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Journal of Health Politics, Policy and Law 29.4 (2004) vi, 557-568


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Professional Sovereignty in a Changing Health Care System:

Reflections on Paul Starr's The Social Transformation of American Medicine

Keith Wailoo

Rutgers University

Timothy Stoltzfus Jost

Washington and Lee University School of Law

Mark Schlesinger

Yale and Rutgers Universities

Click for larger view		 Figure 1
[End Page vi]
And since you know you cannot see yourself,
So well as by reflection, I, your glass,
will modestly discover to yourself
that of yourself which you yet know not of.
—William Shakespeare, Julius Caesar, Act 1, Scene 2

More than twenty years ago, Paul Starr's The Social Transformation of American Medicine (1982) found a receptive general readership and stimulated academics across the disciplines to take stock of medicine's historical trajectory. It was an exploration of medical care that had unprecedented scope and narrative power, garnering the Bancroft Prize for American History, extensive praise from health care professionals, and the 1984 Pulitzer Prize for Nonfiction.

Perhaps the most compelling attribute of The Social Transformation is its capacity to portray a coherent image of the complex worlds of health care and health policy. It did so, in large part, by effectively casting the evolving stories of American medicine and American society as reflections of one another. These not-so-distant mirrors revealed key trends and drivers that had previously been obscure. The changing nature of medical care and medical practices made more sense when understood in the context of broader societal trends; the multiple facets of American culture and values were newly revealed through their incarnation in health care settings. In these twinned reflections lay a story with a powerful narrative arc, a drama told in two acts. Within this grand narrative, Americans could [End Page 557] see and more fully comprehend their own personal stories, reflecting their roles as patients, caregivers, and citizens.

If one steps back from the language and detailed claims of The Social Transformation of American Medicine, it becomes clear that the very nature of Starr's narrative, the structure of the looking glass within which these images are cast, is itself a reflection of the political era in which the book was written, the academic theories that were then in vogue, and the tensions that then loomed large on the agenda of the medical profession. From a vantage point two decades hence, we can get a better sense of how these shaped the book's central images. By comparing the health care system and social order that was portrayed in The Social Transformation to the America and American medicine that emerged over the next two decades, we can better comprehend the book itself, the scope and limits of Starr's analytic reach, and the meaning of the transformations that he so deftly identified in his work.

It was for this purpose that the authors of this issue were drawn together. The essays contained herein reflect various images of The Social Transformation, as seen from the diverse viewpoints of six different disciplines. Some focus on the twinned narratives through which Starr traced the rise of medical authority. These contributions offer alternative perspectives on the transformations of medical practice and its role in American society. They elaborate on consequences that Starr could only sense as looming on our collective horizon. Other essays focus more on the book itself, on Starr's choices about how best to portray medical authority and American culture. Together, these essays explore both the import of The Social Transformation as a scholarly work and the meaning of social changes that the book portrayed.

Like a room of mirrors in an amusement park funhouse, these essays reflect on Paul Starr's own reflections, each from its own distinctive angle. In so doing, we believe that they add further depth and breadth to a work that was already impressive on both scores. Much as The Social Transformation allowed Americans to see themselves in...

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