|Year : 2019 | Volume
| Issue : 3 | Page : 75-78
Medicalization – A growing problem
Department of Neurology, Aga Khan University Hospital, Karachi, Pakistan
|Date of Web Publication||28-Jan-2020|
Dr. Sajid Hameed
Aga Khan University Hospital, Karachi
Source of Support: None, Conflict of Interest: None
Medicalization is the latest growing trend of our modern society. The Western scholars have debated for decades about its merits and demerits. Medical profession has always been blamed for the medicalization, but there are also other factors that contribute to this process. The commercialism, mass media misinformation, and our own impatience are some of the factors that contribute to our excess dependence on the medical profession to solve our problems. Being an underdeveloped country, our resources are limited, and diverting them to less serious conditions will create a big vacuum to fill. It is high time to deeply discuss its origin and propose a solution. Medicalization needs periodic checking; otherwise, excessive medicines will paralyze our society.
Keywords: Medicalization, overdiagnosis, public health
|How to cite this article:|
Hameed S. Medicalization – A growing problem. J Sci Soc 2019;46:75-8
| Introduction|| |
“Speaking for myself, I too believe that humanity will win in the long run; I am only afraid that at the same time the world will have turned into one huge hospital where everyone is everybody else's humane nurse.” – J. W. Goethe.
Medicalization is a modern term adored by our contemporary sociologists to highlight one of the modern life menaces. It is defined as the process by which nonmedical problems are now defined in medical terms, usually as a disease or disorder, and which usually requires medical intervention or treatment. Medicalization apparently pathologizes the diversity of human nature. Medicalization is not an acute process, rather it is a progressive sociocultural change comparable to globalization and secularization.
| The “Bad” Medicalization|| |
Medicalization was earlier confined only to the psychiatric disorders, but now, it has sown seeds in all the realms of medicine. Sadness is a normal healthy reaction to the loss of a loved one, but it may be interpreted as a mild depression. The natural postpregnancy breast drooping is now diagnosed as mammary ptosis and menopause as a hormone deficiency state, requiring hormone replacement therapy and predisposing menopausal women to hazards of thromboembolism and gynecological cancers. Even the physiological premenstrual syndrome is included in the Diagnostic and Statistical Manual of Mental Disorders-V as premenstrual dysphoric disorder that merits treatment. Such diagnoses are uncalled-for, since people are most likely to experience heightened psychological distress when labeled with a stigma of being diseased.
Childbirth is another example of medicalization. Over the years, it has undergone an immense transformation from the social realm of the home to the medical realm of the hospital, with >90% of all births occurring in the United States (US) under obstetrician care. Only a few medical conditions actually merit the cesarean sections, but today, they are being performed superfluously, and their rate has risen to astonishing 32.4% in the US in 2014, even though cesarean sections are packed with adverse health outcomes for both mother and fetus. The similar rising trends are seen in the developing countries. In Pakistan, the incidence of C-section has increased sixfold in two decades from 1991–1992 to 2012–2013. The higher C-section rates are seen in women with higher education and socioeconomic status as compared to lower socioeconomic status (35.3% vs. 5.5%).
| The “Good” Medicalization|| |
Many scholars contemplate the half-full side of the medicalization glass. They stress that the process of medicalization has positive effects and brings health benefits to millions of people worldwide. The recognition of a condition, adversely affecting the quality of life, as a disease or disorder leads to its appraisal and fair treatment. The medicalization of human conditions also helps to gain research funding, approvals, and to conduct drug trials. In the absence of precise working definitions, the nonhomogeneity of the studies will render them futile. The discovery of effective treatments is certainly rewarding and at times, revolutionary, if only it serves the patient's interests. The evolution of “epilepsy” from the early perception of divine order to a psychological disorder and later on refined to the current definition of manageable neurological disorder vows the testaments of good medicalization. Thus, medicalization is neither good nor bad, but somewhere in between the vast gray zone, where most of the modern world technologies lie.
| Drivers of Medicalization|| |
From inception, the medical profession has been held responsible for promoting and expanding medicalization, but this paradigm has now been shifted. In the modern world, the doctor's role has been limited to an advisor , with patient autonomy being the center of health-care delivery. The cardinal players of the medicalization have now been transformed with pharmaceutical industry, biotechnology, and mass media taking the front seat. My intentions are not to insinuate the pharmaceutical industry, biotechnology, or mass media as the etiology of medicalization since medicalization is a complex sociocultural phenomenon, but to imply that they also effectively contribute to this process.
Pharmaceutical industry and marketing
In the US, the Food and Drug Administration's allowance for direct-to-customer (DTC) advertisements has been a magnanimous game-changer resulting in sixfold rise in pharmaceutical DTC television advertisements from 1996 to 2000, mounting the expenses to $2.5 billion, which reached a staggering height of almost $60 billion in 2004. Some authors believe that the pharmaceutical industries are spending more on marketing their products than on research and development. The success stories of Viagra and Paxil attest to it.
In 1998, Viagra (sildenafil) was approved only for erectile dysfunction secondary to chronic medical conditions affecting the vessels, such as diabetes and hypertension, but Viagra's lucrative promotional campaign and the renowned tagline “Ask your doctor if Viagra is right for you” sensationalized the medicalization making people falsely believe that Viagra is a solution for all types of erectile dysfunctions. Over 3 million men took Viagra in the 1st year of promotion, and in the 3rd year, the numbers crossed 6 million.
Before Paxil (paroxetine), the social anxiety disorder (SAD) and generalized anxiety disorder (GAD) were uncommon diagnoses, but Paxil's blockbuster campaign, augmented by the funded Internet websites offering tests to self-diagnose SAD and GAD, created a perception that anxiety is detrimental and Paxil is the ultimate treatment. Since almost every human has some degree of anxiety and fear of public speaking, they indeed fell into the delicately set trap. This made Paxil a household name and the manufacturers, GlaxoSmithKline, the billionaires.
The similar profitable promotional campaigns have been launched in expanding the childhood attention deficit hyperactivity disorder (ADHD) to adult ADHD, the showcasing of idiopathic short stature as a disorder with expensive growth hormone analog treatments, and the esthetic cosmetic surgeries to increase self-esteem. Many authors have observed that the pharmaceutical industries indirectly discourage nondrug interventions such as lifestyle and behavioral changes to achieve desired health outcomes. These industries profit from our helpless attitude of solving every problem with medicines. As Mintzes states, “A pill for every ill– and increasingly an ill for every pill.”
The modern biotechnology and the rapid advancements in new medical knowledge are fundamental in explaining the diseases in terms of basic molecular pathology. It sets a generalized notion that the problem lies in our defective molecules that are only treatable by drugs. Unfortunately, this has led people to increasingly rely on the medical profession to help them cope with their problems, thus dethroning the social and psychological domains.
The biotechnology has also uprooted the risk factors and categorized the asymptomatic people into people at risk of contracting the disease. This has led to a multitude of screenings and prophylactic treatments. It is exemplified by the National Heart, Lung, and Blood Institute's new recommendations for treating hyperlipidemia in the US, which led to an almost threefold increase in the number of adults, from 13 million to 36 million, to receive prophylactic statins. However, it is asserted that 97.5% of people treated with statins would receive no clinical benefits, and they are more likely to experience undesirable side effects associated with statins.
A similar change was seen when the American Diabetes Association decreased the diagnostic serum fasting blood glucose level from 140 to 126 mg/dl. This new recommendation dramatically increased the prevalence of diabetes mellitus worldwide. Therefore, it can be summed that the mounted expertise to diagnose and treat diseases has increased the perceived incidence of disease and thus the medicalization.
Mass media and internet
The mass media is another key player and has been pivotal in educating (or miseducating) the public. It gains profit from increased readership and viewing by sensationalizing the health-related reports. The multifarious drug advertisements and claims of efficacy, which is usually more than a placebo but not the recommended drugs, are gravely misleading. The uncommon syndromes, such as chronic fatigue syndrome and restless leg syndrome, are often highly publicized because of the novel interest of the public. With Google substituting the doctor's advice and different online symptom checkers providing the distorted information and flawed diagnoses, patients are usually associating their mild symptoms with dangerous conditions resulting in heightened anxiety. Further, these same websites then promote their products with a claim of being efficacious resulting in the patients' demand for the advertised drugs and the supererogatory interventions.
The health-care insurances and private health-care providers, though potentially advantageous, have also handcuffed our society. They constrain some needed interventions while providing incentives for others and require a medical definition of a disorder to reimburse leading to medicalization. This is especially overwhelming in psychiatric disorders with decreased insurance coverage for psychotherapy, whereas increased coverage for pharmacotherapy leading to their increased drug use. The physicians are well aware of such discrepancies and are prescribing more pharmacotherapy as per insurance plans  revealing the heinous fact that treatments are not patient directed but policy directed, a gross violation of the Hippocratic oath.
We, the people, are also one of the key players in the process of medicalization. We are excessively intolerant and impatient. We need quick fixes for our mild and benign conditions. We crave the antibiotics for self-limiting innocuous ailments. We are obsessively dysphoric with our bodies as claimed by the staggering 15.62 million cosmetic procedures performed in the US alone in 2014, including 286,254 breast augmentations, 217,124 rhinoplasties, and 210,552 liposuctions. The escalation of Viagra sales, cesarean sections, the incidence of anxiety disorders, baldness prescriptions, and antibiotic-related resistances enunciates the exponential growth of medicalization. The medicalization sheds us from the responsibility of our actions. It makes us believe that we are suffering from a medical disorder that is treatable only by drugs and medical interventions, and we have no control over it.
| Conclusion|| |
Medicalization has immense potential for improving the quality of life. We should plan to prioritize the consumption of our medical resources and widely question the overconsumption of medicines and overdiagnoses. We do not have to focus only on getting people into the shade of our health-care umbrella, but we also have to focus our priorities on how to get people away from the health-care services when they are no longer fruitful. We have to educate our society about the medicalization hazards, self-limitation of innocuous ailments, and pearls of healthy living with a strong emphasis on the positive behavioral changes and personal-coping strategies. The society should be proactive in creating social solutions to our social problems rather than endlessly searching for medical explanations.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Goethe JW. In: Auden WH, Mayer E, editors. Italian Journey: 1786-1788. London: Collins; 1968.
Zola IK. Medicine as an institution of social control. Sociol Rev 1972;20:487-504.
Conrad P, Mackie T, Mehrotra A. Estimating the costs of medicalization. Soc Sci Med 2010;70:1943-7.
Szasz TS. The manufacture of madness: A Comparative Study of the Inquisition and the Mental Health Movement. New York: Syracuse University Press; 1997.
Markens S. The problematic of “experience” A political and cultural critique of PMS. Gend Soc 1996;10:42-58.
Hamilton BE, Martin JA, Osterman MJ, Curtin SC, Matthews TJ. Births: Final data for 2014. Natl Vital Stat Rep 2015;64:1-64.
Tita AT, Landon MB, Spong CY, Lai Y, Leveno KJ, Varner MW, et al
. Timing of elective repeat cesarean delivery at term and neonatal outcomes. N Engl J Med 2009;360:111-20.
Mumtaz S, Bahk J, Khang YH. Rising trends and inequalities in cesarean section rates in Pakistan: Evidence from Pakistan demographic and health surveys, 1990-2013. PLoS One 2017;12:e0186563.
Arunima SK. Medicalization: A growing menance. Delhi Psychiatry J 2012;15:255-9.
Parens E. On good and bad forms of medicalization. Bioethics 2013;27:28-35.
Conrad P. The shifting engines of medicalization. J Health Soc Behav 2005;46:3-14.
Foucault M. The crisis of medicine or the antimedicine crisis. Educ Med Salud 1976;10:152-70.
Abraham J. The sociological concomitants of the pharmaceutical industry and medications. Handbook of Medical Sociology. Vol. 6. Nashville: Vanderbilt University Press; 2010. p. 290-308.
Conrad P. The Medicalization of Society: On the Transformation of Human Conditions Into Treatable Disorders. Baltimore: The John Hopkins University Press; 2007.
Brennan R, Eagle L, Rice D. Medicalization and marketing. J Macro Mark 2010;30:8-22.
Rosenthal MB, Berndt ER, Donohue JM, Frank RG, Epstein AM. Promotion of prescription drugs to consumers. N Engl J Med 2002;346:498-505.
Gagnon MA, Lexchin J. The cost of pushing pills: A new estimate of pharmaceutical promotion expenditures in the United States. PLoS Med 2008;5:e1.
Angell M. Excess in the pharmaceutical industry. CMAJ 2004;171:1451-3.
Loe M. Fixing broken masculinity: Viagra asa technology for the production of gender and sexuality. Sex Cult 2001;5:97-125.
Koerner BI. Disorders made to order. Mother Jones 2002;27:58-64.
Kroll-Smith S. Popular media and 'excessive daytime sleepiness': A study of rhetorical authority in medical sociology. Sociol Health Illn 2003;25:625-43.
Mintzes B. For and against: Direct to consumer advertising is medicalising normal human experience: For. BMJ 2002;324:908-9.
Berndt ER. The U.S. pharmaceutical industry: Why major growth in times of cost containment? Health Aff (Millwood) 2001;20:100-14.
Freemantle N, Barbour R, Johnson R, Marchment M, Kennedy A. The use of statins: A case of misleading priorities? BMJ 1997;315:826-8.
Hofmann B. The technological invention of disease. Med Humanit 2001;27:10-9.
Vuckovic N, Nichter M. Changing patterns of pharmaceutical practice in the United States. Soc Sci Med 1997;44:1285-302.
Bero LA, Rennie D. Influences on the quality of published drug studies. Int J Technol Assess Health Care 1996;12:209-37.
Shore MF, Beigel A. The challenges posed by managed behavioral health care. N Engl J Med 1996;334:116-8.
Goode E. Psychotherapy shows a rise over decade but time falls. N Y Times 2002; p. A21.
Sofos JN. Challenges to meat safety in the 21st
century. Meat Sci 2008;78:3-13.
Maturo A. Medicalization: Current concept and future directions in a bionic society. Mens Sana Monogr 2012;10:122-33.
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