The body as machine

Inventor spends Christmas with his perfect woman - a £30,000 custom-made fembot (The Daily Mail)

"Inventor Le Trung spent Christmas Day with the most important woman in his life - his robot Aiko. ... Her touch sensitive body knows the difference between being stroked gently or tickled. ... 'Aiko is always helpful and never complains. She is the perfect woman to have around at Christmas.' "

Celebrity health advice

Are celebrities crossing the line on medical advice? (USA Today)

"Many doctors say they're troubled by stars who cross the line from sharing their stories to championing questionable or even dangerous medical advice. ... Actress Suzanne Somers-- already well-known for her diet books and ThighMaster products -- in October released her 18th book, Knockout, which experts describe as a catalogue of unproven or long-debunked alternative cancer 'cures.' ... [Celebrities] 'can spread misinformation much faster than the average person with a wacky theory. ... Correcting that misinformation -- even with a mountain of evidence -- can be a challenge. ... 'It's much easier to scare people than to unscare them.' "

Drugs are expensive and drive up the cost of health care. The problem with drug companies, however, is not simply that individual drugs are expensive. There's a story in the news today about how the Obama victory and a Democratic congress may put downward pressure on drug prices. One industry analyst thinks this won't be a serious problem since drugs have a very high markup: the number of products sold, not their price, drives industry growth. If health coverage expands, drug sales will increase, which is good news for drug companies.

In 1976, the chief executive of Merck told Fortune magazine that he dreamed of marketing drugs the way Wrigley's markets chewing gum: to as large a market as possible. The real problem with drug companies is their attempt to convince as many people as possible that they need drugs. This is disease mongering: expanding markets by convincing healthy people that they're sick. Health has come to mean that feeling fine is an illusion easily shattered by the next news cycle or by the next prescription drug you're encouraged to "ask your doctor about."

When a patient has a disease and a doctor prescribes treatment, the doctor can observe whether or not the patient responds to the treatment. If the treatment doesn't work, it's discontinued. When a healthy patient is at risk for disease and a doctor prescribes treatment, there's no way to be certain the treatment is working. The patient might never have gotten sick. So the treatment continues indefinitely. This wouldn't be a problem if pharmaceuticals were harmless, but all drugs have side effects. The more people you treat with preventive pharmaceuticals, the more people there will be who suffer the adverse effects of treatment.

From Iona Heath: "[D]isease mongering exploits the deepest atavistic fears of suffering and death. ... Human societies are riven by the effects of greed and fear. The rise of preventive health technologies has opened up a new arena of human greed, which responds to an enduring fear. The greed is for ever-greater longevity; the fear is that of dying. The irony and the tragedy is that the greed inflates the fear and poisons the present in the name of a better, or at least a longer, future. Ultimately, the only way of combating disease mongering is to value the manner of our living above the timing of our dying."

Medicalization and disease mongering

I don't have a lot of personal complaints about medicalization. As a woman, I don't worry about erectile dysfunction or male pattern baldness. I haven't had to decide to use Ritalin for a hyperactive child or growth hormones for a son who is shorter than his classmates. In my heart of hearts, I consider myself a social deviant (and am proud of it), but I don't exhibit behavior that brings me to the attention of physicians, psychiatrists, or the law.

Many things that used to be considered a normal part of life - childbirth, menopause, insomnia, sadness, excess weight, aging, death - have been redefined as medical conditions and subjected to diagnosis and treatment. This process is called medicalization: Redefining a non-medical condition as a medical one. Medicalization is a major contributor to the health culture. It broadens the definition of health and encourages us to think of ourselves as in need of medical attention.

The active process of converting a benign condition into a medical disease is called disease mongering. Lynn Payer wrote a whole book on the subject: "[D]isease mongering - trying to convince essentially well people that they are sick, or slightly sick people that they are very ill - is big business. For people to use a diagnostic product or service, they must be convinced that they MAY BE sick. And to market drugs to the widest possible audience, pharmaceutical companies must convince people - or their physicians - that they ARE sick."

There was a follow-up letter to "The Last Well Person" (see previous post) from a doctor in Spain. He pointed out that the "extinction of well people" was anticipated in the 1920s by the French comedy, Knock, by Jules Romains. Dr. Knock purchased the unprofitable practice of a country physician and proceeded to diagnose everyone in the village with an illness. He prescribed cures commensurate with the patient's income. (This is really quite considerate compared to the reality of bankruptcy caused by medical costs in the US.)

Just as Dr. Meador used the quotation "A well person is a patient who has not been completely worked up," Dr. Knock was known to say "The healthy are ill people who are unaware they are ill." Meador's response to the letter mentions further explanations for the "The Last Well Person" phenomenon: insurance coverage that requires a specific diagnosis even when there is none, disability insurance, worker's compensation, Medicare, and television advertisements.