Industry, doctors and bureaucracy.

The central actors on the health arena are industry, doctors and bureaucracy. Whilst general trends towards industrialization, professionalization and bureaucratization are not limited to the health field, developments there have been extremely rapid and show unique features. The three actors often cooperate in harmony despite different goals. On the other hand, bureaucracy is often unable to reach its goals because of resistance from the other two actors. Conflicts, however, occur and are intensive in many third world countries. In industrial countries, too, trade interest in pharmaceuticals may over-ride public health considerations. Conflicts concerning individual drugs have received much publicity. In general, doctors as an organized profession tend to protest against bureaucracy but not against industry. In recent years it has become more and more apparent that health issues cannot be treated as the internal affairs of the actors. New actors have entered the arena. Patients' and consumers' organizations, small groups of doctors and new bodies such as Health Action International have changed the scene. Acting together with fundamental societal changes, this adds a new dimension to the debate and raises the question of including a social element in doctors' ethics. Medical research will also be more directed towards the health care system and become closer to the traditional problems of social science. Social scientists will therefore have contributions to make - studying how the relations between the actors influence the health care system and public health, for instance.