Commentary Professionalism as a Countervailing

For the past twenty years, our understanding of the medical profession, particularly in the United States, has been shaped by Freidson’s (1970a, 1970b) concept of professional dominance. This influence gives testimony to the power and timeliness of the original works. They challenged Parsons’s admiring and functionalist concept of medicine in society by focusing on the idea of dominance, an idea that expressed the mixture of awe and anger felt in the late 1960s towards both the technical wizardry and the arrogant in-sensitivity of a seemingly impregnable profession. The public’s ambivalence towards the profession and thus Freidson’s concept continues to be salient. At the same time, a handful of authors have periodically taken stock of technological, cultural, political, and economic changes to assess their impact on the dominance of the American medical profession. Some believe these changes signal the “deprofessionalization, ” “proletarianization, ” or “corpor-atization ” of American medicine. Freidson, in a string of essays (1989), and Mechanic, in this issue of JHPPL, have reviewed these changes and conclude that they do not provide, in Mechanic’s words, “any serious challenge to the hegemony of the medical perspective.” This conclusion rests on two kinds of arguments. First, Freidson and Mechanic are less impressed by, for example, the growing sophistication of patients or the increasing percentage of physicians employed by corporations than they are by continued professional control over medical work. (Partisans on each side of these debates pick their cases and rarely take the points of the other side as hypotheses to be tested with rigor.) Second, as Freidson, an