Kevin MD, a blogger for medpagetoday.com pointed out an interesting, troubling study earlier this week. The study, performed in Norway, attempts to rank the prestige of both medical specialties, and less conventionally, of diseases themselves. If you want to read more about it, here’s an article and the abstract. Basically, they mailed a survey to a bunch of physicians and medical students that had a list of diseases and asked them to rank how prestigious each one was.
Now, there are a number of things about this that are appalling. I am totally fine with the fact that there are differing levels of perceived prestige for different medical specialties. I am also aware that I am planning to select one, psychiatry, that is not often near the top. However, I think that attempting to rank diseases themselves is disgusting. It’s more prestigious to have leukemia than thyroid cancer?! Where does that even come from? It just doesn't make sense conceptually to me.
The study only ranks 38 diseases, so obviously a lot of the biggies are left out. There's probably something to criticize in the methodology of a survey that includes ankylosing spondylitis (very rare) and not diabetes (very common)… but what I really want to talk about are the diseases that come in last on the prestige scale. Because it is not the top of this list, but the bottom that tells me what this survey was all about.
Of the four psychiatric diagnoses included in the survey, none are above the bottom six. The only two diseases that rank lower than any psychiatric condition are cirrhosis of the liver and fibromyalgia. Despite this outcome, the study authors make the claim that diseases located in vital organs in the upper parts of the body have high prestige. Really?
Come on folks. Name the highest up and most vital of all the organs.
The brain perhaps?
Are we really still so deep in the stone age that we can’t admit that someone with schizophrenia, depression or chronic anxiety has a brain problem? How about someone with cerebral palsy, which is only 8th from last?
My reading of these results points to a rather different conclusion. What we have here is the reverse social stigma scale. Diseases that nobody holds against you are near the top. No one tells you to buck up and get back to work if you have a heart attack or a brain tumor. Most of the things in the middle are kind of neutral: not as serious, but no way to assign any blame to the patient either. (It is notable that testicular cancer #5, while ovarian cancer is #12 and breast and cervical cancers are not even important enough for inclusion on the list. Men's reproductive organs are far more prestigious than women's.)
And down at the bottom of the list we find exactly those people that likely don’t need to be told that they’re not at the top of the social status scale. Patients with diseases that are psychiatric (anorexia, depression, anxiety and schizophrenia), poorly understood (fibromyalgia), or associated with culturally unaccepted behaviors or groups (cirrhosis, AIDS).
So I have to ask, what was the point? How could a scientist convince themselves that they had learned something about prestige as opposed to something about prejudice? Does this work really need to be done? Resources were used to conduct this study. Resources that could have been used to try to better understand some of those chronic and terrible diseases at the bottom. Resources that could have paid for antiretrovirals for someone with AIDS or some of the long term care that is so often needed by a patient with cerebral palsy.
The journal Social Sciences and Medicine decided to publish this study. I challenge any self-respecting social scientist to tell me that these rankings don’t have more to do with prejudice against people with the diseases near the bottom than the prestige of the diseases near the top.
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