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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 25 of 45. This is the beginning of the thread.
Posted by Brutus1 on February 24, 2007, at 15:25:05
Medicalize Me: Experts Look at Perceptions of Illness
ANN ARBOR, MI -- February 23, 2007 -- Do prescription drug ads make people think they're sick when they're not, or create "disease" out of thin air? Does the "empowered patient" movement mean that doctors have lost some of their professional clout when it comes to making diagnoses and prescribing treatment?
These questions and more are the focus of a set of probing essays in a special section of the journal The Lancet, all addressing the topic of "medicalization" and what it means in modern society.
The essays, which grew out of an international workshop, zero in on the fact that even the word "medicalization" has a different meaning today than 30 years ago.
"When the term first came into use in the 1970s, it was used critically to mean the 'evil' actions of doctors who turned deviation from the norm into disease, and imposed medical authority on aspects of everyday life such as birth, aging or dying," says Jonathan Metzl, MD, PhD, a University of Michigan Medical School psychiatrist and U-M women's studies researcher who co-organized the workshop and wrote or co-wrote two of the six Lancet articles. "But today, it's used more in connection with the actions of pharmaceutical companies, and we need to understand its effects better."
The six essays focus on the intersections between medicine and society, including the role of the physician and the patient, and of the values, wants and needs that each doctor or patient brings to each interaction.
Metzl co-authored the introduction with Rebecca M. Herzig, PhD, a professor in Women and Gender Studies at Bates College in Maine who worked with him to organize the workshop. They report that a Google search for the term "medicalization" (and its British spelling, "medicalisation") yields more than 358,000 hits most of which have to do with the drug industry's role in changing societal perceptions of disease, "normalcy" and wellness.
But the authors also warn against painting this phenomenon with an entirely negative brush. "The same drugs that treat deviances from social norms also help many people live their lives," they write. While the old definition of "medicalization" painted patients as the victims, the new model gives them the opportunity to be advocates and choosy consumers if they and their doctors discuss openly their beliefs about what they think the drug from the television advertisement will do for them.
Metzl examines the impact of direct-to-consumer drug advertising even further, in an essay on what Europeans can learn from Americans' ten-year experience with the ads if Britain and European countries decided to allow them too.
"Is it the case that our notions of illness are created by the pharmaceutical industry's advertising, or is it also the case that drug companies are reflecting societal expectations?," Metzl asks. "Culture plays a large role in this process, and the drug companies aren't just inventing this from scratch. They're playing to a market that's used to asking for things from their doctors, and it's raising very interesting questions of interpersonal dynamics."
Metzl and other writers of essays in the special section look to history to shed light on the current situation. Metzl is the author of a 2003 book "Prozac on the Couch: Prescribing Gender in the Era of Wonder Drugs," which examined how depression and anxiety medications were represented in advertising aimed at physicians, and in the entertainment media, in the latter half of the 20th century.
Today's ads amplify people's cultural expectations, or even change them, he says in the new essay for instance, erectile dysfunction drug ads that are featured prominently at sporting events as well as on TV play to men's perceptions of what it is to be a normal, healthy man. The same goes for antidepressant ads showing women who are able to fulfill their roles and duties as mothers.
What people do in response to these ads is another aspect to the medicalization issue, Metzl says. Studies have shown that patients who go to their doctors and ask for a medicine they saw in an advertisement are likely to get it which, of course, is part of the reason the blitz of ads has escalated every year since the FDA relaxed the rules for them in 1997.
But this has led to a kind of tension in the interaction between doctors and patients that is new, Metzl notes, as physicians try to decide whether to say yes or no to each request. The fact that physicians themselves are exposed to the same ads, and are part of the same society as their patients, further complicates the issue.
The answer for U.S. doctors, and for the British and European doctors who may soon find themselves in the same position as their American counterparts, may be to bring the social issues directly into their conversations with patients, Metzl explains. "If a problem is being medicalized, we need to look at what else we can do as physicians besides blaming drug companies, and talk to patients about what else they need to be aware of and what may be driving their response to an ad," he says. "Doctors and patients shouldn't mindless follow the suggestions of drug ads, but they should talk about the options and the expectations that they have, and how realistic those expectations may be and then decide whether the medicine is right."
In addition to Metzl and Hertzig, the essay section features writings by Nancy Tomes, of the history department at the State University of New York at Stony Brook, writing on patient empowerment and the dilemmas of today's medicalization; Nikolas Rose of the London School of Economics, who looks at the history and future of medicalization; Troy Duster of New York University, who examines the medicalization of race including medicines that are being aimed at members of certain ethnic groups; and Cindy Patton of Simon Fraser University in Vancouver, who looks at the specific issue of medicalization in the treatment of HIV/AIDS.
SOURCE: University of Michigan Health System
Posted by Phillipa on February 24, 2007, at 20:14:57
In reply to Medicalize Me: Experts Look at Perceptions, posted by Brutus1 on February 24, 2007, at 15:25:05
Funny was talking to my pharmacist today. She said the antidepressants dont work that people expect too much of life. What do you all think of this? Love Phillipa
Posted by laima on February 25, 2007, at 0:58:35
In reply to Re: Medicalize Me: Experts Look at Perceptions » Brutus1, posted by Phillipa on February 24, 2007, at 20:14:57
> Funny was talking to my pharmacist today. She said the antidepressants dont work that people expect too much of life. What do you all think of this? Love Phillipa
That spoof, havidol.com- a faux med's website- sort of addresses this. THAT's something we can't expect!
If you haven't seen it- it's actually quite smart and funny, great comic relief!Antidepressents can indeed work- loads of people have been helped by them, but they can konk out, they can't make one feel fantastic despite a terrible job, horrible living arangements, lack of friends, etc. But, as was explained to me, they can lift one's mood to a point from where one can get off the couch or out of bed, engage in life, and address some of these matters. "Tools" was a term I heard used.
And yes, the happiest people have bad spells- but they can rebound, can usually function, don't typically feel the gloom will last forever. To expect successful treatment will mean no more poor moods ever, is unrealistic and would be unnatural.
I'm fascinated by the "normal", unflapably un-depressed people I know. When bad things happen to them- the sorts of things that would devastate me, make me feel doomd- some of them make jokes about- or get mad, do something, and get over it. They don't beat themselves up mercilessly, or retreat to bed or the couch for days on end, avoiding all social contact. Or they cry- later move on. I retreat- they tend to engage the issue. Me- similar events- months of rumination, despair, feel it's all my fault, I'm a loser, I caused the problem. This is disfunctional, and I'm working on it, have a therapist along with meds, and am making good progress. Fingers crossed!
Tricky question, though.
Posted by med_empowered on February 25, 2007, at 1:37:24
In reply to Re: Medicalize Me: Experts Look at Perceptions » Phillipa, posted by laima on February 25, 2007, at 0:58:35
I don't think the article was fair to the first people to develop the concept of "medicalization." They weren't *demonizing* anyone; the term is descriptive. Society becomes more rational and the form and type of bonds change, so while behavior must still be regulated, it may need to be regulated differently. Example: "madness" was often first interpreted through a religious lens, then through a moral frameowork (hence the overlap of "mad" with "bad") and then a medical one. The behavior(s) are still regulated, but b/c of the different social structure, its regulated differently.
So the argument that psychiatry was largely (perhaps entirely) the "medicalization of deviance" did not mean the theorists were demonizing psychiatry; rather, they were *deconstructing* psychiatry as a form of social control in the modern, western world. The difference is big and very important.
Posted by med_empowered on February 25, 2007, at 1:39:51
In reply to Medicalize Me: Experts Look at Perceptions, posted by Brutus1 on February 24, 2007, at 15:25:05
I think this medicalization of misery reflects financial interests of big pharma and weakened social ties more than anything else. Pills help some people sometimes with some disorders, but so do placebos...so do other people. Our reliance on pills is fostered in part by a mammoth beast of a pharma industry,allied w/ an elite guild (doctors), as well as our increasing social disconnection (anomie) and lack of worthwhile social services (in the US, at least).
Just my thoughts.
Posted by laima on February 25, 2007, at 2:04:34
In reply to Re: Medicalize Me: Experts Look at Perceptions, posted by med_empowered on February 25, 2007, at 1:37:24
Yes- important points. I didn't read very carefully- too tired, time for some sleep.
> I don't think the article was fair to the first people to develop the concept of "medicalization." They weren't *demonizing* anyone; the term is descriptive. Society becomes more rational and the form and type of bonds change, so while behavior must still be regulated, it may need to be regulated differently. Example: "madness" was often first interpreted through a religious lens, then through a moral frameowork (hence the overlap of "mad" with "bad") and then a medical one. The behavior(s) are still regulated, but b/c of the different social structure, its regulated differently.
>
> So the argument that psychiatry was largely (perhaps entirely) the "medicalization of deviance" did not mean the theorists were demonizing psychiatry; rather, they were *deconstructing* psychiatry as a form of social control in the modern, western world. The difference is big and very important.
Posted by Declan on February 25, 2007, at 2:39:55
In reply to Re: Medicalize Me: Experts Look at Perceptions » Phillipa, posted by laima on February 25, 2007, at 0:58:35
Why do some have it and some not?
That's something people here might be interested in.
How do you increase resilience?
Posted by laima on February 25, 2007, at 9:36:17
In reply to Resilience » laima, posted by Declan on February 25, 2007, at 2:39:55
Well that's the zillion dollar question I'd love to know the sure answer to!
Meanwhile, when I encounter someone who seems to have it (resiliance), I can't help but pay attention, fascinated, wonder if I could learn anything. One thing I did notice is that resiliant people seem to not blow things as far out of proportion as I do, and that they take a greater sense of humour about setbacks than I do, and that they even seem to blame another person or entity instead of themselves more than I do- yet still seem to believe they have the capability to turn matters around. They have arsenals of hysterical stories of their misadventures; I am more likely to prattle on about all the injustices I've encountered (if I don't watch it!). I typically tend to assume I did something to cause or bring on any adversity I encounter- whether via my careless actions, choices, stupidity, whatever. Bus late in bad weather? They blame the transit system-maybe even call one of their numerous friends to try to get a ride-or walk to the train, or even go to a bar for happy hour to wait out the rush hour; meanwhile, I curse myself for not having the foresight to dress warmer and get a head start, leave earlier. Bus crowded because of its lateness? I was dumb not to wait for the next one, etc. Boss mean, surly, sneaky? They deduce boss is mean, job is for the birds, and look at help wanted ads. They believe their friends who tell them "so and so is hiring and it's an awsome place to work!" I- am a bit skeptical about such claims, usually. I wonder what I could have done to make boss not like me, and try in vain to be more agreeable to boss-which with some bosses, is utterly futile and very frustrating. So they seem to quit horrible jobs instead of taking on a martyr role, trying to "fix" the office or complete Mission Impossible, as I have typically done-and failed. Ie, "You completed the work of three people all by yourself? Well here's some more for you-wait you're not slowing down, are you? You're slowing down, your productivity is sinking!" (They pick their battles? Are better at assessing reasonable effort and paceing themselves?) They also seem to have more active social lives than me-I'm more prone to withdrawing when stressed. I'm sure not having a mood disorder is a huge help that can't be underestimated. But all this is just my speculative musing.
And no clue as to whether this is learned behavior or inherited affect- though I speculate it's a blend of both.
> Why do some have it and some not?
>
> That's something people here might be interested in.
> How do you increase resilience?
Posted by laima on February 25, 2007, at 9:56:00
In reply to Re: Medicalize Me: Experts Look at Perceptions » med_empowered, posted by laima on February 25, 2007, at 2:04:34
Funny, rereading the article more carefully after having had enough sleep, my reading is far more nuanced and I quite appreciative of the concerns the author(s) raise. They are definately not saying that medications are not necessary or that conditions are fabrications; they rather seem quite astutely concerned about the "medicalization" of normal situations, behaviors, which are actually not necessarily pathological-but rather quite possibly part of the spectrum of "normal". So- which ones fall into which category, I suppose, is another question. Some are clear, some are murkier.One subject I've been reading about lately is sleep- I've seen several blurbs (poorly cited-sorry- in places like Ophra magazine!) which asserted that waking up in the middle of the night might actually be a normal, non-pathological sleep pattern for some people. That such a sleep pattern, as well as sleeping "lightly", might have evolved as adaptive behaviors when our ancestors had to be on guard against predators-and that many people today function just fine this way. (Others of course, do not.) Meanwhile, many of us have come to believe that any waking up at night is bad and must be remedied by sleep meds- which lo and behold- mess with sleep cycles, and before one knows it, an entire slew of complications, including tolerance and ultimately increased sleepiness, can ensue. I'd think this is an example of "medicalization". (Please note: example only- I'm not trying to pass any judgement or offend anyone who is doing well on their sleep meds, benefitting from tthem. I think the entire topic of "medicalization" seems very nuanced and easy to misconstrue, and I do not wish to inadvertently offend anyone, yet think the general topic is worthy of intellectual exploration.)
Posted by Quintal on February 25, 2007, at 14:59:42
In reply to Resilience » laima, posted by Declan on February 25, 2007, at 2:39:55
>How do you increase resilience?
Increase cortisol? According to 'The Sun' there's a pill in development that can do this safely. So there you are.
Q
Posted by Declan on February 25, 2007, at 17:17:34
In reply to Re: Resilience » Declan, posted by Quintal on February 25, 2007, at 14:59:42
Opiates are unexcelled in creating the illusion of resilience.
By contrast, in opiate withdrawawl it is impossible to do anything.
(I've forgotten what this thread's about.)
Posted by laima on February 25, 2007, at 20:31:43
In reply to Re: Resilience » Declan, posted by Quintal on February 25, 2007, at 14:59:42
Huh? I thought excess cortisol = stress and weight gain? What's the story, what's the med?
> >How do you increase resilience?
>
> Increase cortisol? According to 'The Sun' there's a pill in development that can do this safely. So there you are.
>
> Q
Posted by Quintal on February 25, 2007, at 21:29:10
In reply to Re: Resilience » Quintal, posted by laima on February 25, 2007, at 20:31:43
That's true. It's also true that cortisol improves resillience and helps us cope with stress, reduces the need for sleep and produces a feeling of euphoria and wellbeing. Hence those side effects in people being treated with steroids for infammitory conditions.I've read of people using small doses of prednisone to treat chronic fatigue syndrome with success.
http://www.remedyfind.com/treatments/6/2137/
Q
Posted by Phillipa on February 25, 2007, at 21:43:54
In reply to Re: Resilience, posted by Quintal on February 25, 2007, at 21:29:10
Difference between cortisol and cortisone as cortisone killed my Mother? And I thought cortisone could make you psychotic or very anxious? Love Phillipa
Posted by laima on February 25, 2007, at 21:59:15
In reply to Re: Resilience, posted by Quintal on February 25, 2007, at 21:29:10
Really? I won't question your information, but I'm still confused- perhaps there's nuance to it? Or it's a matter of levels or type? I say this, for I had a friend who (god, this is really malpractice) was somehow misdiagnosed with an endocrine problem of some sort by some renowned "expert" specialist- and to make a long story short, she was put on cortisol supplementation, and it made her very, very depressed and agitated and angry in temperment, she gained a severe amount of weight, and appeared to age rapidly- all in about six months. She literally looked 20-30 years older after about six months of this "therapy", and some of the changes appear possibly permanent. A thirty year old who easily passes for over 50-55. So- cortisol is complicated, maybe?
> That's true. It's also true that cortisol improves resillience and helps us cope with stress, reduces the need for sleep and produces a feeling of euphoria and wellbeing. Hence those side effects in people being treated with steroids for infammitory conditions.I've read of people using small doses of prednisone to treat chronic fatigue syndrome with success.
>
> http://www.remedyfind.com/treatments/6/2137/
>
> Q
Posted by Quintal on February 25, 2007, at 22:10:05
In reply to Re: Resilience » Quintal, posted by laima on February 25, 2007, at 21:59:15
Yes, the level of cortisol is very important. Usually only people who have an infuffuciency would benefit from it. It can be lethal if taken to excess for prolonged periods - as in Phillipa's mother. You'll have heard of adrenal insufficiency? They have poor stress coping abilities due to insufficient cortisol and they need more to be able to function properly. Some people do become depressed and irritable when taking steriods but euphoria is more common. Perhaps and excess of cortisol causes this?
Q
Posted by Phillipa on February 25, 2007, at 22:31:36
In reply to Re: Resilience, posted by Quintal on February 25, 2007, at 22:10:05
Q my sister gets poison ivy yearly and has to take the medrol pack which is cortisone and she dreads it as she get so anxious and aggitated and angry. And my Mother also got osteoporosis from it and was psychotic my childhood was her throwing temper tantrums blaming me for her psoriasis and foaming at the mouth she was so hostile. So it's a powerful med.Love Phillipa
Posted by laima on February 25, 2007, at 22:39:11
In reply to Re: Resilience, posted by Quintal on February 25, 2007, at 22:10:05
I think that must be what happened to this friend of mine. A real tragedy of medical mismanagement. She didn't get any of the euphoria part, either. Very tragic story. In reality- turned out she actually had an undiagnosed brain tumour, and the excess cortisol made it worse.
> Yes, the level of cortisol is very important. Usually only people who have an infuffuciency would benefit from it. It can be lethal if taken to excess for prolonged periods - as in Phillipa's mother. You'll have heard of adrenal insufficiency? They have poor stress coping abilities due to insufficient cortisol and they need more to be able to function properly. Some people do become depressed and irritable when taking steriods but euphoria is more common. Perhaps and excess of cortisol causes this?
>
> Q
Posted by Quintal on February 25, 2007, at 22:44:59
In reply to Re: Resilience » Quintal, posted by Phillipa on February 25, 2007, at 22:31:36
Yes, it is a powerful med Phillipa, but your mother had those problems because she was prescribed too much for too long. Just like a person would become psychotic from taking amphetamines in excess for long periods of time. Some people ebcome agitated and irritable on them too, but most feel euphoria.
Q
Posted by Phillipa on February 26, 2007, at 18:10:40
In reply to Re: Resilience » Quintal, posted by laima on February 25, 2007, at 22:39:11
Laima that's horrible. Did she survive? Love Phillipa
Posted by laima on February 26, 2007, at 18:24:14
In reply to Re: Resilience » laima, posted by Phillipa on February 26, 2007, at 18:10:40
> Laima that's horrible. Did she survive? Love Phillipa
I hope so- her personality changed drastically with the tumour, (she became ferociously angry and was seemingly provoked by any and everything)- and she moved far away. It's not a very comfortable situation, and I think of her with great concern, often. But she won't return calls-angry.
Posted by Phillipa on February 26, 2007, at 20:05:39
In reply to Re: Resilience » Phillipa, posted by laima on February 26, 2007, at 18:24:14
But you didn't do anything to her did you? Love Phillipa
Posted by laima on February 28, 2007, at 9:08:59
In reply to Re: Resilience » laima, posted by Phillipa on February 26, 2007, at 20:05:39
> But you didn't do anything to her did you? Love Phillipa
No, it was "equal opportunity anger"- anyone and everyone and everything for the most surprising and seemingly insignificant reasons. It would flash on suddenly, and was definately biologically induced. Extremely tragic situation, and she didn't ever seem to recognize it. Ethically, the situation was very difficult: don't ever want to avoid a friend in trouble, but it became extremely difficult to be constantly yelled at and to be accused of all kinds of offenses, like saying "hi".
Posted by Squiggles on March 2, 2007, at 8:53:53
In reply to Re: Resilience » Declan, posted by laima on February 25, 2007, at 9:36:17
I think they're sociopaths without
a police record. (hard-wired) :-)Squiggles
Posted by laima on March 2, 2007, at 16:34:21
In reply to Re: Resilience, posted by Squiggles on March 2, 2007, at 8:53:53
But you don't understand! She was a very kind and thoughtful person, until the tumour grew in her brain-that's not her fault. It changed her personality dramatically, and she couldn't even see that. It happened very, very suddenly. So confusing. I guess you're kidding, I see the smile.> I think they're sociopaths without
> a police record. (hard-wired) :-)
>
> Squiggles
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