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This paper examines the impact of changes in the medical marketplace on medicalization in U. S. society. Using four cases (Viagra, Paxil, human growth hormone and in vitro fertilization), we focus on two aspects of the changing medical marketplace: the role of direct-to-consumer advertising of prescription drugs and the emergence of private medical markets. We demonstrate how consumers and pharmaceutical corporations contribute to medicalization, with physicians, insurance coverage, and changes in regulatory practices playing facilitating roles. In some cases, insurers attempt to counteract medicalization by restricting access. We distinguish mediated and private medical markets, each characterized by differing relationships with corporations, insurers, consumers, and physicians. In the changing medical environment, with medical markets as intervening factors, corporations and insurers are becoming more significant determinants in the medicalization process.
Over the past three decades there has been a marked increase in the medicalization of society (Zola 1972; Conrad and Schneider 1992; Barsky and Boros 1995; Riska 2003). Medicalization occurs when previously non-medical problems are defined and treated as medical problems, usually in terms of illnesses or disorders. While medicalization can be bidirectional, there is strong evidence for increases in medicalization. This growth of medical jurisdiction is "one of the most potent transformations of the last half of the twentieth century in the West" (Clarke et al. 2003:161). In this same period, the institution of medicine has undergone major changes in its social organization, with the advent of managed care, the declining power of the medical profession, and a rise in consumer advocacy and accountability (Starr 1982; McKinlay and Marceau 2001). As medicine has changed, has the process of medicalization been transformed as well? In an ambitious paper, Clarke and her colleagues (2003) argue that the technoscientific changes in medicine have expanded medicine's boundaries even further into biomedicalization, a wide ranging process that includes complex and multi-sited transformations in medical knowledge, technology, surveillance, and bodies. Our task here is narrower and more focused. We ask, how have changes in the institution of medicine affected the process of medicalization? Have the shifting power dynamics in medicine altered medicalization? What are current engines driving increased medicalization? What factors constrain its growth?
Most previous analyses of medicalization focused on the influence of physicians, lay reformers, or medical and scientific...