The article titled “The Sociology of Prescribing: A Narrative Review and Agenda” by Anthony K. J. Smith (2025) offers a comprehensive sociological perspective on the practice of drug prescribing, challenging its traditionally technical framing by medical science. The author emphasizes that prescribing should not be viewed merely as a rational and standardized act, but rather as a social, relational, and institutional practice shaped by power, expertise, organizational routines, and socio-technical conditions.
The article argues that, unlike the well-established sociology of diagnosis, a structured sociology of prescribing remains underdeveloped. Smith revisits earlier sociological insights, particularly from the 1970s, that examined the symbolic and institutional aspects of prescriptions. He highlights the prescription as a “boundary object,” meaning it has multiple roles—as a legal document, a symbol of care, and a practical instruction—depending on the actor and context.
Drawing on historical, anthropological, and sociological literature, Smith outlines how prescribing is embedded in choreographies of care, institutional authority, and interprofessional dynamics. He critiques the “rational prescribing” paradigm promoted by institutions such as the WHO, arguing that this model underestimates the practical constraints and social realities that shape actual prescribing behavior, including time pressure, pharmaceutical marketing, and cultural norms in clinical settings.
The review is structured around four analytical domains—care, power, expertise, and work—which serve as a proposed framework for future sociological research. For example, in discussing prescribing as power, the paper explores how clinicians exert authority over patients, but also how this is mediated by health policy, insurance systems, and digital platforms. Similarly, in examining prescribing as expertise, it highlights professional boundary work, inter-professional conflicts (e.g., between doctors and nurse practitioners), and the epistemic challenges of prescribing across expanding pharmaceutical landscapes.
The article concludes by calling for a renewed sociology of prescribing that interrogates both the visible and invisible work involved in prescribing, considers new forms of digital health and AI, and explores how prescribing is morally and politically contested. In doing so, Smith contributes a forward-thinking and interdisciplinary agenda for critically understanding this central medical practice.
Reference (APA Style):
Smith, A. K. J. (2025). The sociology of prescribing: A narrative review and agenda. Social Science & Medicine, 368, 117830. https://doi.org/10.1016/j.socscimed.2025.117830
