construction of sickness.

                  **Read** On Blackboard: Phil Brown, “Naming and Framing: The Social Construction of Diagnosis and Illness.”  Pp. 74-103 in P. Brown (ed.), Perspectives in Medical Sociology, 3rd Ed. (Prospect Heights, IL: Waveland Press, Inc. 2000),

and L. Alderman, “The Expense of Eating with Celiac Disease,” New York Times, B:7, 8/15/09

and A. Dreger, “Sex Verification: More Complicated than X’s and Y’s,” New York Times: B8, 8/22/09.

Debate survey distributed in class, due Wednesday.

 

Aug 31    Power, stigma, and health in relationship to identity.

**Read** In Conrad: Joan Jacobs Brumberg, “Anorexia Nervosa in Context”, pp 112-125 and

on Blackboard: Mim Udovich, “A Secret Society of the Starving”, New York Times Magazine, September 8, 2002: 18, 20, 22, 66, 68.

Sep 2        Can a physical malfunction be socially constructed?

**Read**   On Blackboard: Gerald Graff and Cathy Birkenstein, They Say, I Say, pp. 1-14 (New York: WW Norton 2006)—helps explain the idea of an argument paper.

and Herbert Fingarette, Heavy Drinking.  The Myth of Alcoholism as a Disease, Introdution & Ch. 1, pp. 1-30. (Berkeley and Los Angeles: University of California Press 1988)—gives background on alcoholism as a disease.

**Optional Reading**  In Conrad, Peter Conrad, “The Shifting Engines of Medicalization,” pp. 480-492—discusses the sociological concept of medicalization.

**Writing**    Return Debate Survey.

**Writing**    Paper #1. Be prepared to discuss your paper in class. Writing assignments are due in class and may not be handed in late.  Write a three page paper in which you take a definite pro or con position on the proposition that alcoholism is a disease.  For some commentary, look In the Writing Assignments section of the course web site (accessible from Blackboard) under Assignments.  There is a commentary handout called "Is Alcoholism a Disease?"

Sep 4        The Social Construction of Sickness and Disability
There will be a video in class, "When Billy Broke His Head", Call # HV1553 .W53x 1994
**Read** On Blackboard: Beatrice Wright, Ch. 1, "Circumscribing the Problem", pp 1-12 in Physical Disability---A Psychological Approach (NY: Harper and Row, 1960)

and H.M. Johnson, “Unspeakable Conversations”, New York Times Magazine, February 16, 2003.

 

Sep 7        The demographic transition

                  **Read** In Conrad: John B. McInlay and Sonja M. McKinlay, “Medical Measures and the Decline of Mortality”, pp 7-19, and

                  On Blackboard:  J.M. Janzen, “Population and diseases:   The changing indicators of health”.  Ch 4, pp 83-114 in J.M. Janzen, The Social Fabric of Health.  An Introduction to Medical Anthropology (New York: McGraw Hill 2002).

Blackboard Quiz #1 must be completed by 12:00 pm.

Sep 9        Social class and health

**Read** In Conrad:  S. Leonard Syme and Lisa F. Berkman, “Social Class, Susceptibility, and Sickness”, pp 24-30, and John B. McKinlay, “The Case for Refocusing Upstream:  The Political Economy of Illness”, pp 578-591, and

On Blackboard: J. Gabe, M. Bury, and M.A. Elston, “Social Class.”  Pp. 3-8 in Key Concepts in Medical Sociology (Thousand Oaks, CA: Sage Publications, 2004)

                  Assign debate teams.

Sep 11      The Social Class Gradient of Disease

**Film**  We will discuss and watch the first segment of Unnatural Causes.  Is Inequality Making Us Sick? “In Sickness and in Wealth.”  RA448.4 .U53 2008.

**Read** On Blackboard: Helen Epstein, “Enough to Make You Sick?”, pp 74-81, 98, 102, 104, 105, & 106 in New York Times Magazine, Oct 12, 2003.

 

Sep 14     Race and health

**Read** In Conrad: Colin McCord and Harold P. Freeman, “Excess Mortality in Harlem”, pp 30-37 and

On Blackboard: Colin Gordon, “Health Care in Black and White”  Race, Region, and Health Politics”, pp. 172-209 in Dead on Arrival.  The Politics of Health Care in Twentieth Century America.  (Princeton, NJ: Princeton University Press 2003).

Sep 16     Immigrants and health.

**Film**  We will discuss and watch the third segment of Unnatural Causes.  Is Inequality Making Us Sick? “Becoming American.” RA448.4 .U53 2008.

                  **Read** On Blackboard: A four-part New York Times series (1) N.R. Kleinfeld, “Diabetes and Its Awful Toll Quietly Emerge as a Crisis,” New York Times, 1/6/06: A1, A18-A19; (2) N.R. Kleinfeld, “Living at an Epicenter of Diabetes, Defiance, and Despair,” New York Times 1/10/06: A1; A20; A21; (3) I. Urbina, “In the Treatment of Diabetes, Success Often Does Not Pay,” New York Times 1/11/06: A1; A26; A27; and (4) M. Santora, “East Meets West, Adding Pounds and Peril,” New York Times, 1/12/06: A1;A20; A21.

Sep 18     Discuss sample debate topics (available on the web).

Debate teams meet in class for the last 1/2 of the class. Brief discussion of debatable issues related to the various debate topics.
**Writing** Discuss library assignment.  Have teams organize themselves so that individuals have tasks to pursue to complete the library assignment and to develop their teams' research plan.  Note: The Library Assignment is available on the course web site for those who would like to get started early at: http://www.facstaff.bucknell.edu/milofsky/SocMed/LibAss.html

 

Sep 21     AIDS and risk groups

**Read** on Blackboard N.G. Schiller, S. Crystal, and D. Lewellen, "Risky Business: The Cultural Construction of AIDS Risk Groups", pp 707-726 in in Phil Brown (ed.), Perspectives in Medical Sociology, 2nd Edition (Prospect Heights, IL: Waveland Press 1996)

and Helen Epstein, “Why are AIDS rates so high in Africa?” Ch. 3, pp. 49-65 in The Invisible Cure.  Africa, the West, and the Fight Against AIDS (New York: Farrar, Strauss, Giroux, 2007).

Sep 23     Risk.  Video in class, “The Smoking Dilemma”.  When is it right for society to impose controls on risky behaviors?

**Read** In Conrad: R.A. Hahn, S.M. Teutsch, A.L. Franks, M-H. Chang, and E.E. Lloyd, “The prevalence of risk factors among women in the United States”, pp. 451-460 and

On Blackboard: J. Gabe, M. Bury, and M.A. Elston, “Risk.”  Pp. 97-91 in Key Concepts in Medical Sociology (Thousand Oaks, CA: Sage Publications, 2004).

Blackboard Quiz #2 must be finished by 12 pm. 

Sep 25     The scope of the U.S. health care system

                  **Read**   In Conrad: A.S. Relman, “The Health Care Industry:  Where is it Taking Us?”, pp 280-286, and

                  On Blackboard: D. Mechanic, “ A brief anatomy of the American health care system.”  Pp. 462-475 in H.D. Schwartz (ed.), Dominant Issues in Medical Sociology 2nd ed. (NY: Random House 1987).          

                   

 

Sep 28     Trust and the medical profession.

                  **Read** On Blackboard: Reneé Fox, “The professions of medicine and nursing.” Pp 38-71 in R. Fox, The Sociology of Medicine.  A Participant Observer’s View.  (Engelwood Cliffs, NJ: Prentice Hall, 1989), In Conrad: J.B. McInlay and L.D. Marceau, “The End of the Golden Age of Doctoring”, pp 189-214, and D. Mechanic, “Changing Medical Organization and the Erosion of Trust”, pp 224-230.

Sep 30     Library visit with Reference Librarian.  Meet in Library Lab, Lower Level  I. 
**Writing**    Paper #2. Be prepared to discuss your paper in class. Writing assignments are due in class and may not be handed in late.  Complete the library assignment provided on the course web site and bring it with you to class.

Oct 2        Trust vs. Market System

**Read** On Blackboard: M. Finkel, "Complications" NY Times Magazine, May 27, 2001, pp 26-33, 40, 52, and 59.

S. Coronel and K. Dixit, “Setting the Context.  Thirty Years after What Now?”  Pp 13-27 in N. Hallstrom, O. Nordbergh, and R. Osterberg, What Next? Vol. 1 (Uddavalla, Sweden: Mediaprint, The Dag Hammarskjold Foundation, June 2006).

 

 

Oct 5        Nursing and other medical work.

                  **Read**  In Conrad: S. Reverby, “A Caring Dilemma:  Womanhood and Nursing in Historical Perspective”, pp 251-261 and

                  On Blackboard: D. Chambliss, “What It Means to Be a Nurse.”  Pp. 61-89 in Beyond Caring.  Hosptals, Nurses, and the Social Organization of Ethics.  (Chicago: University of Chicago Press, 1996).

Oct 7        The hospital.

                  **Read** On Blackboard: J. Gabe, M. Bury, and M.A. Elston, “Hospitals and Health Care Organization.”  Pp. 203-208 in Key Concepts in Medical Sociology (Thousand Oaks, CA: Sage Publications, 2004) and

                  A. Vosk and C. Milofsky, “The sociology of emergency medicine.” Part I of a three part article, Emergency Medicine News 24 (2): 3 (February, 200a), A. Vosk and C. Milofsky, “The sociology of emergency medicine:  Gatekeeping, protocols, and consultants.” Part II of a three part article, Emergency Medicine News  24 (3): 4 (March, 2000b), and A. Vosk and C. Milofsky, “The sociology of emergency medicine: Power, authority, and control.” Part III of a three part article, Emergency Medicine News 24(4): 3 (April, 2002c).

Oct 9        The need to control health care costs and rationing.

**Read** On Blackboard: M. Mahar, “Preface.” Pp. xiii-xxi in Money Driven Medicine (NY: Harper/Collins 2006),

and Gawande, Atul, “The Cost Conundrum.”  New Yorker, 6/1/09: 1-11.

and Sack, K. and Herszenhorn, D.M., “Texas Hospital Flexing Muscle in Health Fight.” New York Times 6/30/09: A1.

and A. Gawande, D. Berwick, E. Fisher, and M. McClellan, “10 Steps to Better Health Care.”  New York Times: A27.

 

 

Oct 12     Fall Break

Oct 14     Transformation of medicine

                  **Read** In Conrad: P. Conrad and J.W. Schneider, “Professionalization, Monopoly, and the Structure of Medical Practice”, pp 194-200

and On Blackboard: M. Mahar, “The Road to Corporate Medicine.” Pp. 1-29 in Money Driven Medicine (NY: Harper/Collins 2006).

Quiz #3 must be completed by 12:00 pm

Oct 16     Should costs control care?    

**Read** In Conrad: T. Bodenheimer and K. Grumbach, “Paying for Health Care”, pp 321-329; 

D. Callahan, “Rationing medical progress:  The way to affordable health care”, pp 495-498;

and A.S. Relman, “The trouble with rationing”, pp 499-501.

                 

 

Oct 19     How health insurance works and why there’s a problem.

**Read**  On Blackboard:  D.W. Light, "Excluding More, Covering Less: The Health Insurance Industry in the U.S.," pp 464-477 in Phil Brown (ed.), Perspectives in Medical Sociology, 2nd Edition (Prospect Heights, IL: Waveland Press 1996).

Oct 21     Should health insurance be higher for those who behave in a self-destructive way?

**Read**  On Blackboard: D. Leonhardt, “Fat Tax.  Should Overweight People Pay More for Health Insurance?”  New York Times Magazine 8/16/09: 9-10

and D. Zinczenko, “Don’t Blame the Eater.”  Pp. 139-141 in Gerald Graff and Cathy Birkenstein, They Say, I Say, pp. 1-14 (New York: WW Norton 2006).

**Writing**    Paper #3: Should Obese People Be Punished? Assignment is available on Blackboard and on the web at: http://www.facstaff.bucknell.edu/milofsky/SocMed/obese.htm

Be prepared to discuss your paper in class. Writing assignments are due in class and may not be handed in late. 

Oct 23     First Midterm Exam.

                   You will be provided five long essay questions, 60 reading quiz questions, and 60 terms from daily class notes that form the pool for the definitions portion of the exam. 

Before class time you should take these three parts of the exam (quiz, definitions, long essay).

In class you will take the short-essay portion of the tests as a closed notes/closed book test.  You also may complete the other parts of the test (you may, for example, paste answers to the long essays into Blackboard if you have chosen that approach to answering the long essay question.)

 

Oct 26     Comparing national health systems and socialized medicine.

Video: Frontline, PBS, Sick Around the World http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/

**Read**  In Conrad: D.W. Light, “Comparative models of ‘health care’ systems”, pp 538-553 and R.B. Deber, “Health care reform.  Lessons from Canada.”  Pp. 553-560.

                  Quiz #4 must be completed by 12:00 pm. 

Oct 28     Covering the uninsured.

**Read** On Blackboard:  Kaiser Family Foundation, Approaches to Covering the Uninsured (Dec. 2008).  You can also access this report at: http://www.kff.org/uninsured/upload/7795.pdf

Oct 30     Health as a social problem separate from the institution of medicine; the problems are socially constructed.
**Read** Klinenberg, Prolog, “The Urban Inferno” and Introduction, “The City of Extremes”, pp 1-36.

 

Nov 2      Isolation and social connection.

**Video** “A Death of One’s Own”, Bill Moyers video, BF789.D4 05 2000 v.3.

**Read**  In Conrad: J.S. House, K.R. Landis, and D. Umberson, “Social relationships and health.” Pp. 78-86 and

Klinenberg, Ch 1, “Dying Alone: The Social Production of Isolation,” pp. 37-78.        

N0v 4      Neighborhood ecology and health.

**Read**  Klinenberg, Ch 2, “Race, Place, and Vulnerability:  Urban Neighborhoods and the Ecology of Support”, pp 79-128.

Quiz #5 must be completed by 12:00 pm. 

Nov 6      Political process and policy making

**Read** Klinenberg, Ch 3, “The State of Disaster:  City Services in the Empowerment Era,” pp 129-164, Ch 4, “Governing by Public Relations.”

Attend one of the following two film/panel events.  This makes up for class on Nov. 20 which will not be held.

Nov 6      7:00 pm Money Driven Medicine film and panel, Olin auditorium

Nov 7      Money Driven Medicine showing at Campus Theater with film maker panel.

 

Nov 9      Media and the news.

**Read** Klinenberg, Ch. 5, “The Spectacular City: News Organizations and the Representation of Catastrophe”, pp 185-225.

Quiz #6 must be completed by 12:00 pm.

Nov 11    Debate Teams Meet in Class to discuss their presentations.

Nov 13    Debate #1

 

Nov 16    Debate #2

Nov 18    Second Midterm Exam

You will be provided five long essay questions, 60 reading quiz questions, and 60 terms from daily class notes that form the pool for the definitions portion of the exam. 

Before class time you should take these three parts of the exam (quiz, definitions, long essay).

In class you will take the short-essay portion of the tests as a closed notes/closed book test.  You also may complete the other parts of the test (you may, for example, paste answers to the long essays into Blackboard if you have chosen that approach to answering the long essay question.)

Nov 20    No Class (replaced with Money Driven Medicine, Nov,  6 0r 7).

 

Nov 23    Debate #3

Nov 25, 27  Thanksgiving

 

Nov 30    Debate #4

Dec 2       Debate #5

Dec 4       Debate #6

 

Dec 7       Debate #7 (last class)

Dec 11     Papers due, 5 pm (electronic or paper submission OK).