Main narrative

Epstein & Timmermans (2021) refer to the concept of cultural authority, described by Paul Starr, to explore changing meanings of wellness and health in the United States. The authors describe the difference between the social authority of medical doctors and the cultural authority of medical institutions. Social authority is the authority of doctors to advise or recommend actions. Cultural authority is the authority of medical institutions to "interpret symptoms" and to "define the parameters of health, disease, treatment, and wellness” (p.240). Cultural authority can be represented by people (such as doctors), objects (such as medical guidance books), or technologies (such as ultrasound machines). “The cultural authority of medicine potentially extends well beyond the clinical encounter, as medical spokespersons, institutions, and texts offer advice on a wide array of topics in the public sphere” (p.242).The cultural authority of the medical profession and the authoritative positioning of medical doctors had been reinforced over the period between the end of the nineteenth century through the early twentieth century. This cultural authority developed as medicine capitalized on scientific discoveries and marginalized rival healing and intellectual traditions.The authors explore if and how the medical profession is navigating its cultural authority among the new social changes, such as the emergence of movements by health activists that challenge dominant biomedical interpretations of diseases and the public crowdsourcing of health information online. Moreover, the Current COVID 19 pandemia revealed mistrust of medical authority among the public and the spread of anti-vaccine movements.The authors explore the change in cultural authority of medicine in light of social and political changes, such as the development of bioethics, growth of consumer movements, emergence of new intellectual rivals, the emergence of more knowledgeable patients, and new techniques of self-care, the advent of direct-to-consumer pharmaceutical advertising, and so on” (p.242).The authors postulate four assumptions that guide their study of “change in cultural authority in the health domain in the United States” (p.243). First, the study of the cultural authority of medicine should be aligned with an up-to-date understanding of culture in general. For example, one might look at the way cultural authority is represented in technological devices, clinical practices, and in the structure of institutions” (p.243). Second, the concept of cultural authority should be distinguished from the concept of medicalization since cultural authority expands beyond the domain of medical problems. Third, the concept of cultural authority should be distinguished from the concept of “trust” (p.243). The phenomenon of trust is multifaceted and it is used in literature exploring questions such as physician’s altruism, which are not relevant in the study of cultural authority. Finally, the concept of cultural authority should be expanded beyond the domain of medicine to encompass questions of health and wellness.Over the last years, the medical profession underwent several cultural changes. Some of these changes challenged the cultural authority of medicine while others reinforced it. Such changes are:1) diversification of the medical profession to include women and racial minorities (challenged the authority); 2) developments in biomedical research and health technologies which allowed to find indicators of problems before they become diseases (reinforced the authority); 3) growing influence of pharmacological industry in the medical literature ( seemed to threaten the authority yet solidified it because it had to attach the names of prominent physicians to the scientific papers); 4) growing numbers of mid-level practitioners, nurse practitioners, and physician assistants (seemed to threaten the authority but solidified it because these professionals rely on the medical paradigm where medical doctors are an established authority).The authors argue that as the cultural authority of medicine expands into domains of health and wellness, it experiences new types of challenges. To understand these changes, one might look into social mechanisms and factors that warrant cultural authority.