The Medicalization of Health

The way the human body is constructed, pairs of body parts are obvious. If you start at the top, we have two of most everything down to our two feet. The relationship between the pairs is also well documented. If you break a leg, the other one does double duty but both legs will need to heal – one from the break, the other from the overtime.

These supportive relationships – shoulders, hands, hips—have been lost on the health insurance industry and unfortunately many medical professionals who play along. I could bore you with my recent “referral” experience of trying to get help for BOTH shoulders, but you may have been there, done that as well. When I called the doc’s nurse to ask her to just make it for both shoulders, she said they couldn’t do that. Let me just say that by the time the whole process—doc visit, referral, insurance cluster… and authorization for physical therapy was completed, I was out of pain beginning to mend. Of course, strengthening exercises and hands on adjustments from my skilled physical therapists were still greatly appreciated. 

I was looking for a word or term that described the labyrinthian process those of us seeking medical care are faced with. I found the term—the medicalization of our health and bodies that has become the law of the land. What is meant by the term medicalization?

Medicalization refers to the process in which conditions or behaviors are labeled and treated as distinct medical issues. Key drivers of this new approach includes the pharmaceutical industry, biotechnology, medical professionals, and insurance companies, all seeking to develop new markets, revenue and/or treatments.

Some of this medicalization is a product of the rapid advancement of science in the last 30 years. Infertility is a good example. The rise of drugs and technological procedures has led to an explosion in infertility diagnoses. It is now considered a medical condition that can be treated.

What is De-medicalization?

This is the opposite process, where a “condition” is no longer primarily defined or treated as a medical issue, such as the removal of homosexuality from the DSM (Diagnostic and Statistical Manual of Mental Disorders).  While people were unsuccessfully “treated” or punished for these behaviors in the past, medicine now recognizes them as part of a normal and healthy life.

What Are Some of the Ethical Issues Raised in Medicalization?

• Patient Safety. Given the amount of time and especially money pharma companies invest in matching their products with medical conditions, they want doctors to prescribe them ASAP. But have they been fully tested and safe? The medications for attention deficit hyperactivity disorder (ADHD) is a good example. Critics say that while ADHD is a real condition, 2-4 times the number of children in America have been prescribed medication for it than in other countries. This may be the result of companies heavily marketing their drug.

• Social and Cultural Bias. Certain products, such as blood pressure medicines, react differently depending on race in clinical trials, but the drug is widely prescribed regardless. Other critics say this racially profiling denies minorities full access to medication.

• Recreational Drug Use. For example, Viagra® (sildenafil citrate) was initially approved for male impotence, but now manufacturers advertise the pill to men to improve their sexual functioning, regardless of whether they had clinically diagnosed impotence or not.

• Managed care. Managed care is also a force of medicalization. For instance, considering depression as a condition caused by a chemical imbalance legitimates a treatment based on pills rather than on expensive, longer psychotherapy. The result is often that social problems are transformed into medical ones.

• Big Pharma Advertising. In 1997, the laws regulating pharmaceutical advertisement became less restrictive, resulting in the expenditure for prescription drugs ads to increase four times between 1998 and 2007. The increase in advertising has also strongly stimulated disease mongering, which is the “invention of illnesses.” Healthcare and pharma ad spending is shifting from traditional to digital channels, away from linear TV—where, historically, the industry has invested a significant share of ad dollars. Digital channels like connected TV (CTV) and social media are surging as brands swap the greatest reach for targeted, data-driven channels that still scale.

IMHO

My most radical suggestion was and remains that a 2-day, nationwide doctor strike would bring our miserable healthcare system to its knees. Of course, since doctors make money with each visit – left shoulder, right shoulder – they’re not likely to rebel. And. many receive a bonus whenever they prescribe a pharma company’s drug. Once treated like minor gods by an admiring public, now, due to exposed money-seeking schemes, they have lost their high status. With 10,000 doctors working for mega insurance companies, many leaving the profession, and longer appointment times to even get care, the good docs suffer from the actions of the monied minority.

If Congress had any respect for their constituents wellbeing, they would have worked to lift the U.S. healthcare system out of the toilet when compared to most nations – small and large.

But when you look at who’s funding these slackers in D.C. you can see why, very like Operation Epic Fury (or as some call it Epstein Fury) nothing will happen any time soon and only a few members will try to change the system. To overthrow the insurance and pharmaceutical industries would take either a complete financial meltdown or a citizen uprising that amounted to a true revolution where demands would have to be met. I admit to feeling envy when I see massive demonstrations in many countries when citizens have had enough. I’m not holding my breath for either to happen, but a girl can dream can’t she?

I leave you with something Dr. Gabor Maté said during an interview that goes full circle back to the scourge of medicalization of health:

“What then are people to do when doctors,

the gatekeepers to health care and its primary providers,

are blind to the basic realities of what generates health and what undermines it?

When their training denies them knowledge of the unshakeable unity of mind and body?”