PubMed1983
The article considers the answers given by different schools of thought to the fundamental questions about the degree of autonomy of medicine and the kind of articulation between medicine and society as a whole and in its "parts." The answers vary with the thinking in the different social sciences and the philosophic schools associated with them. The author divides his presentation in two broad chapters: The first covers schools of thought in the health field, and attempts to delineate the philosophical foundations underlying the principal current schools of thought in this field, without attempting a history of the philosophical schools or analyzing each of them in detail. Thus, two idealist currents are studied which have exerted great influence in the health field--neopositivism and neo-Kantianism--and marxism as the materialist school, which recognizes the primary of matter, nature, and objective reality, and views consciousness as a property of matter. The second chapter considers the theoretical contest now going on among the schools of thought discussed in the first chapter, which try to explain the relationship between medicine and the social structure; the effectiveness of medical action, and the social determinants of disease. Prior to the seventies, the author says, the dominant view of the autonomy of medicine, its effectiveness, the potential for social change of the medical institutions, and the benefits to health of economic development, was endorsed by the predominance of positivism among these schools of medical thought. The view that medicine was broadly autonomous and at the same level with other subsystems such as the economic, the political and the educational subsystems, assumed the possibility of changing society by an effort begun through any of these "sectors." The enormous growth of productive forces that took place in the developed capitalist countries during the fifties, and even more during the sixties, collided at the end of the latter decade with the existing social production relations, which checked the progress of the production forces and generated a series of challenges in civil society to the aims of economic development and the achievements of science in relation to the inequality of the distribution of wealth. In the health sector, this was a time of criticism of the positivist view and of pointing out the negative effects of medicalization, highlighting the ideological and self-perpetuating character of medical institutions, and proposals for the demedicalization of society.(ABSTRACT TRUNCATED AT 400 WORDS)