Knowledge in the Time of Cholera Read Free Page B

American allopathic journals prior to the twentieth century. Likewise, Koch’s widely reported discovery of
Vibrio cholerae
did not provide the decisive “win” for the bacteriological model of cholera (Rosenkrantz 1985; Warner 1991), as it was beset with inconsistencies that fostered widespread skepticism (Rothstein 1992, 267). And in terms of combating cholera, the bacteriological model did not produce much in the way of improvements in therapeutics (unlike diphtheria or rabies, no widely used cholera vaccine was ever embraced) or prevention (effective sanitary improvements were done in the name of the now discredited miasmic theory of disease) 2 (Dubos 1987; Duffy 1990; McKeown 1976, 1979). These issues—the ambiguity surrounding the theory initially and the lag between the promise of the germ theory and its results—are not just evident in the history of cholera; generally, the biomedical model only yielded significant therapeutic advantages in the 1930s, long after it was accepted by allopaths as legitimate (Spink 1978). Thus, in 1892, the year of the final U.S. cholera epidemic and the dawn of allopathic professional control, the efficacy of the bacteriological model existed largely in its promise. This messy, ambiguous historical record of cholera thus begs the questions, how did this disease come to be seen as a microbe and how did this understanding get folded into the professional project of allopathic medicine?
    Despite these problems, the truth-wins-out narrative has proven obstinately resilient, even as historians have challenged it on a number of grounds (see Grob 2002; Warner 1997, 1998). Were it restricted to publications of the American Medical Association (AMA) or the myths doctors tell themselves, it might not be much of a concern. The problem is that its assumptions insinuate themselves into more critical sociological analyses of professionalization. As such, it is not enough to dismiss it as merely “hagiographic” (Warner 1997, 2).
    It is not surprising that older functionalist accounts of professionalization embrace the truth-wins-out logic. When professions are viewed as arising to fulfill some preexisting societal need or structural imperative (see Parsons 1964), it is difficult to maintain the critical distance necessary to challenge the science that justifies such a role. But what of the more critical sociological research that arose in opposition to functionalism? These critical accounts depict professionalization not as a functional response to a societal need but rather as a political process that involves winning allies and creating a strong organizational infrastructure to promote professional goals. 3 Still, even this research inadvertently reproduces a version of truth-wins-out logic. Here the issue is reproduction through neglect. In reacting against the truth-wins-out narrative, which gives undo power to ideas, critical analyses tend to ignore ideas altogether, mustering organizational and political explanations for the professionalization of medicine (i.e., Berlant 1975; Freidson 1970, 1988; Larson 1977). Through this silence, they unintentionally reproduce misguided assumptions of the truth-wins-out narrative; focused on the
organizational
infrastructure of professions, they neglect the
intellectual
infrastructure. Ideas come to serve merely as window dressing for the real politicking happening behind the scenes.
    The power of the truth-wins-out logic is displayed in the way it insinuates itself into the preeminent sociological treatment of the U.S. medical profession, Paul Starr’s
The Social Transformation of American Medicine
(1982). Critical of both functionalism and purely organizational accounts of professionalization, Starr seeks to integrate organizational and cultural factors, recognizing professional authority as dependent upon force and persuasion (Starr 1982, 13). According to Starr, the AMA was able to consolidate professional authority once