The Persistence and Resurgence of Medical Pluralism

Abstract

��� For Paul Starr, medicine is the dream of reason partially come true, and the recognition and acceptance of this view by most Americans is what has largely determined the development of our health care system. Starr’s efforts to advance this vision led him to neglect the extent to which medical pluralism survived and thrived in America. In the first chapter of The Social Transformation of American Medicine (1982) (hereafter TSTAM), Starr describes a time (1760‐1850) when doctors had little in the way of status or respect. Physicians’ knowledge about disease and their skills as healers were questioned by practitioners of many stripes, including those within their own ranks. In fact, the very need for specialized medical practitioners was doubted by those who saw the home as the natural locus of health care, and family members (informed by popular medical manuals) as the natural and best providers. This cacophony of views was widespread and reflected the diverse set of beliefs held by most of the population, as well as its leaders. The American ethos was to distrust specialized knowledge, particularly knowledge that was “secret” or inaccessible to the average citizen. What changed all of this, in Starr’s view, was the rise and public recognition of scientific rationality. The populace began to recognize that the natural world had a “legitimate complexity” that might not be equally accessible to all. The democratic belief that everyone could know how the natural world really worked no longer seemed accurate or apt to bring about the cure of illness. The growth of education and literacy, along with

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