Tag Archives: medicalization

US healthcare: Atul Gawande has some good news

gawande-mcallen-texas-update

Back in June of 2009, when Congress was just beginning to formulate and debate the Affordable Care Act, Atul Gawande wrote an article on the rising (and exorbitant) cost of US health care. He focused on how waste contributes to cost — not just the usual fraud, high prices, and administrative fees, but unnecessary care: Drugs that are not helpful, operations that do not make patients any better, scans and tests that not only have no benefit, but often lead to harm. Waste accounts for a third of health-care spending. More disturbingly, it can cost people their lives.

Gawande used the town of McAllen, Texas to illustrate his case. McAllen had one of the highest costs in the nation for Medicare — twice as high as El Paso, another Texas border town with similar demographics. And it’s not as if patients in McAllen were receiving better care. Compared to El Paso, patient care was similar or worse.

It turned out that many specialists in McAllen had financial stakes in home-health-care agencies, surgery and imaging centers, and the local for-profit hospital. One local doctor told Gawande: “Medicine has become a pig trough here. … We took a wrong turn when doctors stopped being doctors and became businessmen.” Read more

Share

Reading Notes #1: Health care inequities. Overdiagnosis. The Doctor/Patient Relationship

benefits-harms-annual-mammography-screening

What follows are items I found interesting in magazines I’ve recently read. Normally I would have tweeted these links, but since I was on vacation from Twitter (see My Twitter vacation), I decided to create a type of blog post called Reading Notes (see Blogging and my Twitter vacation).

The bulleted titles below link to the specific item. There’s more detail on the articles I mention under References. OA indicates open access. $ indicates a pay wall. Note that emphasis in quotations has been added by me. Read more

Share

When health was something we could simply “forget about”

get-well-soon

I came across the following sentence in The Positive Thinkers, a book originally published in 1965. It strikes me as a good example of how the meaning of health has changed. (emphasis added)

Health is ordinarily regarded — when it is “regarded” at all, for ordinarily the point of being healthy is to be able to forget about it — as a means to other things; healthy men are those able to pursue their ends.

Health is hardly something we’re able to forget about today. We live in a culture where it’s commercially profitable to constantly remind us of widespread, proliferating risks. The conscious, highly intentional pursuit of health is a mark of social status for which we expect to be admired and envied. We “regard” it all the time. Read more

Share

Why women should not ride bicycles: The medical opinion in 1896

women-bicycles-19th-century

In the 1890s, bicycles became safer and more comfortable to ride (detailed in this Wikipedia entry on the history of the bicycle). This may have something to do with the increased number of women who were attracted to bicycle riding. (There’s a correlation, but the causation is undoubtedly much more complex.)

Some celebrated this development. Susan B. Anthony, for example:

Let me tell you what I think of bicycling. I think it has done more to emancipate women than anything else in the world. It gives women a feeling of freedom and self-reliance. I stand and rejoice every time I see a woman ride by on a wheel … the picture of free, untrammeled womanhood.

Read more

Share

Journal of the History of Medicine and Allied Sciences – July 2014

adelle-davis-books

In the July issue of Journal of the History of Medicine and Allied Sciences:

  • A comparison of 19th century public health measures and the contemporary approach to the AIDS pandemic
  • The conflict between the medical profession and religion in their attempts to portray habitual drunkenness
  • The understanding of dementia paralytica in the Netherlands at a time when psychiatry was attempting to establish itself as a medical profession
  • Adelle Davis’ role in creating the ideology of nutritionism.

There’s also a commentary on the Adelle Davis article, an ‘In Memoriam’ for Sherwin B. Nuland, and reviews of ten books (of which I’ve featured here only two).

Thanks to h-madness (a great blog) for bringing my attention to this new issue. Somatosphere (a most excellent blog — highly recommended) often covers this journal, but I haven’t yet seen the July issue there, so I’ll go ahead and post these abstracts. Note that all articles (other than their abstracts/extracts) are behind a paywall. (emphasis added in what follows) Read more

Share

On healthism, the social determinants of health, conformity, & embracing the abnormal: (4) The abnormal part

Abnormal psychologyContinued from parts one, two, and three.

A year ago, when I decided to call my declining rate of blogging a ‘sabbatical,’ I wrote down some questions to explore while I took time off to read.

How did we find our way into the dissatisfactions of the present – the commercialization of medicine, the corporatization of health care, the commodification of health? Does understanding the path we followed offer any insight into finding a better direction? Was the increasingly impersonal nature of the doctor-patient relationship inevitable once medicine became a science? Or was it only inevitable once health care emphasized profits over patients and the common good?

At the time I thought I would read primarily in the history of medicine, and that was how I started. Appreciating the historical context of medicine is important for understanding both how medicine ended up where it is today and what medicine could become. “The texture and context of the medical past provide perspective, allowing us to formulate questions about what we can realistically and ideally expect from medicine in our own time,” I wrote.

Now that I’ve become more familiar with the social determinants of health, I’m less optimistic about the future. The problem is not simply that the corporatization of health care has increased dissatisfaction among both doctors and patients. The problem is that our focus is so narrowly limited to health care systems that we fail to see the larger issue. As one metaphor puts it, doctors are so busy pulling diseased patients out of the river, there’s no time to look upstream and ask who’s throwing the bodies into the water. Read more

Share

On healthism, the social determinants of health, conformity, & embracing the abnormal: (3) Connections

Continued from parts one and two, where I defined the terms used in the following diagram of my blogging interests. Click on the graphic for a larger image.

Blog topics and their connections

If I had written the previous two posts a year ago, I would have realized how much my interests were intertwined. I guess I wasn’t ready to do that. Anyway, in this post I catalog some of the connections.

Healthism

~ Healthism and psychological and physical conformity: Healthy lifestyle campaigns promote an ideal way of life that encourages individuals to alter their behavior and appearance. Although it’s true that we would all be better off if we didn’t smoke, that doesn’t make anti-smoking laws any less authoritarian, i.e., requiring conformity (see the section on anti-authority healthism in this post). The fitness aspect of healthy lifestyles promotes the desirability for both men and women of acquiring (i.e., conforming to) specific body images.

“Self-help is the psychiatric equivalent of healthism.” That’s a slogan I made up. I’m not sure yet if it will stand up to scrutiny. Certainly the self-help industry encourages self-criticism, which leads to a preoccupation with those aspects of personality currently considered undesirable. Read more

Share

On healthism, the social determinants of health, conformity, & embracing the abnormal: (2) Economics & the socio-political

Continued from part one, where I discussed the first three of my six interests: healthism, medicalization, and psychological and physical conformity. Click on the graphic below to see a larger image.

Blog topics and their connections

The social determinants of health

Social determinants of health (often abbreviated SDOH) refers to unequally distributed social and economic conditions that correlate with unequal and inequitable distributions of health and disease. Presumably there is a causal relationship between the two, not merely a correlation. Definitively identifying the causal mechanisms, however, is difficult. A great many things influence our health (including things we’re not even aware of yet), and it can be difficult to isolate and scientifically study some of the ones we strongly suspect, like poverty, isolation, or a sense of being socially inferior.

The medical model is the preferred framework in modern westernized societies for explaining the distribution of health and disease. It emphasizes risk behavior (smoking, diet), clinical risk factors (blood pressure, blood sugar, cholesterol levels), genetics, health care access and quality, behavioral change, and patient education. One common characteristic of the medical model’s explanation of health and disease is that causes are located in the individual (behavior, genes), not in the individual’s economic and social environment. Read more

Share

On healthism, the social determinants of health, conformity, & embracing the abnormal: (1) Bodies, minds & medicine

It’s always hard to be sure about these things, but I think the reason I decided to take a ‘sabbatical’ from blogging last July was that I was interested in too many seemingly unrelated topics. Writing about all of them left me feeling like I never got to the ‘meat’ of any one of them. And I couldn’t convince myself to focus on just one or two things, since that would mean abandoning the others, which I was unwilling to do.

Now that I’ve taken the past year to read and reflect, I find – duh! – that my interests are not as unrelated as I’d assumed. In hindsight, I should have realized this long ago, but, alas, I did not. I’m writing this post to clarify to myself what I now see as the common threads that connect my interests.

Here is a diagram that groups my interests into six categories. (Click on the graphic to see a larger image.)

Blog topics and their connections

Four of the six categories relate to all five of the others. The two outliers (neoliberalism and medicalization) are not as directly related as I feel the others are. Read more

Share

What is healthism? (part two)

Apple and stethoscopeIn part one of this post I explained the most common meaning of healthism (an excessive preoccupation with healthy lifestyles and feeling personally responsible for our health) and described an authoritarian sense of the term. Here I discuss healthism as an appeal to moral sentiments and as a source of anxiety. I also note an unusual definition of the term as the desire to be healthy, which leads me to end with a personal disclaimer.

Moral healthism

The directive to be personally responsible for our health – whether it comes from a government health policy, the medical profession, or an advertisement – is often fraught with unacknowledged moral overtones. People who practice healthy lifestyles (daily exercise, a Mediterranean diet) and dutifully follow prevention guidelines (annual cancer screenings, pharmaceuticals to maintain surrogate endpoints for risk reduction) are overtly or implicitly encouraged to feel morally superior to those who do not. This includes the right to feel superior to those who ‘choose’ to be unhealthy – after all, isn’t smoking a morally indefensible choice? The implication is that those who fail to take responsibility for their health are undeserving of our sympathy or assistance (especially financial).

This quality of healthism – like the anti-authority healthism discussed in part one – is possibly more common in the US than elsewhere. It’s unfortunate but true that in the US there’s a tendency to blame the poor and disadvantaged for not being able to pull themselves up by their bootstraps. There is a decided unwillingness to acknowledge that differences in wealth and social class during childhood have lifelong effects on behavior and health. Read more

Share

Recommended (online) reading

Woman reading computerI’m still on “sabbatical.” Mostly reading. Thinking about what I most want to write about. I know what my interests are — the problem is, I have too many. Meanwhile, here are some blogs I enjoy reading.

Thought Broadcast by Dr. Steve Balt

Psychiatry is a controversial topic these days. We (speaking for myself, anyway) love to criticize the overprescription of psychopharmaceuticals, the medicalization of the slightest deviation from “normal,” and those psychiatrists who are eager to take “gifts” from the drug companies whose products they subsequently prescribe and promote.

I suspect people relate to psychiatry more readily than to the science of medicine. We’ve all known moments of slippage along the spectrum of mental health. We’d all like to understand ourselves better, something psychiatry used to promise before it tried to reduce us to the chemical interactions inside our brains.

Dr. Balt writes about all of this. What I especially like about his blog is his compassion for patients and his honest assessment of the psychiatric profession. His writing has a quality like Gawande’s: He maintains a strong personal presence without straying too far into the overtly personal.

To get a sense of Thought Broadcast, read Dr. Balt’s My Philosophy page. A recent post I’d recommend: How to Retire at Age 27. It’s on psychiatric qualification for disability. His point is that labeling (and medicating) someone as disabled does nothing to solve underlying social problems. It concludes:

Psychiatry should not be a tool for social justice. … Using psychiatric labels to help patients obtain taxpayers’ money, unless absolutely necessary and legitimate, is wasteful and dishonest. More importantly, it harms the very souls we have pledged an oath to protect.

Read more

Share

Patient safety and corporate profits

Patient safety firstThe Supreme Court recently decided, in the case of Bruesewitz v. Wyeth, that Wyeth Pharmaceuticals could not be held liable for injury to the Bruesewitz’ daughter (following a vaccination) because Wyeth was protected by the National Childhood Vaccine Injury Act.

I was reading an article on this controversial issue in the NEJM when I was brought up short by the following sentence: (emphasis added)

Litigation such as the Bruesewitzes’ can help the FDA in its oversight function by revealing important and previously unknown information about product-related risks, especially during the postapproval period, and by deterring manufacturers from acting irresponsibly and engaging in business tactics aimed at increasing product sales at the expense of patient safety.

Now, I know corporations sometimes put profits before consumer safety (I once owned a Ford Pinto). And I know that, starting in the late 20th century, medicine became driven by corporate profits rather than traditional medical professionalism. (This is not to say that medical professionalism has disappeared. Merely that there has been a shift in values.) But it still troubles me to read a casual reference to profits being more important than patient safety. It’s an acknowledgment that such practices are an everyday occurrence, imperfectly dealt with by regulations and legislation, and are not a matter of what’s ethically right or wrong.

For-profit medicine drives increased use and costs

I believe medicine – which deals with life, death, pain, suffering, and disability – is not just another business like selling consumer goods. (See From MD to MBA: The business of primary care.) Other industries –automobiles, airlines — may need to consider life-threatening safety issues. But the primary focus of those industries is to sell a particular product or service, not to keep people alive and well. Read more

Share

There’s more to life than the pursuit of health

Doctor with stethoscopeA few quotations on attitudes towards the pursuit health:

And do you not hold it disgraceful to require medical aid, unless it be for a wound, or an attack of illness incidental to the time of year, — to require it, I mean, owing to our laziness, and the life we lead, and to get ourselves so stuffed with humours and wind, like quagmires, so to compel the clever sons of Asclepius to call disease by such names as flatulence and catarrh.

– Plato, The Republic, 380 BC

Yes, we suffer pain, we become ill, we die. But we also hope, laugh, celebrate; we know the joy of caring for one another; often we are healed and we recover by many means. We do not have to pursue the flattening out of human experience. I invite all to shift their gaze, their thoughts, from worrying about health care to cultivating the art of living.

– Ivan Illich, Health as One’s Own Responsibility – No, Thank You!, (PDF) 1990

After I had berated the patient for his obvious failure to comply with my recommendations to correct his “misbehavior,” he said, “You know, doctor, there is more to life than good health.” These words have helped me rein in my sometimes overzealous attempts to force patients into that glorious state of wellness and maintain a more realistic approach to the best possible state of health.

– Lewis E. Foxhall, M.D., The Tyranny of Health, 1994

Thinking that we can make death, illness, or privation easier to bear by preparing for them day and night is a sure way to poison our lives, to spoil the slightest pleasure by imagining its end.

– Pascal Bruckner, Perpetual Euphoria: On the Duty to Be Happy, 2000

In the past, health was usually understood as the normal state of affairs, and taken for granted as [a] feature of life largely beyond the control of the person or the society. The proliferation of reflexive techniques which promise actually to improve one’s health has transformed the very meaning of the term ‘health’. The advent of such an immense range of popular ‘health-enhancement’ or ‘self-improvement’ techniques has meant that health is now seen more as a positive goal to be achieved rather than the normal state of a person without illness.

– Christopher Ziguras, Self-care: Embodiment, Personal Autonomy and the Shaping of Health Consciousness, 2004 (emphasis in the original)

There have always been individuals willing to point out that the constant pursuit of health is not the be-all-and-end-all of life. This eminently reasonable attitude, however, is increasingly rare among both doctors and patients. We have been educated to believe – primarily by what Ziguras calls “commodified and mediated health advice,” but also by the medical and public health professions – that feeling good and assuming we’re healthy could all too easily be a delusion. How can we be certain some fatal disease doesn’t lurk in the unreliable interior of the body?

We choose to pursue health or to pursue disease

Read more

Share

Are the most heavily marketed drugs the least beneficial?

Prescription drugs symbolIn a perfect world, doctors would not prescribe – and patients would not take – drugs that do more harm than good. But it’s complicated. The benefits and harms of drugs are determined in randomized, controlled clinical trials. For many reasons, the outcomes of such trials may not provide doctors with the information they need to decide who should take what.

For example, harmful effects (like death) may not show up during the limited time span of a trial. Data from trials may be selected – and other data ignored — to produce positive results. This is apt to happen when clinical trials are conducted by the pharmaceutical industry, rather than by economically disinterested parties, such as the NIH or independent academic institutions. Also, the participants in the trial may differ significantly (in age, gender, and health, e.g.) from patients who end up taking the drugs. As a recent article in JAMA put it, “most clinical trials fail to provide the evidence needed to inform medical decision making.”

The Inverse Benefit Law

If you follow pharma news, you will have noticed that many high profile, aggressively marketed drugs turn out to be either ineffective or positively dangerous (think Vioxx, widely prescribed for arthritis, which turned out to cause heart attacks and stroke). Howard Brody, MD, and Donald Light, PhD, have proposed an explanation for this phenomenon. They call it the Inverse Benefit Law: “The ratio of benefits to harms among patients taking new drugs tends to vary inversely with how extensively the drugs are marketed.” Or (for those who feel fuzzy about inversion): The more aggressively a drug is marketed, the more likely the drug will cause harm, be ineffective, or deliver little by way of benefit. Read more

Share

Sex, lies, and pharmaceuticals

Sex lies and pharmaceuticals Ray MoynihanJust a quick word in reply to a review of Ray Moynihan’s Sex, Lies, and Pharmaceuticals: How Drug Companies Plan to Profit from Female Sexual Dysfunction (co-authored by Barbara Mintzes).

First, the reviewer, British sociologist Linsey McGoey, criticizes the book for continuing its attack on the medicalization of life.

A few pages in, it’s hard not to feel déjà vu. Moynihan came out a few years ago with Selling Sickness, a book tackling the problem of medicalization, the tendency for typical life phases or human behaviour such as shyness to be medicalized – treated as disorders and diseases requiring medical treatment.

IMHO, there can never be enough books educating the public about medicalization.

Next she defends the pharmaceutical industry:

They [the authors] want to condemn [the pharmaceutical] industry for preying on human insecurity and profiting from the oldest adage in the book: Sex sells. The problem is, just as Viagra has been embraced by millions, its pink equivalent would be a sure seller – and not because consumers are dupes, or because industry is inherently malevolent, or because doctors are in the pockets of companies. Sure, some are, but such a thesis always oversimplifies the links between human disease and human desire. Most of them [sic] time, people want to be told that a problem is medical in orientation. It helps to exonerate a sense of personal blame.

Eliminating a sense of blame or shame is exactly the tactic pharmaceutical marketing employs. (See How the pharmas make us sick.) Viagra has been embraced by millions because ED has been medicalized! I was just reading about a “renegade” Canadian doctor who’s quoted on the subject: Read more

Share

Misc Links 2/6/11

Alone Together Sheryl TurkleHit Send, Take a Bow (WSJ)
Sherry Turkle’s Alone Together. Precisely because there is so much opportunity for digital communication, we are losing the ability to make simple, genuine connections with actual human beings. “A behavior that has become typical may still express the problems that once caused us to see it as pathological.”

Who’s the Boss, You or Your Gadget? (NYT)
All of this amped-up productivity comes with a growing sense of unease. Too often, people find themselves with little time to concentrate and reflect on their work. Or to be truly present with their friends and family. “Nobody seems to actually pay full attention; everybody is doing a worse job because they are doing more things.”

You are not the boss of you (Wash Post)
Review of Daniel Akst’s “We Have Met the Enemy: Self-Control in an Age of Excess.” The reviewer pans the book, but the example of over-medicalization that he disses strikes me as spot on.

Health information remains high on the list of popular uses for the Internet (Wash Post)
Search for health information is the third most common activity on the Internet for Americans. (1st is email, 2nd is using search engines) “In many ways, the Internet has become the de facto second opinion.” Read more

Share

A doomed and dysfunctional medical culture

Newborn babyJ.D. Kleinke is a medical economist, health information industry pioneer, and author of the forthcoming Catching Babies. In a dramatic, powerful, and beautifully written post on The Health Care Blog, he captures the essence of what’s wrong with modern medicine.

Kleinke tells the story of Hannah, a family member. She is 39 weeks pregnant (a typical pregnancy is 38 weeks) and has been losing weight. Her baby is small, at the 7th percentile for fetal weight.

Hannah could be experiencing something called intrauterine growth restriction. If she is – and if she continues the pregnancy – her baby could suffer developmental delay and retardation. On the other hand, if she allows the hospital to induce labor, she could end up with a c-section and the numerous complications that often follow this procedure. “The blessing and the curse of modern medicine,” Kleinke writes, “from the NICU to the oncology unit, is its ability to stimulate its own demand, and obstetrical practice is the quintessence of this cost-curve-sustaining paradox.”

Medicalization, patient preference, and provider prejudice

Read more

Share

Andrew Wakfield: The integrity and validity of science

Andrew WakefieldAndrew Wakefield has received a great deal of negative publicity over the past few weeks, ever since journalist Brian Deer, writing in the British Medical Journal, presented evidence that Wakefield faked the data in his study linking the MMR vaccine to autism. Deer also made the case that Wakefield’s motive was financial gain: Wakefield was employed by a lawyer who planned a highly lucrative lawsuit against vaccine manufacturers and investors were promised millions.

Wakefield has publically responded to the charges. In a story from Bloomberg he asserts that his study was “not a hoax.” He also says: “I have lost my job, my career and my country.”

Given the stressful nature of Wakefield’s situation – some accuse him of a moral crime, others feel he should be prosecuted – it’s both eerie and fascinating to watch him defend himself. He appeared on “Good Morning America,” where he was interviewed by George Stephanopolous. In that interview, Wakefield claims his accuser committing a fraud by selectively omitting data.

Read more

Share

Misc Links 1/18/11

Antidepressants for hot flashes of menopauseUse of antidepressant to treat hot flashes raises concern (Montreal Gazette)
“You’re looking at something that is actually a drug for a fairly serious psychiatric disorder that is being used for something that is a normal part of menopause.” It’s called medicalization.

The War on Logic (NYT)
Krugman on health care repeal: “The modern G.O.P. has been taken over by an ideology in which the suffering of the unfortunate isn’t a proper concern of government, and alleviating that suffering at taxpayer expense is immoral, never mind how little it costs.”

GAO takes on health claims. Yes! (Food Politics)
Government Accountability Office recommends FDA action. “Imagine: health claims on food packages that actually have some science behind them. What a concept!” (1/18)

Now you see it, now you don’t: why journals need to rethink retractions (Guardian)
“The role of journals in policing academic misconduct is still ill-defined, but clearly, explaining the disappearance of a paper you published is a bare minimum.” Read more

Share

Mental illness in college students: Overdiagnosed

Mental health college students overdiagnosisThe New York Times ran an article in December about the declining mental health of college students. The focus of the article was actually on how difficult it is for understaffed counseling centers to cope, but the problem was framed with some disturbing statistics: “44 percent [of students] in counseling have severe psychological disorders, up from 16 percent in 2000, and 24 percent are on psychiatric medication, up from 17 percent a decade ago.”

The article offered two possible explanations for these statistics: More students are able to attend college because effective psychiatric medicine is available and/or counselors are now better at recognizing a serious illness than they used to be.

Experts say the trend is partly linked to effective psychotropic drugs (Wellbutrin for depression, Adderall for attention disorder, Abilify for bipolar disorder) that have allowed students to attend college who otherwise might not have functioned in a campus setting.

There is also greater awareness of traumas scarcely recognized a generation ago and a willingness to seek help for those problems, including bulimia, self-cutting and childhood sexual abuse.

Read more

Share

Atypical antipsychotics: Overprescribed, not safer, not more effective

Atypical antipsychoticsAbilify, Seroquel, Zyprexa, Risperal – these are among the atypical antipsychotics for which Americans paid $10 billion in 2008. $6 billion of that was for off-label use.

The FDA only approves drugs when their safety and efficacy have been tested for specific conditions. For example, an antipsychotic might be approved for the treatment of schizophrenia. When it’s prescribed for anxiety or depression, that’s an off-label use.

After heavily marketing off-label use, the makers of Zyprexa, Seroquel, and Abilify were fined a total of $2.3 billion for their defiance of FDA regulations. For the pharmaceutical industry these days, that’s just part of the cost of doing business.

This new generation of atypical antipsychotics is much more expensive than earlier drugs, which are now available as generics. According to a new study, they are not only more expensive. They are neither safer nor more effective than their predecessors, as initially assumed. Here’s what WebMD had to say. (emphasis added)

“Atypical agents were once thought to be safer and possibly more effective,” says study researcher G. Caleb Alexander, MD, an assistant professor in the department of medicine at the University of Chicago Hospitals. “And what we’ve learned over time is that they are not safer, and in the settings where there’s the best scientific evidence, they are no more effective.” …

“Since there were all these new drugs, and it costs 700 to 800 million to bring a drug to market, drug companies needed to make that money back,” says Jeffrey Lieberman, MD, chairman of the department of psychiatry at Columbia University, who was not involved in the study. “These drugs were marketed aggressively.”

Read more

Share

DSM-5: A “wholesale imperial medicalization of normality”

The psychiatrist is inThe American Psychiatric Association (APA) is in the process of revising its bible of mental disorders, the Diagnostic and Statistical Manual of Mental Disorders (DSM). Research planning for the new version, called DSM-5, began in 1999. The release date has now been extended until 2013.

The revision process has been contentious. Daniel Carlat, on his psychiatry blog, described the exchange between opposing psychiatrists as a bar room brawl that had “degenerated into a dispute that puts the Hatfield-McCoy feud to shame.”

The latest history of and update on the warring factions comes from an article in Wired magazine by Gary Greenberg, author of Manufacturing Depression: The Secret History of a Modern Disease. He interviews Allen Frances, lead editor of the manual’s previous version (DSM-IV). Frances came out of retirement to voice his objections to the upcoming revisions. Read more

Share

Medicalization then and now

Traveling quackHere’s an editorial from an issue of The Journal of the American Medical Association published 100 years ago (emphasis added):

One of the cruellest and most despicable phases of the “patent medicine” business is the studied effort made by nostrum exploiters to frighten their victims into the belief that they are suffering from some more or less serious disease. Not content with the sale of their preparations to those who have—or who believe they have—one of the many diseases for which the products are recommended, the “patent medicine” vendors strive to create an artificial demand for their stuff by working on the imagination of the healthy and persuading them that they are sick. The scheme is an old one but none the less disreputable. One of the more recent modifications of this trick is the “gall-stone remedy” fake …

Compare this with a discussion of medicalization by Carl Elliott in his new book, White Coat, Black Hat . After describing how the condition formerly known as “urge incontinence” was repositioned as “overactive bladder” (to remove the stigma), he continues (emphasis added): Read more

Share

Should grief be labeled and treated as depression?

GrievingThe American Psychiatric Association (APA) is in the process of revising the Diagnostic and Statistical Manual of Mental Disorders (DSM) – the psychiatrist’s bible. Its last incarnation — known as DSM IV — was published in 1994, with a “text revision” in 2000. The new version will be DSM V.

Psychiatrist Daniel Carlat described some of the initial arguments over revisions as a bar room brawl. Now that the APA has moved the publication date forward from 2011 to 2013, the number of publically traded insults appears to have died down.

One item in dispute is whether bereavement – the grieving process that follows the loss of a loved one – might qualify a patient for the DSM label Major Depressive Episode. Many symptoms of bereavement are similar to those of depression, such as feeling sad, poor appetite, weight loss, and insomnia.

Here’s one of the APA’s needlessly obscure arguments for including bereavement.

The exclusion of symptoms judged better accounted for by Bereavement is removed because evidence does not support separation [or] loss of loved one from other stressors.

In other words: Bereavement symptoms should be included because bereavement is a source of stress. Just as divorce, job loss, illness, and disability cause stress, so does the loss of a loved one. The assumption here is that stress can lead to depression. Read more

Share

Blogging: Time to get over it

The blogging catDr. Lisa Marcucci, a trauma surgeon and Associate Professor of Surgery, recently did an interview with me for her very successful blog Inside Surgery. It was an opportunity for me to think about why I blog, among many other things. I talked much more freely about myself than I ever do on my own blog.

The interview is quite long and will be posted in three parts. Here’s an excerpt from Part 1, where Dr. Marcucci asks about the mission of my blog.

I started blogging because I wanted to understand something that changed medicine and ideas about health in the 1970s. Prior to that time, the policies of the Kennedy and Johnson administrations had assumed the state should be responsible for the health of its citizens. When political and economic thinking became more conservative in the 1970s and 1980s, governments began to promote the idea that individuals were personally responsible for their health and should practice healthy lifestyles.

A large segment of the population – mainly the educated and economically secure – welcomed these ideas. Feeling personally responsible for one’s health and practicing healthy lifestyles gives one the reassuring illusion of control. In particular, it’s a good distraction from the things that are beyond individual control, like salmonella in our peanut butter and the superbug MRSA at the gym.

Read more

Share

Health Culture Daily Dose #18

Source: Wunderground When did we start calling the whole day before Christmas “Christmas Eve?” I thought Christmas Eve was the evening before Christmas. But no. Senators voted on health care reform at 1:00 AM on Thursday December 24th. To me, that’s still Wednesday night, but it was widely reported as happening on Christmas Eve. Perhaps… Read more

Share

Contempt and compassion: The noncompliant patient

Source: Salvation Army “After I had berated the patient for his obvious failure to comply with my recommendations to correct his ‘misbehavior,’ he said, ‘You know, doctor, there is more to life than good health.’ These words have helped me rein in my sometimes overzealous attempts to force patients into that glorious state of wellness… Read more

Share

Still useful after all these years: The gall bladder

The gall bladder is another useful but expendable organ (see recent posts on the appendix and the spleen). Unlike losing your spleen, living without a gall bladder is not detrimental to your health, though it may be inconvenient at times. The gall bladder is located under the liver, on the right side of the body.… Read more

Share