DIFFERENCES IN MEDICINE:
AN INTRODUCTION
Annemarie Mol
&
Marc Berg
In
1981
Barbara Smith published an article under the title
Black Lung: The Social
Production of Disease.
She stressed that not just anybody risks developing the
disease "black lung." What turns it into a reality for some - miners - and not
for others - for instance, the shareholders of the mining companies - is social
relations. Moreover, the often early and severe development of black lung that
Smith encountered in the region she reports on, West Virginia, is not an inevi-
table consequence of mining. The onset and course of the disease depend on
the specific working conditions in the mines: on the amounts of coal dust and
on the levels of oxygen miners get to breathe. And, related to that, on the ex-
tent to which miners are or are not granted control over the way they work.
But what happens to the lungs of miners is not all that is socially produced.
Social relations also shape the
categories
used in discussing health conditions.
Smith, for example, examines which specific miners were judged to be
ill
enough to be entitled to a financial compensation from the mining company
they worked for or, later on, from the government. She shows that there is not
just one set of terms with which to discuss this question but two. Initially, one
might note that it is possible to make an X
ray
of a miner's lungs: the whiter the
picture, the blacker the lungs. Above a certain threshold the miner can then be
said to be
ill
enough to deserve compensation. This, in fact, is how company
doctors proceeded. They wanted an objectified image to point at, a picture that
could be measured against a standard, to avoid the complexities of further dis-
cussing the rights and wrongs done to people in specific cases.
But the miners didn't agree. Such objectified images had little to do with
their suffering. Standardized judgments of X-ray images led to what they saw
as completely arbitrary decisions: one worker might get compensation while
his neighbor, who was worse off, got none. The miners felt that they deserved
financial compensation, not
if
their X rays were bad, but if they
suffered:
if,
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