Notes on "The Expansion of the Market."

Coming into public health lacking any business background, or business sense for that matter, the concept of market forces exerting a large effect on the medical profession was completely alien to me. Yet, as I have come to learn through the author’s clever use of imagery and examples, it would be foolish to ignore market forces and the role it historically played in shaping the medical profession and granting its practitioners societal status.

The market forces did much more for medicine, in my opinion, than is explicitly outlined in the chapter. The scientific aspect of medicine must have depended throughout history on the need for, and the belief in, medicine. The market creating need for physicians’ services and their authority growing, research and development --and the funds available for them-- were more a la mode. This has a snowballing effect. Medical advanced enlarge the market potential and opportunity, while a larger market base creates “a dependency”--as Starr so eloquently puts it.

I found Starr’s account of the eighteenth century in America as the pre- ‘laissez faire’ era very intriguing because America, at least to someone who is not cognizant of American history, might just seem to always have been all about economic laissez faire. The notion that at a certain point in American history some prices were fixed by government was quite surprising. I had previously assumed that a nation has to either be capitalist or socialist at heart, and that that America, the land of capitalism, must have started out that way. In light of that, I am viewing Egypt’s transition into Capitalism as something that just needs time to be completed, as opposed to my previous skepticism.

While this chapter has been very enlightening, some of the points made by the author raised a few questions in my mind. Paul Starr mentions professional overcrowding, and then goes on to describe the arduous journeys physicians had to take in the time prior to decent transportation and hard roads being readily available. With such an abundance of physicians, why was there apparent maldistribution? The way I see it, there might have been a doctor at every corner with no licensing requirements and no formal education required.

I am also wondering whether the rise of sovereignty of medicine can be examined thoroughly through a socio-economical analysis--one which does not incorporate technological advanced into account. The way Paul Starr dismissed lack of technology as reason for the lack of training of nineteenth century physicians seemed just too simplistic for my liking. Why did he deem it completely irrelevant? Although his argument is well-founded, and well supported with references, the role of the technological advances is important enough to merit closer scrutiny.