Early on, Biomedicine was the reality in terms of which other medical systems, professional or popular, were implicitly compared and evaluated. Like science, Western medicine was assumed to be acultural—beyond the influence of culture—while all other medical systems were assumed to be so culturally biased that they had little or no scientific relevance (e.g., Foster & Anderson, 1978; Hughes, 1968; Prince, 1964; Simons & Hughes, 1985). Not only did this ideological hegemony devalue local systems, it also stripped the illness experience of its local semantic content and context (Early, 1982; Good, 1977; Kleinman, 1980, 1988a). This stripping served to obscure the "thick" polysemous realities that became obvious in ethnographic and historical inquiries, challenging the "thin" biomedical interpretations of disorder (Early, 1982; Good, 1977; Ohnuki-Tierney, 1984).
An appreciation of the diverse cultures of illness and of professional and folk medicines arose as Biomedicine itself came under a comparative scrutiny through the incorporation of symbolic and interpretive anthropology into medical anthropology. Interpretive perspectives were being applied in the fields of the anthropology of religion and psychological anthropology by people specializing in one (e.g., Margaret Lock, Nancy Sheper-Hughes) or both (e.g., Thomas Csordas, Atwood Gaines, Byron Good, Robert Hahn, Arthur Kleinman, & Allan Young) (Gaines, n.d., a). During the 1980s, these two fields were enfolded within the expanding domain of medical anthropology because of their foci on (religious and ritual) healing and (ethno-) psychiatric and medical knowledge systems (Gaines, n.d., a) (e.g., Deveraux, 1953, 1963, Good, 1977; Early, 1982; Edgerton, 1966; Evans-Pritchard, 1937; Jordan, 1993; Levi-Strauss, 1963a, 1963b; Middleton, 1967; Prince, 1964; Vogt, 1976).
Anthropologists initially exploring Biomedicine met resistance both from fellow anthropologists, even medical anthropologists, and from their biomedical host-subjects. This resistance may have had a common source—"a blindness to a domain of one's own culture whose powers and prestige make it invisible to member participant observers" (Gaines & Hahn, 1985). A major turning point in medical anthropology's consideration of Biomedicine was the publication of two largely interpretive works edited by Gaines and Hahn (Gaines & Hahn, 1982; Hahn & Gaines, 1985). These works "marked a new beginning in medical anthropology" (Good & DelVecchio Good, 2000, p. 380). They featured empirical studies of a variety of medical specialties, including psychiatry, internal medicine, family medicine, and surgery, as well as considerations of the conceptual models in medicine that guide and made sense of clinical practices. These works "legitimized anthropological work on North American and European biomedicine and launched wideranging studies of biomedicine by these authors and their students" (Good & DelVecchio Good, 2000, p. 380). They pointed to variations within biomedical praxis as well as to its ideological commonalities.
In these seminal works, Gaines and Hahn defined Biomedicine as a "sociocultural system," a complex cultural historical construction with a consistent set of internal beliefs, rules, and practices. Analyzing Biomedicine in this way enabled medical anthropologists to fruitfully cast their gaze on it from a relativistic perspective, (re)conceiving Biomedicine as "just another ethnomedical system," one that, like all others, reflects the values and norms of its creators (Hahn & Gaines, 1982).
This perspective has greatly facilitated the comparative study of Biomedicine vis-à-vis other medical systems because it challenges Biomedicine's claims to the singular authority of truth and fact. Gaines and Hahn identified three features of Biomedicine as a sociocultural system: it is a domain of knowledge and practice; it evidences a division of labor and rules of and for action; and it has means by which it is both produced and altered (Gaines & Hahn, 1985, pp. 5-6). These features are elaborated and extended here.
First, Biomedicine is a distinctive domain within a culture that features both specialized knowledge and distinct practices based on that knowledge (Gaines, 1979, 1982a, 1982b; Lindenbaum & Lock, 1993). In any medical system, a key factor is the relationship of medical knowledge to medical action (e.g., Gaines, 1992d; Hahn & Gaines, 1982, 1985; Kleinman, 1980; Kuriyama, 1992; Leslie & Young, 1992; Lock, 1980, 1993; Unschuld, 1985). Action is made reasonable and is justified by belief in the form of medical "knowledge"; in Biomedicine's biologically defined universe, only somatic interventions make sense (Good, 1994).
Second, Biomedicine exhibits a hierarchical division of labor as well as guides or rules for action in its social and clinical encounters. The hierarchies of medicine are complicated and multiple. Some are based upon the nature of intervention: intensive somatic intervention is more highly prized, hence surgeons have more prestige and higher compensation than family doctors or psychiatrists (Johnson, 1985). The treatment of women, children, and older people all carry less prestige in Biomedicine, as well as usually lower compensation (Gaines, 1992d; Hinze, 1999). While such social structures are specific to Biomedicine's domain, its fundamental principles, generative rules, and social identities mirror the discriminatory categories of the wider society in terms of gender and sexual identity (Hinze, 1999; Ginsburg & Rapp, 1995; Martin, 1994) and ethnicity, social status, and age (Baer, 1989, 2001; Gaines, 1982a, 1986, 1992d, 1995; Good, 1993; Hahn, 1992; Nuckolls, 1998). For specific examples, we note that nurses, traditionally subordinate to physicians, have traditionally been women, and both women and members of ethnic minorities have had to struggle for access to biomedical treatment and education.
The focal subject of Biomedicine is the human body. The body so treated is a construct of biomedical culture (Foucault, 1975; Gaines, 1992c), exhibiting the scars of specialty conflict as well as marks of the often invidious and discriminatory distinctions made in the wider society (Gaines & Hahn, 1985; DelVecchio Good, Helman, & Johnson, in Hahn & Gaines, 1985). Through its discursive practices (Gaines, 1992b), Biomedicine creates bodies as figures of speech in culturally specific ways. These form part of what Gaines (1992c, n.d., b) calls "Local Biology."
Third, as an internally cohesive system, Biomedicine reproduces itself through studies that confirm its already-established practices and, most salient, through apprenticeship learning—mentors tend to pass on to students what they are sure they already know. This self-reproduction is encapsulated in a term physicians themselves often use to refer to their knowledge system: "traditional medicine." Yet all biomedical practitioners are taught, and tend to believe, that Biomedicine is science-based. In part, it is. As a consequence, the field also contains means by which it alters itself (e.g., medical research and its "advances," practice and its presentation in medical journals and conferences, and concomitant alterations in what mentors "know"). Social scientists have shown that science itself is culturally constructed (Kuhn, 1962; Rubinstein, Laughlin, & McManus, 1984). Scientific traditions can be extremely resistant to change, yet the culture of science in general has shown itself to adapt more quickly to new information than the culture of Biomedicine. Issues of "competence" (DelVecchio Good, 1985, 1995) arise here because the scientific "standard of practice" can change abruptly with the reporting of new research findings, as in the cases of X-ray, thalidomide, cholesterol, and, most recently, hormone replacement therapy. Often scientific evidence that challenges traditional medical practice takes decades to be incorporated (a phenomenon known as the "evidence-practice gap"), whereas evidence that supports traditional assumptions is more likely to be quickly taken into account.
Was this article helpful?