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Lecture

Health Care Controversies.docx

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Department
Social Science
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SOSC 1801
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Jon Johnson

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February 6, 2012 H EALTH C ARE C ONTROVERSIES P UBLIC VS .P RIVATE H EALTH C ARE Controversy: What is better, a privatized system of healthcare, or a public system of healthcare? H ISTORY OF M EDICARE INC ANADA  Early Influences  Large disparities especially with regards to health care o Between urban and rural areas – rural areas were underserviced o Between the wealthy and the poor – huge amount of inequity in health care – if you got sick, you paid for it; it was an out-of-pocket expense. The poor would have to go to the hospitals, and the care there was not great, they were not the healing centers that they are today and therefore most people never came out of the hospital  Great Depression o Most could not pay for health care o Charity provisions/hospitals supportive – if you couldn’t pay for your own health care, you’d be sent to a charity and you didn’t really have a say in what treatments you got (i.e., if a doctor wasn’t available, you didn’t get one etc.)  Universal coverage in other countries – countries had started experimenting with public models of health care service. They were dealing with the same issues as Canada as a result of the Great Depression o UK, Sweden, New Zealand  Beginnings  Post WWI: 80% support universal care – people were afraid that the same situation would occur (like during the Great Depression)  The average worker or the poor were the most interested  Saskatchewan farmers (generally poor, and would often get sick because of their jobs) lobby for comprehensive universal care  1947: Saskatchewan implements universal hospital insurance funded through provincial taxes; as a result of the huge amount of demand in Saskatchewan at the time, only Saskatchewan implemented this national hospital insurance scheme  1957: hospital Insurance and Diagnostic Services Act o Approximately 50% of hospital costs paid by feds o Penalties for provinces with user fees  Opposition  There were all kinds of interests – how things get implemented and how they get implemented have to do with the struggles of money, power etc.  Many powerful lobby groups opposed Medicare (fearing taxes, limits to profits and professional autonomy) o Most medical professional associations (CMA, CDA, etc.) – opposed because their professional autonomy would be threatened – the would have to listen to the federal government as to what they could treat/couldn’t treat. They feared that they would lose money o Chambers of Commerce and industry – industry lobby organizations; there’s a split between capitalists and workers – those who are wealthy often looked at universal 1 healthcare as a threat to their wealth. Because they’re paying more, but using less of the social services which catered to those with less money o Private insurance companies – afraid of the potential to lose profit o Pharmaceutical companies – fear of regulation surrounding drugs  U.S American Medical Association (AMA) equates Medicare with communism – anything that looked like communism made the government very scared; socialized healthcare has negative connotation like abusive power in the government T HE H ALL C OMMISSION ,1961-4  Where the government solicits as many inputs/opinions of people all across the country (i.e., doctors, nurses, lay people, professionals) to get an idea about possibilities. They listened to those who were opposed and those who supported  To study options for improving health care o Broad consultation of supporters  Recommendations o Develop national universal health plan o Cover all health-related services o Government should payer – the government will collect tax and use a certain amount of the tax to cover costs o Physicians keep private practice and fee-for-service model – physicians were outraged by this idea and the threat it posed to their job. The physicians held a lot of power in that they could easily refuse to work, therefore the government had to capitulate – the physicians would charge for the service but bill the government  National health plan implemented in 1968 C ANADIAN H EALTH CARE T ODAY  Canada Health Act, 1984  Five criteria for provinces to qualify for federal funding of health care 1. Public administration 2. Comprehensiveness – you would have a broad array of services available to you; medically necessary – any serve that is medically necessary has to be covered by the federal government. The province had to maintain that they would have to have all these services that were medically necessary 3. Universality – everyone has to have the same care, regardless of race, religion, class, wealth – everyone has the same quality of care and same services available at the same price 4. Portability – if you decide to move from one province to the next, who pays for your care? Therefore, it was decided that no matter where you move across Canada, your health care is taken with you. There is never a point where you cannot have heath care as a citizen of Canada. 5. Accessibility – everyone has to be able to access care – so its relatively close by. This was to ameliorate the huge disparities between rural and urban areas  User-fees/extra-billing discouraged  Limited or no ability to buy better care – no one should be able to buy extra health care – it’s either publicly funded, or nothing – trying to eliminate the disparities in care in terms of the wealthy and poor 2  Financing and Delivery  Single-payer system – originally, the federal government paid for everything – this system is key to an efficient health care system – you don’t have to worry about who pays for what. o Originally finding shared equally by provinces and federal government o Private financing of publicly-insured services is not allowed o Allows efficient admin, and cost control  Service delivery is mix of public and private (for-profit and non-profit) – some health care professionals are salaried by the government, and some are private (i.e., family physicians are private and bill the government, and nurses are public who work for the government, some hospitals are managed privately, but bill the government) o Fees are heavily regulated by the government  Non-Insured Services  Only physician, diagnostic equipment and hospital services are covered – provinces can choose to cover more if they choose to o Approximately 70% of all health spending  Non-insured health services o Dental, vision, prosthetics, drugs, home care, non-physician/alternative therapies, ambulance etc. o These things are considered not medically necessary, therefore must be paid out-of-pocket, via private insurance or group benefits  Major Expenses  About 10% of GDP ($172 billion) spent on health care per year in Canada  Major expenses: o Hospitals: 28% o Prescription drugs: 14.6% - one of the expenses that keeps increasing o Physicians: 13.4% o Residential care facilities: 10% o Dental: 7%  First Nations  Federal government is historically responsible for First Nations health – especially those who live on reserves  However, the majority of healthcare is provincially-based  This is problematic because the quality of care is lacking, and the federal government is sometimes not willing to keep up with the advancements of the provincial system  Reserve-based health facilities mostly federally-run o Has lagged in quality and quantity compared to provincial services  Provinces increasing health care delivery to First Nations o Administrative confusion – Jordan had a severe array of disabilities, and ended up being shipped down from his home on his reserve – the bodies of government were too busy figuring out who was responsible to deal the care that he died. T HREATS TO PUBLIC H EALTH C ARE  Increased expenditures on health (especially drugs) – since healthcare has been implemented universally, it is getting more expensive (i.e., how much each province decides to fund services. Also, drugs have really skyrocketed in price - we use to have a system where the government was 3 able to overcome the patents of companies to create the products at a cheaper price. Since that system has been scrapped, pharmaceutical companies are able to charge whatever they want since they have such strong patents. Also, there has been an increase in use – life drugs for depression, learning disabilities etc.)  Declining federal funding (from approx. 50% to 25%)  Tax cuts leading to rising government deficits and declining social spending – we tend to like this idea, however, those taxes go to things like the healthcare system. Therefore when you eliminate taxes, you’re also elimination the money available for health services and programs (i.e., seeing a chiropractor used to be 100% covered, but now it’s only 50% covered)  Aging population needing more care – beginning to develop chronic issues (i.e., cancer, arthritis) that are causing the health care system a huge amount of money PRIVATIZATION –T WO T IER M ODEL (one private and one public) Proponents – those who advocate for Opponents – those who advocate for public privatization healthcare  Health professional associations (excluding nurses) Some doctors and health professionals (including – doctors feel that they have more to gain in a nurses) – some doctors feel that regardless of their private system. A lot of doctors go south because ability to make money, they’re still able to make they can make much more there enough money. Also, they can just provide care and  Private insurance companies –mostly because of know it will be paid the lack of regulation  Social workers  Business associations – the same people who  Public majority – 86% of Canada today supports opposed the origin of public healthcare are still universal healthcare, therefore the minority opposing it represents a lot of the power and influence in  Pharmaceutical companies Canada which is why it’s such a strong debate  Fiscal conservatives – the idea is that under a  Trade unions capitalist system, the free market will regulate  Fiscal liberals – the government has a crucial role itself through supply, demand etc. and the in the capitalist system to protect citizens government is just getting in the way.  Debate over allowing a two-tier system of public and private financing – keep the public system, but also allow people to pay for their own health care if they want to  Proponents argue: o Preventing people from paying for health care infringes on human rights o Allowing wealthy to purchase services decreases demand for public services – in Quebec there was a wealthy individual who wanted to purchase a transplant but was not allowed to – claimed that the government is infringing on his public right, and his means to protect his own health and he won the case o Privatization would keep more doctors in Canada, reducing wait times o Private service delivery already exists – most of the care we receive today is already private, they’re proposing to change the payer to private – you could pay at that hospital if you wanted to – they’re arguing that it’s not that different o Increased competition would increase efficiency and quality while lowering costs – a private system will create efficiencies – reduction in costs etc.. However, we see in the U.S that administrative costs increased by virtue of the reduction of cost 4  Opponents argue o Health care is not a commodity o Wait times would only be improved for those able to pay extra – only improve wait times for those who was wealthy enough to buy their way to the front of the line. Privatization may reduce wait time for some, but it will not reduce for everyone which will create inequality o Growth of private system would be at the expense of the public system  Would increase privatization and inequality in health care o Evidence that privatization could decrease efficiency and increase costs o 86.2% of Canadians support more investment in public heath care  Passive Privatization  You can get privatization slowly over time even if you’re not trying to  Results from government declines in health care funding o Delisting health services not considered ‘medically necessary’ from coverage – when the government decides that it want to spend less on health care, then the government will begin to determine what is no longer considered ‘medically necessary’ (i.e., pushed out of the hospital earlier than necessary) o Increased reliance on private insurance for NIHBs o Earlier patient discharge from hospitals  Health care being shifted to the home  Can lead to more active privatization – when you see underfunding in the health care system, you get long wait times, not as many doctors per patient, less time for patient in the doctors office S UMMARY  Publicly-funded health care was won through concerted public struggle despite powerful corporate and governmental opposition  While Canadians currently enjoy a relatively progressive and successful public health care system, debates still continue on whether Canada should pursue more privatization, more public funding or a balance of the two February 10, 2012 Tutorial  Barriers in health care system today: o Wait times for hospital admissions o Surgeries, specialists, diagnostics o Drug companies influence over physicians o Shortage of doctors, especially in rural areas (i.e., if all doctors are getting the same fee for service, why would they go to the rural areas, because there are more services in the city etc.) o Cost of prescription drugs o Not enough after-care (i.e., you’re “kicked” out soon after surgery) o Shortage of General Practitioners (G.Ps) o Less qualified nurses (however, these nurses are useful to perform more mundane tasks; i.e., bathing, changing IVs etc.)  Privatized o Private might increase efficiency for public 5  Public (solution) o National drug plan o Increase public funding and reallocate o Increased government control of pharmaceutical companies o Tax breaks o Salaried – quality of service – however, if doctors are salaried, they won’t be as motivated to help as many people as possible. Rather, they’re be interested in meeting their quota 6 February 13, 2012 A LTERNATIVE H EALTH AND B IOMEDICAL H EGEMONY CONTROVERSY  Complementary (medicines that can be used with western medicine – it can be argued that nowadays chiropractic and be complementary because its becoming more and more similar to western medicine) and alternative therapies (i.e., chiropractic, acupuncture etc.) are increasingly popular, but how effective and safe are they – is there a high likelihood of getting hurt? o Scientific uncertainty about whether or not these things work or not – there’s a lot of debate about that o Propriety of scientific assessments – can you use science to evaluate the safety or efficacy of the therapies, especially if some of the alternatives may not be based on science  Historical and ongoing struggles among biomedical and alternative professions over legitimacy o Determined more by biomedical hegemony than popularity, demand of efficacy U TILIZATION OF C OMPLEMENTARY /A LTERNATIVE M EDICINES (CAM S)  Uncertainty concerning exact usage – everyone classifies the therapy in a different way  Popularity is increasing  Users tend to be more educated, wealthy, Caucasian, female – the reason for this is because many of the alternative therapies are not covered by OHIP and therefore can be very expensive to those who cannot afford it. In addition, these therapies may be preventative, which means that you have to go to several sessions, which could be get very costly  United States: o 2007: 38% of adults and 12% of children used at least one CAM in past year o Most popular: natural products – herbs/supplements (17.7%), calming deep breathing exercises (12.7%), meditation (9.4 %) and chiropractic (8.6%)  Canada o 1994-2003: 15-20% consulted CAM practitioner in past year o Not counting independent use of herbs, meditation, prayer etc. o Most popular: chiropractic (11%), massage therapy (8%), acupuncture (2%), homeopathy/naturopathy (2%)  Used concurrently with biomedicine  Used for chronic conditions  Popularity of CAMs  Socio-economic factors o Increased chronic diseases – Biomedicine has been proven to be quite effective in areas like gene therapies to treat genetic illnesses. At the same time, biomedicine has been proven to be less successful for other illness like arthritis. Western biomedicine has not been potentially as effective and therefore people look elsewhere. o Globalization – new age movement came out of globalization. With globalization comes an increase in awareness as to how other people do things – general exposure will lead to a general overall acceptance of alternative ways of doing things o Increased skepticism of biomedicine  More patient satisfaction with CAMs o Holistic perspective on health - people are more satisfied with CAMs, because unlike Western biomedicine, the CAM practitioners embrace a more holistic/total system of care, 7 and not just focusing or reducing health problems to just the physical. There’s also a focus on the emotional aspect. o Increased time/attention from provider – less hierarchical, and will provide more attention. Some people like the idea that a CAM practitioner touches you, and it feels good so they feel that they’re getting their moneys worth o Increased patient involvement in care – They feel more willing to be honest with their practitioners to try different treatments; some people don’t feel as comfortable with their doctors o Less invasive – the extreme forms of medical intervention are what medical practitioners are doing as opposed to yoga SCIENTIFIC /B IOMEDICAL H EGEMONY  Hegemony: dominance of one social group over others to the extent that the cultural/symbolic values of the dominant group are naturalized as ‘common sense’ by the rest of society  Scientific hegemony: idea that science is the best and only way to discover objective truth o Knowledge which is not scientific cannot be trusted – “unscientific” is considered an insult  Biomedical hegemony: idea that biomedical doctors and practitioners are the most authoritative, effective and objective health practitioners o Rooted in scientific hegemony – biomedicine practitioners have had science as their focus, and have therefore been able to convince others that they’re the most authoritative and objective by virtue of the fact that they are science-based  Hegemonic status allows biomedicine to maintain highest status among all health professions o Occupy most key positions in health agencies because they’re more scientific, and this is why physicians play the key role o By virtue of their status, they have access to most research funding o As the hegemonic group, they have the authority to label other therapies as unhealthy/unsafe, ineffective, unscientific – and we tend to believe without too much questioning. It could be that they’re right, but it’s also the case that historically, this authority over healthcare has been abused, but not in favor of the citizens. Arguments are couched because they’re trying to protect their own territory (e.g., chiropractic). Sometimes decisions are made on the basis of economic and political self-interest  But actions are not always based purely on science, but on political/economic interests of the profession  Safety of CAMs  Safety is controversial  Biomedical practitioners: will say that CAMS are not always safe, and sometimes dangerous. o They tend to deem natural as more unsafe o Some unregulated, non-standardized supplements are dangerous o Potential contraindications with biomedical therapies  Studies: CAMs are generally safer than biomedical therapies – there’s an assumption that what’s not biomedical is unsafe and unscientific E FFICACY OF CAM S  There is some evidence of efficacy for almost all CAMs o Acupuncture – pain management, nausea, migraines o Chiropractic – more effective in a lot of studies than western medicine in things like manual injuries, especially lower back pain, muscle pain o Homeopathy – pain management 8 o Reiki – relaxation, pain relief o Yoga – low back pain, improved pregnancy outcomes, stress  Biomedicine emphasizes o Need for randomized controlled trials (RCTs) to truly evaluate the efficacy of CAMs o Most scientific evidence of CAM efficacy is flawed or unscientific  But RCTs are not always appropriate o Using physical system of thought and measurement to evaluate non-physical  Decontextualizes CAMs to examine physical – if there is an emotional component, it tends to be ignored in RCT. i.e., you can’t measure the effect of a spiritual cure, therefore if there’s a spiritual effect, it’s hard to tell with a RCT.  Psychosomatic reactions are not valid – the idea is that you manipulate patterns and ways of thinking, to allow them to heal themselves. I.e., you “trick” someone into believing that they’re healed than they actually might heal themselves. Studies have shown that your mind does have influence on your body. But in the Western way of thought, psycho-somatic thinking is not accepted – its about the physical  Denies presence/significance of spiritual o Placebo studies can only evaluate physical cures that can be discretely withdrawn o RCTs rely on standardized treatments but many CAM treatments must be individually tailored for efficacy – in biomedicine, there’s an emphasis on universalism – you shouldn’t have to tailor things. A drug is a drug and it should work on everyone. However, CAM practitioners look to work with the patients and standardized methods of healing are not always effective. It may not always be an appropriate way of measuring CAMs, and by forcing CAM practitioners to prove using scientific philosophy to meet the expectations of dominant scientific hegemony, they’re able to keep their position as the dominant group  Most RCT studies limited to evaluating efficacy of herbal supplements and manual therapies  Only CAMs (or parts of CAMs) which can be scientifically proven to be effective with be granted legitimacy by biomedicine  The majority of research on efficacy of CAMs is done by biomedical practitioners o Most funding for scientific study of efficacy of CAMs goes to biomedical practitioners o CAM practitioners are not always trained scientifically and cannot participate o CAM practitioners are often denied access to key research hospitals, research facilities and equipment to conduct efficacy research  Objectivity of biomedical studies is sometimes compromised by professional conflicts of interest C HIROPRACTIC  End of 19 century (1800s): biomedicine was not hegemonic, it was just one way of healing out of a whole variety of ways of healings, because: o Unpleasant treatments (i.e., bloodletting – deliberately cutting skin to release blood, purgatives) with sporadic efficacy o No standardized medical education – there was no government regulation to lay the qualifications – pretty much anyone can call themselves a biomedical practitioner – it was about reputation o Start of bacteriology and scientific medicine – scientists and doctors were starting to come to terms with the idea that bacteria can cause disease. Sanitation was not even considered important o As a result. There was growing dissent towards biomedicine – which lead to “dissenting healers”  Growth of dissenting healers (i.e., magnetism, spiritual healers, naturopathy, chiropractic) – they did the opposite of biomedical practitioners. They were considered better because they were 9 offered cheaper, more pleasant treatments. Laborers were able to treat their musculoskeletal problems  1895: Daniel David Palmer performs first chiropractic adjustment in Iowa – Palmer was working as a magnetist and spiritual healer and there was a janitor who had to stoop to work, and he was deaf in one ear. When D.D Palmer asked how tis happened, the janitor explains how it happens. And D.D Palmer suggested to perform a chiropractic adjustment which worked o Rejected germ-theory of disease, didn’t believe that germs exist o All disease caused by vertebral subluxations that interrupt ‘innate intelligence’ – spiritual energy o His theory was a combination of Christianity and science – there’s a spiritual manifestation in the body o All disease can be treated by manipulating the spine, allowing body to heal itself naturally  Rapid rise in popularity and spread of chiropractic schools in U.S o Synthesis of science and religion had public appeal o Manual therapy popular among workers o Cheaper than biomedical treatments  Early chiropractors positioned chiropractic in direct opposition to biomedicine – because biomedicine became hegemonic overtime, and biomedical practitioners had ‘hitched’ their philosophy on the scientific ‘wagon’, they too became hegemonic o Attacked premises of biomedicine  Opposition in U.S o AMA regards chiropractic as a real threat to biomedicine o Early 20 century: arresting chiropractors for practicing medicine without a license – they were making martyrs of all this chiropractors o AMA, 1922: instead of jailing chiropractors on this idea of legality, they did so scientifically by claiming that chiropractic is unscientific and therefore unsafe. Biomedical practitioners were able to convince and manipulate the public in thinking that they were more scientific  Chiropractors forced to take science exams and essentially failed – therefore it became almost extinct – they started to incorporate science in their curriculum so that chiropractors were able to pass the exam o 1963: AMA committee on Quackery – a committee designed to point to the scientific problems – targeted chiropractors and their philosophies o Chiropractors labeled as ‘quacks’ o Forbade association with chiropractors – doctors were not allowed to associate with chiropractors, they were not allowed to refer patients to chiropractors, or accept referrals from chiropractors o 1976: chiropractic profession wins ‘anti-trust’ suit against the AMA – they were able to convince the court that the AMA was creating a monopoly for itself and ‘anti-competitive’. As a result, physicians were no longer allowed to discriminate to exclude chiropractors from patients  Opposition in Ontario o Ontario biomedical profession has also opposed chiropractic since 1907. As soon as this happens, western practitioners try to prevent chiropractors from treating patients  Lobbied government to systematically prevent any growth of chiropractic in Ontario  Right to be called ‘doctor’ or to practice  Denied them the right to self-regulation and Medicare coverage – biomedical practitioners, because of their hegemonic status, were able to convince the public and key government figures to not allow it  University affiliation and hospital access 10 o Argued chiropractors and unscientific medical training o Unscientific necessarily meant unsafe/ineffective  Over time, chiropractors shift from position of dissent to accommodation of biomedical authority – after a while, chiropractors begin to think that germs to exist, and not everything can be cured by chiropractic adjustment o Downplayed concepts of ‘Innate Intelligence’ and subluxation – began self-centering themselves o Limited treatment of neuro-muscular conditions – can’t cure diabetes, cancer etc. but can cure muscular conditions o More emphasis on scientific validity of chiropractic o Increased scientific education o Although some chiropractors are called unscientific, they have the same training, and even more clinical practice than doctors. It doesn’t matter what the truth is, it matters who’s going to listen to you. Therefore, doctors are still justified in excluding chiropractors from studies etc.  Chiropractic o Is now widely recognized as effective for neuro-muscular problems o Is not self-governed and regulated – only able to gain this status when they showed that they’re scientific o Education is as scientific as biomedicine o Became partially covered under OHIP in 1970 but was delisted in 2004 – chiropractic was a causality of privatization o Is still marginalized from hospitals and by some medical practitioners o Has still been unable to offer education through public universities o May become a specialty under biomedicine o Disingenuous - more about competition because if biomedical practitioners wanted chiropractors to be more scientific, than they should let them into the universities – there actions were based more on competition than on genuine care for their scientific credibility S UMMARY  CAMs are becoming increasingly popular world-wide for a variety of health issues  Controversies surrounding safety and efficacy of CAMs are at least partially due to the limitations of science and biomedical hegemony and opposition to CAMs  The case of chiropractic illustrates how biomedical hegemony and opposition can subvert most challenges to the biomedical monopoly over health care February 18, 2012 Tutorial  Examples of CAMs that are the most effective/safe: o Chiropractic – scientific proof o Yoga/meditation – many studies have shown that yoga reduces stress, breathing exercises o Home remedy – effective/safe based on advice from peers, natural, longevity – people wouldn’t be using it for the past 100+ years if it wasn’t effective o Turmeric – health experts are looking at these more natural things as being potential cures  Factors that render us to believe that these CAMs are in fact effective: o Efficacy – if we see physical improvement, sometimes be base our opinion on past use/perception o If something is natural, there’s this increased belief that it’s in fact safer (i.e., less harsh side effects) o Scientific empiricism – sometimes we make our assumptions based on scientific hegemony 11 February 27, 2012 M EDICALIZATION AND S OCIAL C ONTROL C ONTROVERSY  Some diseases or medical issues are considered controversial since there is ongoing debate about whether they are actually ‘real’ conditions that should be treated biomedically (i.e., with drugs) o Are new diseases discovered, or are they consciously invented? I.e., Alzheimer’s o If some diseases are being invented, why? Who benefits? M EDICALIZATION  Recall skin tag commercial  Medicalization: the process by which certain issues, behaviors, life stages or ways of thinking become defined as (1) Classification – abnormal or deviant, (2) Biomedical treatment – as medical issues to be treated via biomedicine o Alcoholism – there was this idea that alcoholism is abnormal – wasn’t considered a disease; it’s a sign of weakness and immoral behavior, o Hysteria – a disease that came out of the Victorian time (i.e., skin showing was considered taboo) – as a result, women had nervous breakdowns, seizures and it was classified under this large disease of hysteria – a disease of the uterus (i.e., because you’re a woman). This was quickly medicalized and treated through things such as medical masturbation o ADHD – used to be considered over activity in classes, they were often disciplined for causing a ruckus, and it was considered their problem, that they weren’t able to control themselves. Now this condition has been medicalized, and drugs are given to the children to calm them down and enhance their behavior o Menopause – used to be considered a normal stage in a woman’s life, but since the 1950s with the creation of artificial estrogen, it became understood as a estrogen-deficiency disorder and therefore abnormal, and became a disease that could be treated medically (i.e., estrogen replacement therapy) o Depression – before it was not medicalized, you were just considered sad, there was no treatment; but nowadays it’s considered a disease that can be treated with drugs o Erectile dysfunction – now treated with pills like viagra o Pregnancy – historically was something done at home; you didn’t necessarily see a physician, and you gave birth at home. Now, pregnancy is universally considered dangerous and is now “medicalized” – an abnormal condition that poses risks and requires medical attention  Contributors to Medicalization: 1. Biomedical hegemony – the dominance of biomedical practitioners over health (i.e., doctors know best and they’re the most credible and trustworthy by virtue of their status) o Allows physicians the authority to define illness and expand sphere of control – when a doctor says they’ve discovered a new disease, we tend to believe them o Doctors as a profession want to have as large of an influence as possible 2. Pharmaceutical companies – there’s a new disease created, then there’s a need for a new drug to treat it. Alternatively, if there’s a new drug, then there is a need for a disease o Research and education efforts to define new diseases to be treated with drugs o Translates to expanded market for products 12 3. Physician desire to ‘do something’ for their patients – physicians would rather do something rather than nothing (i.e., flu/colds are viruses that can’t really be cured with antibiotics but physicians will prescribe antibiotics to make it look like they’re helping) 4. Some patient advocacy groups – patients who are suffering but don’t get any recognition for their suffering because the illness doesn’t have a category (i.e., chronic muscular skeletal disease – not considered a real disease by doctors therefore you might not get antibiotics or time off work) o Chronic fatigue syndrome (so tired that you can’t even get out of bed – doesn’t have a discernably physiological cause therefore it doesn’t exist under the biomedical field), fibromyalgia, ADHD o Desire recognition from doctors of experienced symptoms of a disease  Medicalization and Stigma  Medicalization is a way of legitimating problematic/’abnormal’ behaviors o Addiction as moral weakness o Epilepsy (seizures) as spirit possession – before people understood the physiological reasons behind epilepsy, people thought that it had to do with spirits and were subject to things like exorcisms o ADHD as bad behavior/parenting  Definition as disease leads to: o Reduction associated stigma as a medical condition beyond individual control and eliminates the idea that these behaviors are abnormal and because of the individual o Authenticates suffering as a real medical issue o Allows access to social benefits – if you have ADHD then you can get acco
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