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Classification and Process in
Sociomedical Understanding: Towards a
Multilevel View of Sociomedical
Methodology
ROBERT A. RUBINSTEIN , SUSAN C. SCRIMSHAW,
AND SUZANNE E. MORRISSEY
lNTRODU CTlON
The various social sciences that contribute to the understanding of health, illness, and health sys- tems employ a variety of research methodol- ogies. In this chapter we distinguish between methodology and methods. By methods, we mean the particular data collection tools - such as surveys, interviews, observations, and the like - and the techniques of data analysis - such as statistical manipulations, content analy- sis, or coding schemes. Methodology, in contrast, is concerned with the epistemological and onto- logical foundations of inquiry. Our main concern in this chapter is with methodology. Methodologies include not only the methods used for data collection and ways of manipulat- ing these data for analysis, but also their under- lying theoretical and philosophical assumptions. Each discipline, such as sociology, anthropo l- ogy, psychology, economics, and epidemiology, has its own favorite array of methods, which are the subject of debate, even within the discipline. Across disciplines, there has been a historical misunderstanding, and sometimes disrespect, regarding the methods of other fields, yet at the same time, disciplines borrow methods from each other, sometimes without recognizing their similarity to methods which they claim to disparage.
Increasingly, we see a convergence and com- bination of methods among the various social sciences. Shared theoretical approaches or philosophical commitments that underlie the methodologies do not always accompany this convergence in data collection and analysis stra- tegies. In this chapter we explore the importance and implications of going beyond a multimethod strategy to take a multilevel and theoretically holistic approach towards sociomedical re- search, and relate the increasingly sophisticated methods of research that seeks a better under- standing of the complex relationships between health, illness, and healing (which we call socio- medical research) to such an imperative. In this regard, sociomedical inquiry focuses not only on the biological, organic correlates of health and illness, but also on the roles played by social and cultural factors for the triggering of the onset of disease or for the role played by these factors in increasing the susceptibility of individuals and populations to disease. We define holistic as an approach that takes the broader context into account. This includes the wider settings of both space and time. For example, an observed health system should be seen in the context of a wider community and culture, and the requirements of that health sys- tem may vary with seasonal variations in disease entities as well. We define multilevel in terms of the unit of analysis. For instance, health out-
37 Sociomedical Understanding in Classification
of a combination on comes may be dependent
family provider behaviors, factors, individual
community the and factors, cultural setting,
context.
convergent valida- that We take for granted
systemic organization, of tion from a single level
while serving well efforts to increase the sophis-
is methods in sociomedical research, of tication
inadequate basis for the future development an
the of sociomedical research. We discuss some of
multilevel view has with our that continuities
previous work, mainly in anthropology. Then
upon discuss some cultural characteristics we
based, been has research sociomedical which
revision. of these are in need that and we suggest
expert of paid to the role is Particular attention
technology, and the of knowledge, the valuing
experience. of reports of discounting
CoNTEXT HrsTORICAL REcENT
only be dealt with can Problematic situations
effectively once they have been defined as prob-
al. 1984). et lems (Rubinstein 1984; Rubinstein
ordi- that Problematic situations are situations
troublesome and for which nary persons find
professional research- For they often seek help.
by problematic situations are constituted ers,
depart from the expected, anomalous that data
dis- be may results anomalous Such results.
taken as a site for profitable investi- or missed
; 1984 al. et Rubinstein 1970; (Kuhn gation
Ward and Werner 1984).
specialized knowl- on In most areas relying
from to construct problems the ability edge,
troublesome experience develops of the analysis
1983), Schon 1980; practice (Argyris through
less formally, in rules or codified, more is and
classification. The methods and methodology of
used by sociomedical researchers give them ways
construing physical, psychological, and other of
problems to of 'difficulties' as particular kinds
be explored and understood. Sociomedical cate-
gories thus reduce people's problematic experi-
our which to ences to relatively familiar patterns
be applied. These methods and methods can
approaches are increasingly recognized as cultu-
rally and socially situated (Freund and McGuire
al. 1991). This has the et Romanucci-Ross 1999;
ethno- or introducing a cultural bias, of effect
centricity, in these approaches and their results.
that the information of e value and utilityTh
the on part results from their use depends in
meaning the between conflict or congruence
people by them to ascribed significance and
Romanucci- ; 1991 (Kottak practitioners and
Ross 1991).
II years, a schism War the early post-World In
developed within the sociomedical research com-
methods applied who those between munity
techniques hypothetico-deductive on based
science, of grounded in positivist philosophies
and those who applied more inductively defined
of visions alternative in based techniques
1994; (Hollis pragmatism as such science,
differences these Because 1998). Schweizer
involved competition for resources and also for
authoritative, useful knowledge, of the definition
for some time these two traditions developed in
one another (Diesing to antagonistic relation
1991). This antagonism was often expressed as
a contest between qualitative and quantitative
hy- time, some For methods. to approaches
quantitative - approaches - pothetico-deductive
achieved a certain dominance and set the terms
sociomedical methods (Hempel about debates of
1998). Schweizer 1996; ; Kuipers 1965
three decades, quali- or During the past two
humanist with associated methods tative
approaches in the social sciences have gained
authority as objectivity in science has been called
on the implications contingent and into question
scientific knowledge have been explored (Latour
greater 1987). This exploration has created a
result that the knowledge claims that recognition
hypothetico-deductive and inductive ap- from
contingent and incomplete. both proaches are
many among remains Considerable suspicion
the represen- of the usefulness about researchers
tations produced by each method. Nonetheless,
the epistemological difficulties shared by these
approaches have resulted in a greater willingness
reconcile to ways seek researchers to among
this rapproche- of them. The most obvious fruit
increase in efforts to integrate an ment has been
methods qualitative and quantitative research
1986; al. et Janes 1981; (Brewer and Collins
Scrimshaw 1990).
Perhaps the most basic principle underlying
methods ought to that these efforts is the view
knowl- our of increase the validity and reliability
a phenom- of edge by using multiple measures
enon (Jenkins and Howard 1992; Pelto and Pelto
1996). The high value placed on this convergent
triangulation, has been one area or validation,
where qualitative and quantitative approaches
have sought common ground.
re- sociomedical to interest of Phenomena
a number of any on searchers might be found
At 1). systemic organization (Figure of levels of
the macrolevel, health policy researchers might
find their attention directed to the societywide,
encoded symbolically of artifacts behavioral
the microlevel sociomedi- at information, while
cal researchers might focus on individual bio-
disease. and illness of aspects logical
Sociomedical research typically involves the use
39 Sociomedical Understanding in Classification
professionally adaptive of and the development
niches such as medical anthropology.
As anthropologists have joined other socio-
to seeks that research in researchers medical
'problem oriented - answer practical questions
in there has been a discernible shift - research'
report anthropologists methods of kinds the
1993; al. et Lurie 1986; (Gorman using
1986). More frequently Perloff Rubinstein and
anthropologists instance, for before, than
a or one only on relies that research report
that they are the phenomenon of indices few
increasingly be these whether investigating,
reflexive or well-bounded quantitative measures
analytical frameworks. Also reported are more
results based on short-term ethnographic field-
Scrimshaw 1992; work (Manderson and Aaby
Zambrana 1992; Scrimshaw and Gleason 1992;
focus so tightly on that studies or et al. 1997a),
other that life social of aspects particular
ignored (Chambers or are lost data of sources
1984). Ward and Werner 1997; McGuire 1985;
converged have methods anthropological As
sociomedical in standard more those with
research, the commitment to holism has seemed
some irony in this, as it was is to fade. There
that holism penchant for the anthropological
early medical anthropolo- of brought the work
sociomedical other of notice the to gists
noted, be should It 1955). (Paul researchers
studies focused tightly more that however,
One holism. exclude completely not need
is anthropological holism of important feature
that influences or factors to alert remain to
data to of were not within the original scope
the in these include to and collected, be
research if they seem important to the problem
hand. This, even a focused study, can change at
and expand in response to the researchers' will-
ingness and ability to take the broad view. This
to be collected, and some- data change in the
are questions which from view the in times
asked and observations are made as the study
precisely what makes traditional is progresses,
qua- about quantitative researchers so nervous
retain to helps what also is It litative work.
continually is researcher the because holism,
on influences possible broadest the to open
the phenomenon under investigation.
VALIDITY' 'CONVERGENT AND HOLISM
Despite its having faded in prominence, the hol-
the of istic perspective remains in our view one
most valuable developments in efforts to under-
a perspective is It standing the human condition.
problem- from lacking lamentably is that
1982; (Hall research sociomedical oriented
Simon 1983), despite 1983; and Walker Penfold
of precisely in the intersection is it that the fact
of biological, psychological, and social aspects
health and illness that it might most naturally
found. To some degree, sociomedical research be
has drifted away from holism because such a
move enabled well-bounded studies that could
form the basis upon which claims for funding
because and rest, could resources other and
the grant-review of the social organization of
process which disburses research support.
research reward structure for The resulting
thoughtful interdisci- of works against the kind
plinary research required for holistic investiga-
instance, extensive publication records For tion.
cap- is are taken as indications that a researcher
able and 'productive,' which in turn encourages
researchers to go to press with 'the least publish-
able bit' rather than with fuller and more inte-
the Also, topic. their of treatments grative
pressure for productivity frequently constrains
publica- - researchers to report positive results
negative results, even when such or null of tion
results might provide interesting clues about the
sociomedical phenomena, are dis- of dynamics
couraged, if only informally.
decisions face researchers before Indeed,
about publication they must first find support
this regard they face chal- In for their research.
also make holism in sociomedical that lenges
instance, For research more difficult to achieve.
specialized to directed are proposals grant
within work highly rate that sections review
the of paradigms disciplinary particular the
seek to integrate theory that Proposals members.
disciplines thus of methods from a number or
of between the institutional arrangements fall
the review process. Funding agencies, often in
directors, of boards or response to the public
in periodically emphases funding their shift
sociomedi- of order to stay on the 'cutting edge'
cal knowledge. This allows the funding agencies
to claim that they are pushing the development
researchers not, or Wittingly knowledge. of
respond to these 'fads and fashions' by altering
their research, even, perhaps, before they have
upon problems earlier the Investigated fully
and (Lane focused work their which
Rubinstein 1996b).
is the holistic perspective of the values of One
technical and scientific that recognition the
knowledge are understood to be always incom-
1980; Brewer thus fallible (Argyris plete, and
1983; Pacey 1967; Cantril 1981; Collins and
Simon 1983; Schon 1984; al. et Rubinstein
always is 1983). Because specialized knowledge
incomplete informa- of constructed on the basis
tion about phenomena, it must always be seen as
provisional.
Health and Medicine in l Studies ia Soc of Handbook^40
course, a of knowledge is, of The contingency
that other perspectives of fundamental insight
falli- and also emphasize the provisional nature
the world. This prin- of knowledge our of bility
instance, in the American found , for is ciple
Rescher 1980; Peirce (Almeder of Pragmatism
- and James (1978), in the skeptical phi-
Salmon (Popper 1962; Hume David of losophy
1967), and in contemporary evolutionary epis-
Collins 1981; Campbell and temology (Brewer
these diverse sources, the 1973, 1974). Given
knowl- of the fallibility and provisional nature
edge deserve to be taken most seriously.
of the methodological implications of Some
by epistemologists work- out this have been set
volutionary epistem-'e of tradition ing in the
realism' hypothetical 'critical or ology,'
; 1973 Cohen and Naroll 1973; (Campbell
This 1984). a!. et Rubinstein ; 1981 Pinxten
col- of because each way that work emphasizes
is carries a particular perspective, it data lecting
important to use multiple measures to assess a
equally is phenomenon. Problem-oriented work
requires multiple and limited in its perspective,
'tunnel if be used disciplinary perspectives to
to be avoided. is vision' (Pacey 1983)
instance, David Hufford (1982a) made a For
the 'sleep of studies of comprehensive review
and nightmare by characterized disorder'
experience - which incubus an and paralysis
g experience. HuffordHa Old Hufford calls the
shows that the accounts offered by researchers
Old the disciplines that studied the of from each
of experience are all characterized by a kind Hag
sociolo- s, anthropologists, Thu vision. tunnel
gists, and medical folklorists ascribe it to tradi-
tion, treating the phenomenon as culture-bound
researchers attempt to character- Sleep artifact.
sleep disorder of ize the phenomenon as a kind
sleep, REM of sual patternsunu associated with
the of None and psychiatrists as a mental illness.
researchers are able to account fully for the phe-
experience, yet as Hag Old the of nomenology
of Hufford (1982a: 116) points out, the effect
plainex to been their disciplinary efforts 'has
the phenomenon away while discouraging the
it. ' of a thorough description of development
sociomedical research the prescription for In
pursue a to been has vision tunnel avoiding
(Campbell validation' 'convergent of strategy
iteration' 'multiple and 1959) Fiske and
1973), and its propo- (Werner and Campbell
is it at nents have been explicit in arguing th
as legitimate many differ- er important to consid
knowing' (Balshem 1993; Gifford of ent 'ways
; Lieberson 1992). 8619
for multilevel research designs adds ll ca Our
the principles methodological two sethe to
the convergent validation be that requirement
a necessary is This s. made from multiple level
the of addition because precisely what aspects
phenomena under study are salient to an inves-
tigation depend upon how the problem being
73; : 1989 (Albrecht framed is investigated
; 1989 Tanur and Fienberg ; 1998 Diez-Roux
only Not 1983). Schon a!. 1984; et Rubinstein
of knowledge contingent because each our is
measures provides only partial information our
or (as critical hypothetical realism emphasizes),
because particular professional lore provides a
as because, but solutions, of range limited
con- is pointed out, the world (1960) Whitehead
infinite concatenation an processes in of structed
our systems within systems. At any given time of
of portion small a only capture will models
reality.
described well is phenomenon a if Even
come from a that measures of with a variety
that of single-level, maintaining the authority
requires very strong, and single-level account
our in clauses if ' indefensible, 'as ultimately
(Humphrey behavior social of explanations
1983). Convergent validation on a Simon 1984;
the result is that guarantee not l doeseve single l
phe- of not fundamentally provisional. Accounts
nomena are useful only when they capture those
levels that are required to answer a particular set
failing to recog- By questions (Holland 1987). of
are we nature, multilevel essential their nize
of e that the phenomena um more likely to ass
rather e, concern are themselves stable over tim
act ifart an is the apparent stability if than to ask
analysis used. of the techniques of
addition to the critical hypothetical realist In
is knowledge our analysis which emphasizes that
knowing with which of fallible because the ways
access only particular per- data our gather we
also tenta- is knowledge our reality, on spectives
tive because every phenomenon has multilevel
are which of combinations aspects, differing
questions. different resolving for important
of levels multiple by introduced The fluidity
as important for problem-defin- is organization
for research in is ing sociomedical research as it
Adequate prob- ).b 8219 2a, 198 general (Hufford
three least at meet must work lem-defining
multiple (I) essential methodological principles:
ons, and (3) mul- ti measures, (2) multiple itera
tiple levels in analysis.
of nature recognizing the complex Anyone
sociomedical phenomena ought to concur with
the intuitive requirements for complexity and
However, it l accounts just outlined.eve multil
elslev remains to specify how to decide which
is inap- It ganization need to be considered.or of
propriate to propose decision rules for making
must se judgement at this time because the that
much more experi- of be developed in the light
explicitly attempts to that searchre ence with
explanatory ade- of meet this intuitive model
cial Studies in Health and M edicine So Handbook of 42
social construction and relativiza- of processes
diffi- physical' 'strictly to equally apply tion
erosis'cl arterios 'cerebral as culties - such
(Sicherman 'neurasthenia' 1974), (Feinstein
'dwarfism' or 1969), (Scott 1977), 'blindness'
(Ablon 1984) - as they do to psychological dif-
and (Penfold 'depression' as ficulties - such
(Kaplan 1983), 'personality disorders' Walker
'schizophrenia.' or 1983),
Both approaches to sociomedical categories
with lyve effecti deal to that acknowledge
people's difficulties they must be able to classify
them according to some system, and thereby to
problematic processes as problems. nd understa
each of e between advocates bat The point of de
those to granted status the on view focuses
sha it because important is which problems,
actice.pr implications for sociomedical research
realist inter- e- the one hand, the normativ On
ds to aea sociomedical categories l of pretation
which are reliance of world view the hallmarks
oblem assess-pr 'objective' technology for on
knowl- rt expe of sis on the rolemphae an ment,
the of acceptance limited a and edge,
their experi- of reports 's people of authenticity
gmatist-pra the hand, er tho the On ence.
iewv world a s upports ach pproa nominalist
pert ex y situated, lla ci at sees technology as soth
and tentative, and partial as knowledge
perience as authentic ex s of theirport people's re
is It n. ctio tru for problem cons nt and importa
es that form the turea these, and other similar, f
research sociomedical of contexts cultural
categories.
AL EDIC i OMoc S OF ESR uLTU C HE T
R ESEARCH
ses tusta ontological and l ca epistemologi The
ded to sociomedical categories are impor- oracc
e the cultural con- fin because they help to de nt ta
which that sociomedical research practice in text
situated, and circumscribe what phenomena is
n- co While there is a y. are researchable and wh
practitioners, the re- ll siderable range among a
sociomedical categories results from of view st lia
or vi s a view of health care and behart o uppand s
from that underlying ntre ffe y di ll is radica that
that the ewvi uris o It agmatist perspective.pr eth
ent ofpm st views in the develo liea ivileging rpr
d arow unt sociomedical research has had some
plicit ex tant to makepor im is It consequences.
the consequences for sociomedical research of
ews of research. Wevi st li rea the dominance of
y ll especia is suggests why it on i ss think this discu
be research l ca sociomedi that nt ta or imp
s.i ysl ana of oached from multiple levelsppr a
Here it may be useful to consider in a bit more
these untoward of depth one interesting example
health and of privileging a realist view of effects
illness. An illustrative example is found in the
'hyperac- of search for the biological validation
This disorders. deficit' 'attention and tivity,'
research of untoward result occurs in the context
of can be characterized by the application that
multiple iteration - that and multiple measures
half-a-dozen About by convergent validation. is
biological measures have been of different types
discussed As .' 'disease the validate to used
below, the results have been equivocal - provid-
a of ing only tenuous support for the validation
normal and troubled en general difference betwe
not including specific support for but children,
. Nonetheless, ADDH and ADD subtypes like
search results are robust in indicatingre these
these nonspecific differences, and thus the clini-
cal community continues to treat hyperactivity
ll s as a disease entity was wetu as though its sta
major five been have ereTh established.
hyper- of e biological validationth aches to pproa
e outlined below.ar eseTh entity. an activity as
Re- hyperactivity. manage drugs nt Stimula
children if that reasoned have searchers
hyperactive as sedno diag been ve ha who
this y, therap pharmacological to respond
at thereth evidence prima facie response is
underlying pathology physiological a is
. In 9) 719 hyperactivity (Brown and Sleator
hyperactive children with of fact, treatment
the therapy of choice for many is nt a stimula
hyperac- that take it turn clinicians, who in
tivity is an objective, nonnormative disease.
at there isth ct e fath This is the case despite
to se pones little clinical specificity in this r
success port g therapy. Several studies re dru
the eattr to g therapydru using stimulant
problems pediatric of spectrum entire
spondre 1983), and 'normal' children er (Rutt
ses ofpon sre are similar to the that in ways
hyperactive children when they are adminis-
gs.dru nt tered stimula
c- fa sk perinatal difficulties are ri nd Prenatal a 2
gators ti Several inves_. tyi iv eractypr h fo tors_
have tried to validate hyperactivity biologi-
cally by linking it to difficulties encountered
Some s. during the pre- and perinatal period
ated that suchtr of these studies have demons
oral dif- vi difficulties are related to early beha
ulties. However, it appears from the litera-fic
in diminish rapidly these that e tur
other factors in on to ti importance in rela
of the environment, and that the influence
ve ti hyperac on s nteve perinatal and e-pr
e-pr yll ear by the diagnostica pp or disa vi beha
them- In 3 years. of ribed 'age of onset'sc
not do events natalri pe and pre- lves,se
44 Handbook of Social Studies in Health and Medicine
Set-Theoretic Metaphor
At the center of the dynamic system of meanings in which sociomedical research has been grounded is the belief that the difficulties dealt with by medical practitioners are a set of health behavioral activities, experiences, or physio- logical events. This 'set-theoretic metaphor' (Straight 1979)- which treats behavior as a set of discrete, stable 'things' to be discovered - allows researchers to assume that their job is to discover the elements of this set. Because this is a discovery process, not a process of eva- luation and construction, this cultural assump- tion serves as a heuristic that allows researchers to carry out their work without reference to aspects of the problematic situation not included within their expert's technical knowledge. Moreover, this set-theoretic metaphor allows practitioners to assume a reductionist locus for causality and, by placing a premium on the internal elegance and parsimony of their theore- tical systems, it pushes researchers to systemati- cally oversimplify various asymmetries in the processes with which they deal, as for example when quantitative data are smoothed to exclude 'o utliers,' or qualitative researchers take a nar- row solipsistic reflective stance. It is useful to reca ll that 'lay' and 'profes- sional' understandings often differ. For example, in considering how various publics understood the ri sks assoc iated with needle exchange pro- grams, Lurie and his colleagues found that what people considered as relevant to calculat- ing 'risk' varied depending on their po sition within the political, le gal, or health professions, · or the general population (Lurie et a!. 1993). Such a finding is not unu sual, as Mary Dou glas and others have shown (Douglas and Wildavsky 19 82; In g ham 1994). All heuristics have biases (Piattelli-Palmarini 1994; Simon 1983; Wimsatt 1980). Among those introduced by the rea li st dominance of socio- medical research is the belief that the social stru cture of some settings (in this case; medical se ttings) allows us to take for gra nt ed the mean- ings of pr oblematic (or other) activity. Co ntr ary to this view , however, a number of researchers have shown that the meaning of human conduct is a lw ays 'established as a result of the conjoint adjustive responses of interacting and communi- cating individuals' (Maines 1977: 239).
Dominance of Expert Knowledge
In much of sociomedical research our expe rt knowledge is given a special statu s. In part, this follows from a view that expe rt knowled ge
is stable and cumulative. In this view, 'profes- sional practice is a process of problem so lving. Problems of choice or decision are solved through the selection, from ava il able means, of the one be st suited to established ends' (Schon 1983: 39-40). This view fosters a kind of 'scientism' th at leads to an emphasis on dealing with proble- matic situations by means of technique alone. In the realist view, sociomedical categories are said to be objective and 'scientific.' This general perspective also underlies the realist view of the social arrangements of practice. Because the professional technology is taken to be neutral (or seeking ways to achieve neutr ality), its use allows the introduction of the belief that prob - lem definitions are objective, and that the tech- nology for dealing with those objective problems is itself culturally neutral and value free (Martin 19 87; Sibley 1995). Following t hi s conception of practice allows the practitioner to ignore the fact that the prob- lem definition is negotiated, and that this nego- ti at ion process a ffe cts the ends to be achieved and the ways that these ends will be reached. The search for the single-le ve l validation of research ca tegories results in the use of just such an 'objective' technical fix. The privileged position given to sociomed ical categories, of the research methods developed to describe and acco unt for these phenomena, and their deriva ti ve technology results in reinforcing the guild interests of sociomedical researchers (Balshem 19 93; Gifford 19 86; Lane 1994). By giving special, privileged status to information derived by sociomedical research methods, problematic si tuations are removed from public discussion and made into topics for expert tr eat- ment. The claim that these discussions are neu- tral and value-free elevates their status, and insulates the sociomedical research professionals from the consequences of their work. Yet there is considerable debate abo ut the sta- tus and adequacy of exp ert knowledge. In parti- cular, there is considerable debate about how such knowledge develops. Does expert knowl- edge come from a smooth process, a process that consists of fits and starts, but in a stru ctured fashion or does expert knowledge result from disjunctive and more h ap hazard processes (Diesing 199 1)? ·
Discounted Experience
Treating the goal of sociomedical research as seeking to describe and account for health beha- vioral activities, a nd experiences and categories that are objectively discoverable entities, not o nl y supports a privileged view of expert know!-
Health and Medicine in Studies Social of Handbook 46
methodological work in of The recent history
sociomedical research reaffirms the contingent
of understanding our of and dynamic nature
behavior, health, and illness. During the middle
contingencies these century, twentieth the of
research. in sociomedical temporarily receded
of metaphors structuring the result, a As
and 'control' (as in disease control and 'proof'
efforts (Lane our dominate to eradication) came
that clear is it Now 1995). Rubinstein and
despite great technical advances and technical
knowledge claims must be our sophistication,
made with care; they must be made relative to
made with a more hand and at the question
especially so because we is modest tone. This
people's behavior and under- that now recognize
illness are and standing associated with health
and (Lane situated culturally always
the committing avoid To 1996a). Rubinstein
descriptions' cultural detachable of 'fallacy
(Rubinstein 1992) and seeing homogeneity and
essen- is dynamic processes, it of stability instead
researchers continue to that sociomedical. tial
the upon draw and another one learn from
offer. to best their fields have
on order to achieve this, we must focus In
the the- at disciplines of realizing the integration
oretical and methodological levels, not merely
technique. This and method of level the at
of kinds the of re-evaluation a require will
as useful knowledge. count that ought to data
the place necessarily will re-evaluation That
meaning as equal to quantification of treatment
essential is This realignment 1990). (Scrimshaw
in specificity greater to lead will it because
sociomedi- of interpretation our research and in
such inter- on is, after all, It cal phenomena.
our of pretive acts that the quality and utility
work ultimately depends.
MENTS EDG WL CKNO A
Lane, D. Sandra Albrecht, Gary thank We
Bernard for their ll Gretel Pelto, and H. Russe
this chapter and of comments on earlier drafts
Isabel Martinez for research assistance.
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