Who rules? The new politics of medical regulation.

The recent politicization of medical regulation in the United Kingdom has destabilized the historic relationship between medicine, society and the state. The purpose of this article is to present a political analysis of that relationship and its likely future by identifying the essential elements of power which determine its composition and its capacity to change. That analysis is in three parts. First, it identifies the underlying political tensions in the relationship between medicine, society and the state and the implications of those tensions for any proposed settlement on the future of medical regulation. What are the political criteria by which such a settlement must be judged if the tensions are to be resolved? Secondly, it explores the ideological conflict concerning the nature of medical regulation between the major players, the expression of that conflict in their use of quite different discourses, and the incompatibility of the power assumptions contained therein. Thirdly, it examines the medical profession's particular response to the pressures for change. Finally, the article reflects on the necessary dialogue which must take place between medicine, society and the state before a lasting resolution of the present tensions can be achieved.