IS OUR WORK DANGEROUS - SHOULD IT BE

Three case histories show how work in the medical social sciences-to t he extent that such work reveals the origins of health problems in soc ial structures of wealth and power-can become dangerous enough to thre aten one's livelihood and in some instances one's very life. In this p resentation, I encourage critical and engaged scholar-ship by referrin g to examples of dangerous work that should receive more attention: so cial medicine in Latin America and the critique of managerial ideology in the United States. Although social medicine has become a widely, r espected field of research, teaching, and clinical practice in Latin A merica, its accomplishments remain little known in the English-speakin g world. For centuries, indigenous cultures in Latin America have held belief systems linking social conditions to patterns of illness and d eath. Latin American accounts of social medicine's history, emphasize its European origins, especially in the contributions of Rudolf Vircho w. In the United States, with the impact of the Flexner Report (1910) and its supporters, Virchow's vision of social medicine went into decl ine. On the other hand, in Latin America, social medicine flourished a s a focus of education and research. Since social medicine's ''golden age'' during the 1930s, teachers, researchers, and practitioners have produced major achievements despite the dangers of this work, which in several instances have included torture, imprisonment, or death. An i deology favoring managerial decision making in the United States has i nfluenced crucial policy decisions, and the justifications for these d ecisions have manifested symbolic politics in addition to the evaluati on of factual evidence. With ambiguous empirical support, managerial i deology has foster-ed the general growth of managed cave, the implemen tation of Medicaid managed care by state governments, the expansion of managed care in rural areas, and the impact of ''evidence-based medic ine'' on policy and clinical decisions. If the occupational risks of c ritical work in the medical social sciences are not taken, we forfeit some of the most important gifts offered by ''the sociological imagina tion.