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Lecture 9

Lecture 9 Nov 8th.docx

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Gail Coulas

Sociology 3HH3: Sociology of Health Nov. 8th Lecture 9: Medicalization con’t Medicalization - Biomed has increased, has been given authority - Social belief in the power of science and med has led soc to allow/demand more authority to med jurisdiction - Med doesn’t just happen, is constructed in the whole social framework - Why has soc given med such power: o Decline of social authority of law o Decline of social authority of religion  To provide explanations for us o Aesculapian authority Aesculpian Authority - Power we give to med related to our psych dependency o Med has the answer, is the only one who has the answer  Incredible belief that med and only med has the solution o Want more and more of med, even though we know we need to shift towards health, we can’t let go o Suggests that we as a pop are psych dep on med to help us  i.e. issue about death and dying? Used to turn to religion, now turn to med - Exemplified by the placebo effect o Exemplifies the social construction of health o Placebo – pharmacologically inert substance – does nothing o Homeopathy  Like healing like, rather than opp healing opp  Often something diluted a lot by water – but yet people are cured  Placebos? o Often administered by a double-blind drug trial o Effect much wider than an inert substance  Is the belief of those receiving and those administering that effects the placebo substance – the fact that it works – creates efficacy  Belief has both a psych and physio effect o Benson and Ebstein  Placebos have effect on any organ system or condition in the body  Psych effects include the relief of anxiety, schizo etc. o Depending on expectations, placebos can cause physical side effects  Give placebo, says it will make you sleepy  Get sleepy o About 25% of people taking placebos report adverse effects or psych dep on placebos  Bad side effects o Placebo effect is culture bound and psych  Have to believe in it  Dep on what your soc has told you works  Bound by the cult – diff cults use diff placebos o BAD science – ben goldacre  Chapter on placebo effect  Saying if people have such a belief that placebos work, then why not let them use alternative meds? o Who does it hurt?  Suggests it is one of the most bizarre and enlightening areas of science and med research  Reveals connections btw our bodies and our mind o Role of healing  Used to be placebos vs. med trials but then placebos became unfashionable in med o Became kind of unethical – if someon has a legit disease and you have a possible cure, it isn’t ethical to give them a sugar pill  Placebos are safer basically o Give them a sugar pill instead of a real pill with toxic effects  Exs. Of people preforming full surgeries, amputations etc. without drugs with people being fine  In contemp world of clinical practice – q is not whether a drug works better than nothing, but on whether it works better than existing best treatment  Daniel moerman o Metaanalysis on placebo trial data of gastric ulcer medication  Compared placebo data of 2 sugar pills vs. 4 sugar pills  No real treatment for either  People with 4 sugar pills healed way better than those with 2 sugar pills o Studies similar to this have been replicated o About the cult meaning of the treatment  Blue pill = calming, sedative  Pink pill = upper  Colour has cultural meaning  Placebos: Colour, administering – pill vs. capsule vs. injection  All have cult meaning and all heal diff  Saltwater is more effective in healing than a pill  Capsule more effective than a pill  Effect on and from the healer as well  Both what a physican says and what they believe effect the healing process  Sugar pills to people getting a dental injection o One did a huge oversell – this pill is amazinggg o Other downplayed the pill – dunno how good it is etc. o The pill with the pos message = way less pain, way less anxiety, saying felt almost no pain with the injection  Even if a physican says absolutely nothing about a medication o What he knows or feels about it leaks out in his mannerisms  His physical mannerisms tell you how he feels  3 pills – one to increase pain, one to block pain, one doing nothing before wisdom teeth surgery o Physician had to sell it to the patient o Divided into 2 groups  1 group – docs were told the 3 options nd  2 group – docs were told it would do nothing or increase the pain  Reality was that some patients did get pain relief, but just thru manipulation thru what the physician believed, there was a diff in outcome btw the 3 groups st  1 group experienced sig less pain than all groups  So doctors belief had an effect  Indicates the value we have in the therapeutic rela o The doctor says – you will be ok, gives you a placebo, you are ok cause he said so  Nothing unusual about the people who respond to the placebo – they are like everyone else o We all respond to placebos o Placebo responders are just a normal array of people - “The Best Medicine” Walter a Browne, md o Eg of the social construction of illness and how our social belief supports the idea of med o Did a good chunk of his research trying to figure out – what is the placebo, how does it work and why  Research suggests that the mere act of seeking and receiving med care (being in the treatment situation) has a placebo effect  Placebo then illustrates our psych dependency on biomed – belief that it works  Says the hist of med is largely the hist of placebos  When subjected to scrutiny, the overwhelming majority of treatments (both old and new) derive their benefit from the placebo effect  Less than 20% of the treatments physiicians use everyday are actually effective when you look at the research  A lot of pharmaceuticals are only effective for a certain time, then your body gets used to it and needs something different  They do work though – related to a treatment effect o Response to a treatment situation o So what is a placebo?  Those components of med care that have no intrinsic value for the condition being treated but nonetheless make people feel better and have pos results  What are some of the placebos?  Getting a med examination  Receiving a diagnosis  Being given a plausible treatment and expecting to feel better  The healer’s enthusiasm and commitment to you  The placebo effect is simply the improvement that occurs as a result of the component of care o Research suggests that it has been estimated that across a wide range of afflictions, about 30% receive relief from placebos alone  E.g.  How people’s perception relates to the perception of the quality of the med they are receiving o Gave chronic pain sufferers a placebo o Group 1 told pill cost 2.97 each  Reported reduction of pain 85% of the time o Group 2 told pill cost .05  Reported reduction of pain way less - Why do placebos work? o Placebo treatment is diff than no treatment  Does have something therapeutic to offer  Has 4 features  A person in distress o Kid cut his knee  An expert o Mom  An explanation of the condition o You got hurt cause you fell  A healing ritual o I will gie you a cookie and a bandaid and you will be fine  Its our belief in the treatment and in the healer
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