Review Article: Prestige and its significance for medical specialties and diseases

Abstract: Aims: The aim of this paper is to review the literature concerning the existence of prestige hierarchies for medical specialities and diseases. Moreover, the implications of prestige for priority setting in healthcare systems are discussed. Methods: The study is based on a review of the literature. Papers were obtained through the National Library of Medicine, PubMed. The search was conducted on 14 July 2005, and included articles from 1950 until that date. The medical subject headings ``disease'', ``illness'', and ``medical specialities'' were combined with the search word ``prestige''. A total of 183 papers were found. Only studies focusing on prestige hierarchies for medical specialities and diseases were included. The final search identified 20 articles, six of which specifically established hierarchies for medical specialities and diseases. Results: The review documented prestige hierarchies for medical specialities and diseases. Explanatory characteristics behind the distribution of prestige were identified. It was demonstrated that active, specialized, biomedical, and high-technological types of medicine practised on organs in the upper part of the bodies of young or middle-aged people were accorded high levels of prestige. Medicine with the opposite characteristics had low levels of prestige. Conclusions: Medical specialities and diseases differ with regard to prestige. Characteristics related to specialties and diseases determine their prestige. The authors suggest that differences in prestige bear consequences for actual priority setting in healthcare systems, and contend that this should be further investigated.