Abstract

Professions accrue power and prestige in proportion to their social efficacy—that is, their perceived ability to "do things" that are socially valued. Such power allows professions and the institutions they control to define social problems and their solutions in their terms. The greater a profession's perceived efficacy, the broader the domain over which it can exert control, and the more societal issues it will be asked to address. Few professions offer better evidence of this principle than medicine. Physicians, once viewed as quacks who killed more people than they cured, by the last third of the 20th century had gained almost unrivaled social prestige and power, having demonstrated the ability to treat an expanding array of illnesses. This expanded authority led to what has been termed the "medicalization" of an ever-increasing range of physical, psychological, and even social issues (1). In the early 21st century the expansion of medicine's domain has taken a new turn. Whereas once it was the physician's role to define and treat disease, medicine now confronts the additional task of treating individuals' dissatisfaction with their identities—their bodies, moods, behaviors, social lives, and, indeed, "themselves." This process has not been entirely physician driven; pharmaceutical advertisements