Medicine Culture: Notions of Health and Sickness in Britain, the US,
France and West Germany by Lynn Payer, Victor Gollancz, pp 204, Pounds sterling
12.95
LYNN PAYER is a medical journalist who, having had her own thoughts
about health and medicine provoked by spells outside her native US, has
written a thought-provoking book about how medical practice is embedded
in culture. Having started out believing that European deviations from American
medical norm were the result of backwardness, she came to see how cultural
prejudice influences American ways of perceiving and managing health and
sickness as it does those of any other country. Although she intended to
write about a larger number of countries, she eventually confined herself
to France, West Germany, Britain and the US.
The differences between these four countries in their notions of health
are fascinating. Particularly interesting are the ‘wastepaper-basket’ categories
of diagnosis she identifies: in France, there is spasmophilia and crise
de foie and Herzinsuffizienz and vasovegetative dystonia in West Germany,
and viruses in the US.
Although the absence of hard comparative data, often frustrates her,
Payer is sometimes able to make extremely illuminating quantative comparisons
between countries. For example, did you know that there are 120 000 different
drugs on the market in West Germany, compared with 1180 in Iceland? That
rates of coronary bypass surgery are up to 28 times as high in the US as
in some European countries? That the frequency of consultations for low
blood pressure was 0 per million in England and 163 per million in West
Germany? Or, indeed, that the low blood pressure treated with 85 drugs as
well as hydrotherapy in West Germany would entitle its ‘sufferer’ to lower
rates for life insurance in the US? Anecdotes shed other light on cultural
differences. I especially liked the story that young journalists in the
US are taught never to write in an obituary that someone died of ‘natural’
causes, apparently because no one ever considers death to be natural.
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Though an enjoyable read, the book is poor on analysis, as the author
admits. She tends to take at face value the explanatory theories of her
sources in the various countries, and thus concludes that Descartes produced
French medical thinking, romanticism German, and the empiricists Locke,
Berkeley and Hume were responsible for British medical attitudes as the
frontier experience was for American. Such conclusions beg the question
of the relationship between philosophers and the cultures from which they
come, and of the relationship between medical, scientific and lay thinking
about health and illness.
I was initally irritated by the lack of any reference to the material
being cited; it was only when I had finished reading the book that I discovered
that there were references and footnotes, but they were all bunched together
at the end and completely unsignposted in the text.
The book bears comparison with a BBC Horizon programme; interesting
and enjoyable, with contributions from a range of knowledgeable key informants,
but ultimately disappointing to those who know about the subjects in any
depth. As with Horizon programmes, however, the book’s value may well lie
in stimulating people’s awareness of the topic and encouraging them to pursue
it further.
Sally Macintyre is director of the Medical Research Council’s Medical
Sociology Unit, Glasgow.
