Order 1031714: The Medicalization of Society

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Medicalization of Society

The social construction of medical knowledge

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Medicalization of Society

  • Describes a process whereby previously non-medical problems become defined and treated as medical problems, usually in terms of illness, disorders, and conditions.
  • Some suggest that the growth of medical jurisdiction is one of the most significant transformations of the last half of the 20th century.

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Definition

  • The term refers to the process by which certain events or characteristics of everyday life become medical issues, and thus come within the purview of doctors and other health professionals to engage with, study, and treat.
  • The process of medicalization typically involves changes in social attitudes and terminology, and usually accompanies (or is driven by) the availability of treatments.

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The prevalence of medicalization

Indicators:

percentage of gross national income increased from 4.5% in 1950 to 16% in 2006

# of physicians per population has doubled in that time frame, extending medical capacity

Jurisdiction of medicine has grown to encompass new problems not previously deemed ‘medical’

Examples: ADHD, eating disorders, CFS,PTSD, panic disorder, fetal alcohol syndrome, PMS, SIDS, obesity, alcoholism

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  • Medicalization concerns itself with deviance and ‘normal life events’.
  • Behaviors once defined as immoral, sinful, or criminal have been given medical meaning moving them from badness to sickness.
  • Common life processes have been medicalized: including aging, anxiety and mood, menstruation, birth control, fertility, childbirth, menopause, and death.

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Increasing Medicalization

  • New categories of disease and drug therapies.
  • Expanding/contracting medical categories.
  • Elastic categories: Alzheimer Disease (AD) and the removal of age criteria led to AD encompassing senile dementia sufferers, sharply increasing the number of AD cases (now a top 5 cause of death in the US).
  • Demedicalization whereby a problem is no longer defined as medical problem worthy of medical intervention (e.g. masturbation, homosexuality). Unsuccessful attempts include childbirth. Partial success includes disability.

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Beyond Sociology…

  • Numerous articles on medicalization in Medline search.
  • British Medical Journal (2002) special issue on medicalization.
  • PLoS Medicine (2006) devoted to ‘disease mongering’.
  • President’s council on Bioethics dedicated session (2003).
  • Seattle Times (2005) Suddenly Sick series.

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Medicalization has gained attention beyond the social sciences.

Increased medicalization

  • New epidemic of medical problems? Or,
  • Is medicine better able to understand and identify and treat existing problems? Or,
  • Are life’s problems increasingly defined as medical problems despite dubious evidence of their medical nature?

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We’re not interested ncessarily in whether conditions are really medical or not, rather, we’re going to think of medical knowledge and the conditions which come to be understood as medical - as social creations.

Social Constructionism

  • Consider medicalization as the result of discursive processes which construct ‘reality’ in particular ways.
  • Disease and conditions (scientific ‘facts’) are not stable realities but are the product of social processes.
  • ‘Disease’ and conditions(medicine’s ‘objects’) are created through language and practices (going to the doctor, receiving a prescription, activity in laboratories, and so on).
  • These processes give rise to a ‘way of seeing’: a pathological ‘gaze’ (Foucault).
  • Our perception - our reality - is shaped by discourse and practice.

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Rather than ask the question of whether is something real or not, we’re interested more in the processes which create medical categories. We’re interested in the social underpinnings of medicalization…

Specifically, we’re interested in how this phenomenon has come about; that is, how have so many conditions and ordinary life circumstances come to be under the jurisdiction of biomedicine. Crucially, we’re concerned with the social implications or consequences of this development.

Ways of Seeing

Medical ideas are constrained and enabled by the language and culture of a society. Epistemological norms delimit the representation of the world. Medical knowledge emerges from these delimiting contexts.

Examples:

Biomedicine/Western World

Ayurvedic/Asia

Curanderismo/Latin America

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Our understandings of our bodies, of illness, of the medical system are the result of human activity: no matter how precise the empirical ideas, these ideas are always open to the influence of social factors in their production, transmission and development.

Different societies have different cultural values and rules and norms for producing knowledge - epistemology is tethered to social and cultural contexts.

The Scientific Paradigm

  • In the West, the scientific paradigm is privileged.
  • Paradigms are socially created and are reproduced and developed through institutional processes.
  • This is a shared paradigm that orients the medical community and is dispersed through society.

  • Paradigm promoted through schooling and specialized, professional organizations.
  • Rules for ‘talking’ about illness and suffering which limits what can be thought and communicated.
  • Rules of evidence and conceptual schemes limit epistemologically.

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Paradigms are frames for seeing - much like a lens. Different socieities and different cultures within that society - will be characterized by differing paradigms. Paradigms are formal knowledge frameworks.

This paradigm means that we put much power in very particular groups of people: In scientists and doctors, for example, who are privy to this specialized and technical language and know-how. At the same time, other forms of knowing and healing are downgraded and re viewed as inferior.

We might say that biomedicine is hegemonic in that we generally accept biomedical facts without questions - they are always-already valid…

Social Constructionism

  • Radical constructionists: don’t suppose the existence of an external reality.

“The fact that the body became legible does not imply that some invariate biological reality was finally revealed to medical enquiry. The body was only legible in that there existed in the new clinical techniques a language by which it could be read” - Armstrong (1983).

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Reality does not exist objectively - but is made. This is a more Foucauldian perspective… the idea that the body and medicalization is solely an effect of discourse.

Constructionism Cont…

  • Realism: presume the existence of an external reality, but argue that there are various, competing accounts of that reality.

“[They] seek to demonstrate the social and cultural character of all medical knowledge, but, there is, of course, a biological reality, but the moment that efforts are made to explain, order, and manipulate that reality, then a process of contextualization takes place in which the dynamic relationship of biology with cultural values and the social order has to be considered” (Lock,1988)

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Constructionism Cont…

  • Different emphases within this perspective - from radical to realist constructionist approaches.

However, they agree that ALL knowledge is socially contingent.

  • All constructionists are interested in how knowledge (here, medical categories) is created.
  • Also interested in the effects of this knowledge production

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Saying that knowledge is socially contingent is not the same as saying that all knowledge is worthless…

Knowledge is contingent, however, and crucial to keep that in mind. If we consider the shifting and changing disease categories this past century and a half, we see, for example, how ecomomic, political and religious forces impact knowledge production. Afrcian Americans had specific diseases levied at them during slavery. Masturbation in the end of the 19th century.

Poitical forces can also influence scientific discoveries of new diagnostic categories because of funding… (AIDS, women’s health)More research done on men and the knowledge is extended to women who might experience that disease very differently. For example, heart disease…- thus shaped by social, culural, and political factors.

Some painful conditions are not readily medicaized, too… Black lung, is an example, also tardive dyskinesia (disorder of the central nervous system)- caused by pharamceuticals - thus an iatrogenic side effect of antipsychotic drugs. Largely not accepted by medical establishment because it hurt the economic and political interests of many clinicans who had prescribed the actual drugs.

In examining medicalization the focus is:

  • To examine how medical ideas and concepts are produced and diffused through culture and society (e.g. research, medical practice, marketing, media processes, etc).
  • To examine how (bio)medical intervention is represented as a viable answer to our life problems.
  • To examine the multifarious effects of these collective discourses/meanings.

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Producers of knowledge

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Others? Lay people, advocacy groups, drug companies, etc. Not as simple as the annexation of new problems by doctors and medical professions.

Knowledge Production

  • Beyond the medical establishment, and includes lay people social movement, corporations, etc.
  • Alcoholism became defined as a medical problem through a social movement (AA).
  • Physicians were late to define it as disease.
  • Public shift: less tolerant of mild symptoms, spurring a “progressive medicalization of physical distress in which uncomfortable body states and isolated symptoms are reclassified as disease” (Boros, 1995: 1931)/

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More than medical imperialism and moral entreprenuriship.

However, it is critical to keep in mind that different people in society are afforded more power and authority to produce knowledge. We often think about power and knowledge being connected, but it’s not how much knowledge you have that gives you power, it’s really the ability to create knowledge and to define reality in a way that is accepted by others.

Power and knowledge

  • The power and authority to medicalize and to produce medical knowledge is of consequence.
  • This capacity is socially distributed.
  • The medicalization of childbirth: battle between medial establishment and midwifery (doctors’ interests over patients’ interests).
  • Increased scientism has increased the pharmaceutical industry’s ability to produce medical knowledge.

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Case Study

Drug companies medicalize through DTC advertising and through the physician-drug rep relationship.

  • Ads create medical-markets through the production of disease categories.
  • Drug companies do not just sell and create drugs, they are also creating and marketing diseases.
  • Paxil is a SSRI medication competed with many other drugs (I.e. prozac) for depression.
  • GlaxoSmithKline responded to the saturated market by specializing in the anxiety market.

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Prfofit and corporate interests motivate much medicalization. We consume ads and we often are encouraged to self diagnose.

Paxil

Paxil and SAD

  • Social Anxiety Disorder (SAD), previously obscure diagnosis, was targeted.
  • Ads framed common characteristics such as worry and shyness.
  • Deep resonance with the audience.
  • Self-diagnosis through ‘awareness campaigns’.
  • Increased diagnosis of SAD and GAD.
  • The marketing of Paxil extremely successful: became 3rd most widely recognized prescription drug in the US.

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Female Sexual Dysfunction

  • Success of viagra with the diagnoses ‘erectile dysfunction’.
  • Researchers working closely with drug companies to create a female equivalent, which can be similarly medicated.
  • In order to build markets, there is a need for a medically diagnosable condition.
  • ‘Thought leaders’ collectively creating criteria; funding research; sponsored conferences and meetings, etc.(Pfizer)
  • Female Sexual Function Forum.

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Difficulties into Disorders

  • Article in JAMA in 1999 - the authors linked to Pfizer.
  • Article contained a statistic that 43% between 18-59 of women contend with dysfunction. Widely cited both in scientific and lay literature.
  • Highly problematic statistic.
  • Crucially, sexual dissatisfaction is reduced to female pathology. Relationships and social settings are ignored in favor of medical intervention.
  • Who benefits?

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Ideological Interests

  • Ideology: an organized system of ideas and beliefs. Ideology circulates as the natural order of things - or as common sense. However, ideologies serve the interests of specific social groups at the expense of others.
  • Medicalization serves specific interests - e.g: medical establishment, corporate pharmaceutical interests, patriarchy.

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Legitimates the power and authority of social groups in society.

Power and knowledge intimately interconnected: always serves interests….

Ideology and Media

Ideology is dispersed through culture and society via mass communication (I.e media).

  • How are biomedical ideas promoted/not promoted through cultural/media representations?
  • How does the advertising of drugs affect society and the individuals within that society?

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FDA began allowing drug makers to advertise directly to consumers on TV in 1997.

Spending on drug advertisements reached an all time high of 4.8 billion dollars In 2006 compared to 2.6 billion in 2002.

Media Effects

  • We are socialized to have trust in biomedicine.
  • Biomedicine appears to provide answers for our suffering.
  • Legitimates ideological interests.
  • Affects how we experience ourselves.
  • Affects our behavior.

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Drugs Ads and Behavior

http://www.youtube.com/watch?v=XgOcFu3Kp5I

  • Prescription drug advertisements prompt nearly one third of US adults to ask their physicians about an advertised medication.
  • 82% of those who ask about drugs are given a prescription.
  • Among adults who requested a specific drug 44% said physicians prescribed the one they asked for, slightly more than half were prescribed a different one, and, in some cases, they received both.
  • Percentage of adults receiving prescriptions after asking about an as has increased since 2005.

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Consequences….

  • Benefits Legitimates peoples’ experience of pain when diagnoses are given. Also offer hope that suffering can be alleviated. Affords rights to certain groups,
  • Cons: transforms everyday life into pathologies in need of transformation, narrowing what is acceptable. Also focuses the source of the problem in the individual rather than in the social environment.

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Cons Continued…

  • Medicalization leads to reification - whereby individuals are reduced to diseases (assigned to them by a powerful entity), thus ignoring the socio-environmental conditions. This leads to individual treatments - tranquilizers, etc. Responsibility is placed on shoulders of individuals and the inequities of society are ideologically overlooked.
  • Usually, specific medical interventions accompany ‘diagnoses’. The side effects of these therapies are far ranging. (e.g. viox, Paxil, xanax, psychotic medications).

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Paxil Case-Study Cont…

http://www.youtube.com/watch?v=hfQUTHrWnRk

  • The creation and extension of the diagnosis SAD and GAD was very successful.
  • However, Paxil has many side-effects, some of them are fatal.
  • Misleading ads were ordered halted by a federal judge in 2002.
  • Habit forming, severe withdrawal symptoms, increased risk of suicide amongst adolescents.
  • However, the medicalization of anxiety is still the result.

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Phenomenological Effects

  • How we define reality affects our experience of that reality.
  • Medicalizing life’s problems and events can further symptoms.
  • Labeling: people incorporate their diagnosis into their identity so that it becomes a master status.
  • Social meanings can affect physiological response and experience; e.g. menopause viewed negatively in the West. In Islamic and some African countries menopause is ‘freeing’ and those women don’t experience the same symptoms of women in the West.

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When those women emigrate, they experience the symptoms of their new cultural milieu, Social meanings thus influence individuals’ physiological and psychological experience.

Little empricial evidence of pathology in respec to the menopause- rather a concerted effort of medical elite in the 30’s nd 40’s to formulate a specific etiology and the development of specific pharmaceutical methods of treatment. In the 1970s the menopause - described as a deficiency disease - was being heavily medicated with estrogen and HRT - hormonal replacement therapy - despite the numerous side effects and the reality that 85% of women experuenced few or no problems. Estrogen was the fifth most prescribed drug….

Medicalization and Social Control….

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