December 1983

The Social Transformation of American Medicine

Author Affiliations

Hamilton, Ontario


by Paul Starr, New York, Harper & Row Publishers Inc, 1982.

Arch Surg. 1983;118(12):1451-1452. doi:10.1001/archsurg.1983.01390120071024

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This comprehensive, literate, and provocative book is a social history of the American physician and medical profession from colonial times to the present. It documents the development of a sovereign professional group that would not be governed or directed by the state and that controlled the industry that supported its actions. In commercial, financial, and corporate marketplace terms, the book describes how independent physicians achieved professional cohesion and expressed themselves through self-controlled and -regulated influential organizations—a cluster of small businessmen fighting off government intrusion into their activities. The author also documents the movement from household to hospital as the dominant place for care of the sick, resulting in the rise of hospitals as an influential market force and creating the second or third largest industry in the United States. It is an industry with considerable uniformity but without regulation, basically, a "doctors' workshop." The author also shows how hospitals and

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