The Shifting Engines of Medicalization

TLDR

Since the 1970s, scholars have examined medicalization, largely attributing its growth to the medical profession, interprofessional dynamics, and social movements. The article argues that recent transformations in medicine are reshaping the medicalization process, calling for a revised sociological focus in the twenty‑first century. The study finds that biotechnology, consumer demand, and managed care have become the primary engines of medicalization, with doctors playing a subordinate gatekeeping role and commercial interests now driving the expansion of medical categories.

Abstract

Social scientists and other analysts have written about medicalization since at least the 1970s. Most of these studies depict the medical profession, interprofessional or organizational contests, or social movements and interest groups as the prime movers toward medicalization. This article contends that changes in medicine in the past two decades are altering the medicalization process. Using several case examples, I argue that three major changes in medical knowledge and organization have engendered an important shift in the engines that drive medicalization: biotechnology (especially the pharmaceutical industry and genetics), consumers, and managed care. Doctors are still gatekeepers for medical treatment, but their role has become more subordinate in the expansion or contraction of medicalization. Medicalization is now more driven by commercial and market interests than by professional claims-makers. The definitional center of medicalization remains constant, but the availability of new pharmaceutical and potential genetic treatments are increasingly drivers for new medical categories. This requires a shift in the sociological focus examining medicalization for the twenty-first century.