Review - Trusting Doctors
The Decline of Moral Authority in American Medicine
by Jonathan B. Imber
Princeton University Press, 2008
Review by Leo Uzych, J.D., M.P.H.
Oct 27th 2009 (Volume 13, Issue 44)

Trusting Doctors is a book about the historic evolution of the public's trust in the moral authority of American medicine, with an important emphasis on linkages historically connecting medicine and religion in America.  The author, Professor Jonathan B. Imber, is the Class of 1949 Professor in Ethics and Professor of Sociology, at Wellesley College.  In an "Introduction" to the text, the reader is introduced pithily to Imber's belief that, over the course of the past few decades, the trust of the American public in the moral authority of physicians has declined.

A noteworthy contribution of this book is that, for the thoughtful reader, the engaging discourse of Imber may intellectually conjure to mind a plethora of questions importantly relevant to the book's substantive contents.  At its heart, these contents are concerned with moral authority and with trust, in the context particularly of American medicine.  But how can the "moral authority", of American medicine, be quantified?  And what, quantitatively, is "trust"?  And if moral authority and trust are, instead, qualitative terms, bereft of reliable quantitative measure, is the absence of quantitative measurement a fatal blow to academically rigorous evaluation of moral authority and trust concerning American medicine?  Or, are there alternative, qualitative means to investigate effectually this subject with academic style rigor?

A notable feature of the book is the extensive research referencing of its text.  Citations for multitudinous referenced research materials (including many that are annotated) are given in the "Notes" structural section.

Embedded in the textual terrain are numerous quotes, of varying length, drawn from referenced sources.  These quotes, individually and collectively, breathe animating life into the text's nostrils, and contribute materially to the substantive matter of the text.

Critically discerning readers may opine that the distinctly abstruse nature of Imber's writing is molded to far more closely fit academics and professionals (rather than laypersons).

In a different critical vein, Imber's writing may be chided critically as being, at times, somewhat rambling.  But plainly, Imber is versed very well about his subject, and informs the reader about it in an insight laden, critically informative, and extensively researched text.  The historically evolving interface of religion and medicine in America especially garners the close attention of Imber.

In this regard, Imber expounds instructively on the Protestant strand interwoven prominently into the fabric of 19^th century American medicine.  The Catholic tradition of "pastoral medicine", enveloping the perspective of this tradition regarding Cesarean section and craniotomy, likewise draws the rapt intellectual attention of Imber.

Imber's detailed study of the interface joining historically the medical profession and religion in America encompasses careful examination of the growing tension, erupting in the mid to late 19^th century, and entrapping the American medical profession between conflicting forces of scientific advancement and traditional theological authority.

In the context of the escalating tension, between medical science and religious faith, Imber interestingly describes the "prayer gauge" debate.  Arising in England near the end of the 19^th century, and reaching eventually to America, the debate (as Imber explains) sparked heated exchanges of views, relating to the possible efficacy of prayer with regard to healing the sick.

The substantive area covered by the text ranges further to elaboration of Imber's belief that, in the later decades of the 20^th century, there was a decline in public trust in American medicine.  The sociocultural dynamic accompanying this perceived phenomenon, significantly including the emergence of the women's health movement, is elaborated upon.

Some of the developing roots of the field of "bioethics", and the entanglement of those roots with religion, appear also on the radar screen, of Imber.

Unfolding epidemiologic understanding of the harmfulness of tobacco, and the impact of epidemiologic evidence of smoking related harms on the authority of medical practitioners, is a further topic falling within Imber's wide ranging ken.  And, in the book's last chapter, Imber labors hard to disentangle some of the knotty threads binding the end of life debate.

The population of prospective readers who may be held in thrall by the pensive musings of Imber is quite expansive, and extends at least to: medical historians, bioethicists, clergy members, theologians, sociologists, social scientists, public health professionals, epidemiologists, medical clinicians, philosophers, and health policy makers.

© 2009 Leo Uzych

Leo Uzych (based in Wallingford, PA) earned a law degree, from Temple University; and a master of public health degree, from Columbia University.  His area of special professional interest is healthcare.