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IntroductionIf we view the health care delivery sys-

tem as a social system, it becomes amena-ble to sociological analysis. Sociology dealsbasically with the behaviour of socialgroups, organizations and institutions. As

well, it deals with the phenomenon of so-cial process and social change. It is valu-

able in analysing the behaviour of a par-ticular social group to identify the majoractors and the nature and source of theirbehaviour. Where there are multiple ac-tors cemented together tightly by commongoals, a social complex emerges in whichdiverse actors participate, nevertheless cre-ating a predictable pattern of behaviour.

In analysing social systems, whethersimple or complex, it is very important to

understand the world view or belief sys-tem (paradigm) that guides their behav-iour and tends to determine roles, norms,status, hierarchy, rewards and values. So-cial systems are subject to radical changeor paradigm shifts and we can discern thebeginning of just such a shift in thecurrent health system.

The existence of socio-political com-plexes is a natural consequence of groups

and organizations (the actors), held to-gether by strongly shared norms, roles,values and world views or paradigms. Weare basing our analysis on the U.S.A., adominant power in the world and one

which strongly influences Canada. We candiscern three distinct social complexes inthe U.S.A. the military-industrial, theautomobile-petroleum-highway, and themedical-pharmaceutical-insurance com-plex. These terms identify the major so-cial actors or members of the complex. It

will be, in part, our task to identify theparadigm that guides the latter system.

It is important to describe the larger

context in which the medical-pharmaceu-tical-insurance complex has evolved. Thiscontext is the current process of globaliza-tion which imprints its values and para-digms on all dominant social systems. This

will permit us to understand the trueanatomy of our current health system. Itis no accident that the U.S.A. is the only

country in the economically developedworld which does not have a national uni-versal health care plan. Moreover, exam-ining a group of social indicators measur-ing the state of general health, public, en-vironmental and nutritional health andhealth care delivery, the U.S.A. has the

worst record among all industrializedcountries. It has the highest infant mor-tality, lowest life expectancy, highest inci-

dence of cancer, cancer among men andbreast cancer, as well as the highest percapita consumption of beef and snackfoods. It also has the highest per capita pro-duction of all major pollutants and toxic

waste.

The Two Faces of GlobalizationThere are two faces to globalization.

One, represented by the international non-

governmental organizations concernedwith peace, justice and ecology, presents avision of global equality, global unity, theacceptance of cultural diversity, and aboveall, a high level of cooperation accompa-nied by a dedicated program of aid fromNorth to South, guided by ecologicallysustainable technologies. This, obviously,requires fundamental changes in theNorth, and above all, to cease imposingits version of progress on the South, sup-ported by economic and political domi-nation, both covert and overt.

The dark side of globalization is thatit is a new form of neo-colonialism. Theauthority and power of the most powerfulinternational institutions and their insti-

The Sociology of Health

F. H. Knelman, Ph.D.1

1. #4, 4631 Lochside Drive. Victoria, B.C., Canada V8Y 2S9

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Journal of Orthomolecular Medicine Vol. 11, No. 3, 1996

tutional support groups such as the Inter-national Monetary Fund, the World Bank,and the General Agreement on Tariffs &

Trade (GATT) with their narrow focus onstructural adjustment policies is attempt-ing to impose a single dominant unifieddevelopmental model on the entire world,

while crushing the identity of indigenouspeoples, local communities and alternativecultures. In effect, what the North hasimposed as the new globalism is a beliefsystem of unrestricted economic expansionand unrestricted exploitation in pursuit of

that economic imperative. If this worldview were to truly pervade the entireplanet, life would inevitably find itself onthe precipice of extinction.

The condition of the world in the late1990s is worse than Susan Georges judge-ment, How The Other Half Dies.1 We maynow be talking about how the other threequarters die. Moreover, the North has re-structured the South so that debt exceeds

income, a counter-productive process thatcan only lead to the deepening of the mul-tiple crises.

What the world is really facing is a gi-gantic crisis in values. The underlying valueof the current globalization trend is to makeeconomic values dominant, reducing allother social values to their economic netbenefit. Socially valued services such ashealth and education are being reduced tothe privatization of the business enterprise

whose sole criteria is profitability. The trag-edy is best expressed by F. Scott Fitzgerald,The victor belongs to the spoils. The lossis the best that was human the spiritual,the creative and the humanistic. Healthdelivery has become a business therebysubverting the historically evolved right tohealth for everybody.

A new and powerful kingdom hasemerged in the world, more powerful thangovernment. This is the kingdom of thehuge international cartels and multina-tionals. They are also a manifestation ofthe new globalism. Their operations areplanetary. There are no genuine restrictions

on their activities. They are mobile, nevertied to place or time, but always movingto where profits can be maximized. They

are totally indifferent to the real conditionsof living for masses of people.They have a vision of a world of Coca

Cola and Corn Flakes, or McDonalds andBurger King. That this is no exaggeration issupported by the following statement by thePresident of Nabisco I am lookingforward to one world of homogeneousconsumption... to the day when Arabs and

Americans, Latinos and Scandinavians, will

be munching Ritz crackers as enthusiasticallyas they already drink Coca Cola and brushtheir teeth with Colgate.2

The vision of the multinationals iscoming true. They have created the finalunsteady state. At present no counterforceof equal power exists. Creating such acounterforce is the task of the next revo-lution. The goal of the global businesscommunity is to create a homogeneous

culture of mass consumption and to freethe global marketplace of all encumbrancessuch as health, safety and environmentalregulations, and standards or public invest-ment in health and education. Their goalis to shred the social safety net. Deregula-tion and privatization of everything is theirformula for creating a global free market.The freedom of enterprise is to be com-pleted and the economic imperative, thepower of the bottom line, is to becomethe exclusive measure of all values: mate-rial, spiritual, human and cultural. Eventhe value of human mortality and mor-bidity are to be reduced to economic val-ues. It is a saving for a corporation when alow-wage worker dies or becomes ill fromthe companys operations, rather than a

worker in a high-wage area. In general, the

death of women is valued less than that ofmen. These are the formulae of the multi-nationals as they export waste or manu-facture toxic substances.

What propelled the globalizationtrend was the demise of the Soviet Unionand the emergence of a unipolar world


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establishing the Americanization of theplanet, the essence of which is that thereare no other meaningful operational val-

ues in this world other than the economic.This globalization of the economic im-perative exerts enormous pressures on allcountries to conform to an economic treat-ment of health that represents the triumphof the marketplace. For those business andgovernment leaders who subscribe to this

world view, the social safety net and itscomponents of government support ofhealth, education and other important

social services is a violation of free enter-prise domination. A direct consequence ofall this is that the medical-pharmaceuti-cal-insurance complex serves a commongoal of maximizing profits, thus reducingthem to a business rather than a service.

Ancillary groups emerge and attachthemselves to the above complex. Associa-tion of doctors, health institutes, lobbies,regulators, research institutes, university

departments of medicine, all tend, withnotable individual exceptions, to indulgein an elite accommodation of the majorgoals of the complex. This often takes theform of seizing on uncertainty to delay ordeny the existence of serious health risk.In the end, they indulge in the art ofbiopolitics, which is an attempt to treatsomething which is biologically hazardousas if it were biologically acceptable. Theyemploy universal tactics in order to avoidregulation. First denial, then delay andthen to reluctant regulation, or in somemajor cases, permission to continue to re-lease hazardous substances to the environ-ment. The social dynamics of the complexand its ancillary groups is to create a mono-lith of collectivity of all the actors, guidedby a dominant paradigm and various sets

of roles and norms.

The Disease SystemUnderlying all of this, but also a con-

sequence of the above evolution, is a morefundamental distortion of our health sys-tem, in that it is really a disease system

with an exclusive concern with treatmentand cure, and a profound neglect of pre-vention. This follows naturally from the

power of the economic imperative. Sincethe treatment of disease is a business ven-ture, only those patients who can gener-ate profit will tend to be treated or givenpreference in treatment. In fact, the insur-ance companies have a name for these pa-tients revenue generators. This, ofcourse, leads to the neglect of health carefor the majority of the poor, and many ofthe aged and disabled. These people are

simply sacrificed at the altar of organizedgreed. This is a system of functional inhu-manity which views social services gener-ally as subversive of free enterprise, thusthe focus of deregulation. The need fortreatment remains valid as long as diseaseexists. Like hazardous waste, we must cleanup the past even as we prevent the errorsof its ways for the future.

Economics of Health CareDeficit cutting and balancing the

budget are the current dominant economicpolicies of the economically developed

world. However, this entails a very biasedset of instruments. The major target is toshred the social safety net health care,child care and education being prime tar-gets, while also cutting taxes, particularlyfor the richer people and the corporations.Thus there is an organized system of un-fair taxation predicated on the notion ofthe validity of the trickle-down theory.

At the same time, the military budget isable to escape these cuts even in the faceof the end of the Cold War. This is ration-alized by continually inventing new threatsto security. And the ultimate irony, of course,is that this totally violates the principles of

free enterprise. The external baggage of thepost-Soviet world is the curse of a new worldorder prescribed by the U.S.A.

The prescription for this new globalmarket economy is to rob federal govern-ments of all legitimate roles in settingstandards, whether for the health of the


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people or the environment. Deregulationand decentralization become dominantpolicy since all regulations are viewed as

violations of the freedom of the market.Laws protecting wildlife, natural resourceslike forests, or for that matter, the qualityof air, water and soil, or the integrity ofbiodiversity, are viewed as unacceptableobstacles in the part of the markets rolein mediating all matters. Still another as-pect of the new global order is privatiza-tion. The private sector is to be trusted toapply the laws of the marketplace to all

matters social and environmental. The testfor response to toxins in our environmentis to measure the harm of continued useagainst the alleged greater economic harmof a ban, even if the substance is a car-cinogen, the benefits being easier to quan-tify than the harm, when it involves hu-man pain and suffering.

It is a great irony that the universalcompulsion to cut the debt is accompa-

nied at the same time by the greatestgrowth in environmental debt the worldhas yet known. The cost of clean-up andsafe disposal of the total wastes that havealready accumulated, many of them a con-stant health hazard, dwarfs the positivenumber of the Gross National Product(GNP). In effect, gross national pollutionexceeds GNP, yet we continue to deferpayments to future generations, makingit a cowardly lie to talk about cutting thedebt in the interest of those future genera-tions. The law of capital investment is tomaximize the return of the investment byany means, none of which has ever been aconcern for future generations. In fact, aprime means of maintaining these profitsis to defer payment of environmental debt.

Yet this debt could be managed simply by

a fair taxation of the most wealthy. In1992, 66,000 of Canadas most profitablecorporations paid no tax. We dont have adebt problem, we have a revenue problem.

A very subtle and dangerous develop-ment is GATTs support for the U.N.s

World Health Organization Codex

Alimentarius Commission of Rome. Theruling body is dominated by the worldsmost powerful pharmaceutical cartels and

allied multinational corporations. The lat-est tactic of this imperial alliance is to at-tack the entire field of dietary supplements,recognizing these as a threat to theirhegemonic control of the medical field.Under the Proposed Draft Guidelines forDietary Supplements:

(1) No dietary supplement can be soldfor its preventative or therapeutic use;

(2) No dietary supplement sold as a food

can exceed dosage levels set by the Codex;(3)The above Codex regulations

would become binding with no GATTescape clause that has previously allowednations to set their own standards;

(4) All new dietary supplements wouldautomatically be banned unless they con-formed to the Codex approval process. Thisis a deliberate plot to downgrade and elimi-nate the entire burgeoning field of nutri-

tional medicine, which is now challeng-ing conventional medicine all over the

world and is having remarkable success indisease prevention and health promotion.

If you wish to have a picture of whatwill happen in every country, the Norwayexperience is frightening. Fifty percent ofall health food stores and supplementmanufacturers have been forced out ofbusiness. No amino acids, minerals or traceminerals are permitted for sale. VitaminC and vitamin E have been redefined asdrugs. In other countries companies havebeen indicted for selling vitamin C. All thisis ironical in the face of the avalanche ofnew research supporting preventive medi-cine and the rich harvest of new medicinesfrom natural products. But this develop-ment is also predictable. The powerful in-

surance, health service and pharmaceuti-cal companies will not tolerate any threatto their powerful position. This viciousaction by the international trading com-munity is on a par with the wanton de-struction of indigenous peoples, local com-munities and entire cultures, not count-


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ing the vast ecoculture of nature.However the status and power of the

Codex Alimentarius Commission on Nu-

trition and Foods for Special Dietary Usesis being challenged. According to the May1996 issue of the International Journal of

Alternative and Complementary Medi-cine, Codexs claim that the rules it makeson these matters is binding on all mem-bers of GATT has been challenged by theU.S.F.D.A. According to F.D.A., nothingin GATT can restrict either the sale of di-etary supplements or the type of informa-

tion manufacturers provide to consumers.These are subject to U.S. law. Thus it ap-pears that the original vote of 16 to two in1995 on a draconian resolution, put bythe German delegate, is being recognizedas binding in the European CommonMarket but not by the U.S.A. The aboveCodex resolution would ban the sale of anydietary supplement sold for preventive ortherapeutic use. Nor could any supplement

exceed Codex-established levels. In fact, allsupplements could be banned unless per-mitted by Codex. This is a case of the glo-bal multinational kingdom attempting toimpose its rule on the entire field of alter-native and complementary medicine, aclassic example of the new global order. Inthe U.S., nevertheless, the F.D.A. is undersiege by the Republican Congress. Despitethis, new laws protect dietary supplements,having accomplished deregulation. This isboth good and bad news, the latter beingthe shift to the total deregulation of theindustry.

The Special Case of CancerThis author has called cancer the

plague of progress. The reason is that to amajor extent cancer is the result of the

millions of chemicals in our air, food andwater, including known and suspected car-cinogens, exposure to ionizing radiation,and exposure to sidestream tobacco smokeor even secondary smoke, all of these be-ing environmental factors and subject toban if the political will exists. In fact

sidestream smoke from burning cigarettes,clearly an environmental factor, is moretoxic than inhaled or exhaled smoke. Thus

cancer is not merely a biogenetic diseasebut a biopolitical disease. According tovarious sources, there is now widespreadagreement that roughly 85% of all can-cers are caused by environmental factors. 3

This estimate is hotly disputed, predict-ably by industry and its captive advisors.Some apologists, such as Bruce Ames, haveindulged in a dedicated campaign of eliteaccommodation and thus have become

leading figures in the estimates game.4Ames has suggested that natural productsare far more carcinogenic than environ-mental pollution, on a par with RonaldReagans assertion that it is trees that arethe major cause of pollution. In the distri-bution of causes between lifestyle (e.g. dietand smoking), biogenetic and environ-mental, the exact numbers are still uncer-tain. But the downgrading of the latter is

a perfect example of biopolitics, i.e. argu-ing that a biological hazard is of minimalsignificance. The environmental factor hasbeen vigorously defended by such scien-tists as Dr. Samuel Epstein, a major figurein the dispute, whose analyses of the poli-tics of cancer wars is incisive. Howeverhe has, in the past, possibly reduced therisk of lifestyle factors.5,6

A special class of cancer-causingchemicals are xenoestrogens, found insome pesticides, cosmetics and plastics,

which can behave in our bodies like hor-mones, mimicking estrogen or blockingtestosterone. These are all hormone-dis-rupting pollutants. There is little argu-ment about their impact on various ani-mal populations, destroying the ability toreproduce and reducting in immunity to

disease. Some investigators are now ar-guing, with considerable scientific merit,that these same xenoestrogens can acti-vate natural forms of estrogen in humanfemales, increasing the risk to breastcancer .7

A leading epidemiologist and con-


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sultant to the Department of Health andHuman Services, Dr. Devia Lee Davis, hasargued effectively that xenoestrogens are

related to increased risk of both prostateand breast cancer.8

Theoretically, all of the cancers in-duced by environmental factors are pre-ventable by the exercise of political will.The basic reason they are permitted ispatently obvious. In our social system,economic values supersede and tran-scend human values. In the U.S.A. alonethere are some one million cases of can-

cer currently and the death rate is over50%. In 1971, former President Nixondeclared his ill-fated war on cancer.Current mortality and morbidity rateshave continued to climb, bringing uscloser to epidemic levels. Like the Viet-nam War, the cancer war is a lost one,despite billions of dollars spent on treat-ment. In fact, if we compare the totalsocial cost of some one million cases, it

is clear that prevention would be far lesscostly. The trouble is that cancer treat-ment is a business and the private sectordiscounts social costs in favour of pri-vate profits. And this is done with gov-ernment condonation and collusion.Surely we cannot avoid making thecharge of corporate crime for those com-panies responsible for the release of car-cinogens into our environment. Norcould we ever account for the humancost of suffering for patients and theirloved ones. In fact, as we have earlierpointed out, modern economics sink tothe very depths of inhumanity in thatthey use synthetic cost accounting meth-ods to put a price on morbidity and mor-tality. The latter, for example, is the valueof lost earnings between the time of

death and retirement. The poor and un-employed thus have zero value, andwomen generally less than men. On theother hand, expensive treatment and di-agnostic procedures produce billions ofdollars of profits, yet in the case of can-cer are not always effective.

Paradigm ShiftA Hope For HealthIn Thomas Kuhns seminal work, The

Structure of Scientific Revolutions, he de-

scribes the process whereby dominantparadigms, apparently firmly entrenched,eventually succumb to revealed contradic-tions, anomalies and a general failure atpredictive capacity, and then give way to anew alternative group of practitionersarmed with with an alternative paradigm.

which proceeds to replace the old concep-tual/theoretical change in the health field.

9

However, the Kuhnian model is not merely

appropriate to the advanced evolutionarystage of science, where there is much valueresident in the old scheme that can be ab-sorbed by the new. The paradigm shift heretends to be much more one of approach,of orientation, of strategy and tactics, thanrejecting the valid supporting scientificfields, i.e. it is a social paradigm shift, ac-companied by new practices.

There is probably no single or simple

term, as yet, to describe the emerging para-digm shift in health. By definition, whatis emergent and not yet fully evolved is ina dynamic state of evolution. Some of thetributaries of this new stream in the healthfield are preventive medicine, functionalmedicine and nutritional therapy, but nosingle term encompasses all the nuances.For want of a better term, and in fullknowledge of residual ambiguity, we arecalling this emerging health paradigm thecomplementary health field. It is impor-tant to distinguish, within this field, thedifferences between nutritional medicine,

which is moving rapidly into the main-stream of the medical sciences, and whatis officially called alternative medicine,comprising such techniques as acupunc-ture, hypnosis, music therapy, yoga and

some of the ancient medicine schools ofIndia and China. In fact, the U.S. NationalInstitute of Health (NIH) has created anOffice of Alternative Medicine, to fundresearch to assess the validity of these al-ternatives. And, even earlier, the WorldHealth Organization had called for a New


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Medicine, which weds conventionalmedical science to the older, traditional,non-toxic, non-invasive practices. Never-

theless, treatment will always be requiredfor those people who fall through thesafety net of wellness. Therefore there willcontinue to be legitimate questions of

what is appropriate treatment, giving con-sideration to both the extension of lifeand the quality of life.

An even more radical aspect of theparadigm shift in health is that even theconservative National Cancer Institute

(NCI) has called for a redirection of policytowards prevention, early diagnosis, andthe swift application of new treatments.Even further, NCI has recently undertakenthree large trials on the use of vitamins andminerals in preventing cancer inLinxian, China, utilizing 34,000 subjectsrelated to oesophageal cancer; in Finlandamong 29,000 smokers related to lungcancer; and among 1,000 Americans at-

tempting to prevent the reoccurrence ofbasal-cell skin cancer. They are also fund-ing a world-wide study to search for natu-ral plant substances that might fight can-cer, and also have established a CancerNutrition Laboratory to study dietary fac-tors associated with cancer.

This reappraisal of vitamins and re-discovery of natural medicines is also partof a more fundamental challenge to con-ventional medical practices. The focus ofthe new health paradigm is on health pro-motion and disease prevention throughnutrition, and the application of naturalproducts and vitamins with therapeuticvalue. In general, medical sciences havealso tended to discount environmental fac-tors, both external and internal, as causesof disease. The basic principle involved is

that prevention is intrinsically less costlythan cure. There is also another cost-savingprinciple, and that is community health carefocusing on the promotion of health. It of-fers significant savings opportunities.

In Canada, provincial health authori-ties are searching for a more cost-effective

health care system. In 1992, the bill forhealth in Canada was $60 billion, yet upto 50% of all patients in acute care hospi-

tals could have been much more economi-cally treated in community health care fa-cilities. One of the principles of commu-nity health care is to actively enlist patientsin building their own good health or

wellness on the principle of informed con-sent. In the 90s, home has again becomethe global work place for increasing num-bers. It is rational that it could also be-come the site of much of primary health

care. Coupling this to the application ofnutrition to strengthen the bodys own de-fences against cancer by enhancing immu-nity and destroying toxic agents and proc-esses, we can begin to see the fulfilment ofthe paradigm shift in the health field. It istoo early to assess how such a program

would impact on cancer incidence, but ingeneral the creation of a state of wellnessshould, in itself, reduce all diseases.

References1. George S: How The Other Half Dies. New York.

Penguin Books. 1976.2. Mander J: Absence of the Sacred. San Fran-

cisco. Sierra Club Books. 1991; 31.3. U.N.E.P.: Saving Our Planet: Challenges and

Hopes. 1992; 143.4. Proctor RN: Cancer Wars. New York. Basic

Books, 1995: 54-74.5. Epstein S: The Politics of Cancer. New York.

Anchor Press.1977.6. Epstein S: Fallacies of Lifestyle Cancer Risk.

Nature. 1981; 127-130.7. Spake A: Is That Her? Health. October 1995;

53-56.8. Davis DL: Medical Hypotheses: Xenoestro-

gens as Preventable Causes of Breast Cancer.Environmental Health Perspectives. 1993; 101:372-377.

9. Kuhn T: The Structure of Scientific Revolutions.Chicago. University of Chicago Press. 1962.

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