Experts Look at Perceptions of Illness

Subject: Medicalize
Me: Experts Look at Perceptions of Illness
From: DON PHILLIPS
daphil15 [at] hotmail [dot]com>
Date: Sun 25 Feb 07, 12:22 a.m.
To: SRC Blog

Subject: Medicalize Me:
Experts Look at Perceptions of Illness -- Medicalization of Badness

Hi Listmates,

It might have been Harrison Trice from Cornell or Paul Roman from Tulane (now at Georgia)
who I first heard use the term "medicalization of badness" in the seventies. It had a very distinctive behavioral health connotation at the time. At least for me and the field of addictions:

Excerpt:

“When the term first came into use in the
1970s, it was used critically to mean the ‘evil’ actions of doctors who turned deviation from the norm into disease, and imposed medical authority on aspects of everyday life such as birth, aging or dying,” says Jonathan Metzl, M.D., Ph.D., a University of Michigan Medical School psychiatrist and U-M women’s studies researcher who co-organized the workshop and wrote or co-wrote two of the six Lancet articles. “But today, it’s used more in connection with the actions of pharmaceutical companies, and we need to understand its effects better.”

Don back. Now it has broadened and my very special visceral reaction to
all the prescription drug ads on TV is very much a part of that. But there is
some value in the old definition in examining our intentions and goals as a
society. And a useful construct to examine cultural differences around the
world. Just some random thoughts from one of your 'old codgers'.

Don

Source: University of Michigan Health
System Released: Mon 19-Feb-2007,
09:00 ET

Embargo expired: Thu 22-Feb-2007, 18:30 ET

Summary Description

Do prescription drug ads make people think they’re sick when they’re not, or create “disease” out of thin air? Does the “empowered patient” movement mean that doctors have lost some of their professional clout? These questions and more are the focus of a new set of probing essays on the topic of “medicalization” and what it means.

Newswise — Do prescription drug ads make people think they’re sick when they’re not, or create “disease” out of thin air? Does the “empowered patient” movement mean that doctors have lost some of their professional clout when it comes to making diagnoses and prescribing treatment?

These questions and more are the focus of a set of probing essays in a special section of the Feb. 24 issue of the journal The Lancet, all addressing the topic of “medicalization” and what it means in modern society.

The essays, which grew out of an international workshop, zero in on the fact
that even the word “medicalization” has a different meaning today than 30 years ago.

“When the term first came into use in the 1970s, it was used critically to mean
the ‘evil’ actions of doctors who turned deviation from the norm into disease,
and imposed medical authority on aspects of everyday life such as birth, aging
or dying,” says Jonathan Metzl, M.D., Ph.D., a University of Michigan
Medical School psychiatrist and U-M women’s studies researcher who
co-organized the workshop and wrote or co-wrote two of the six Lancet
articles. “But today, it’s used more in connection with the actions of
pharmaceutical companies, and we need to understand its effects better.”

The six essays focus on the intersections between medicine and society, including the role of the physician and the patient, and of the values, wants
and needs that each doctor or patient brings to each interaction.

Metzl co-authored the introduction with Rebecca M. Herzig, Ph.D., a professor in Women and Gender Studies at
Bates College in Maine who worked with him to organize the workshop. They report that a Google search for the term “medicalization” (and its British spelling, “medicalisation”) yields more than 358,000 hits –most of which have to do with the drug industry’s role in changing societal perceptions of disease,
“normalcy” and wellness.

But the authors also warn against painting this phenomenon with an entirely
negative brush. “The same drugs that treat deviances from social norms also help many people live their lives,” they write. While the old definition of
“medicalization” painted patients as the victims, the new model gives them the
opportunity to be advocates and choosy consumers – if they and their doctors discuss openly their beliefs about what they think the drug from the television
advertisement will do for them.

Metzl examines the impact of direct-to-consumer drug advertising even further, in an essay on what Europeans can learn from Americans’ ten-year experience with the ads if Britain and European countries decided to allow them too.

“Is it the case that our notions of illness are created by the pharmaceutical
industry’s advertising, or is it also the case that drug companies are
reflecting societal expectations?,” Metzl asks. “Culture plays a large role in
this process, and the drug companies aren’t just inventing
this from scratch. They’re playing to a market that’s used to asking for
things from their doctors, and it’s raising very interesting questions of
interpersonal dynamics.”

Metzl and other writers of essays in the special section look to history to shed
light on the current situation. Metzl is the author of a 2003 book “Prozac on
the Couch: Prescribing Gender in the Era of Wonder Drugs,” which examined how depression and anxiety medications were represented in advertising aimed at physicians, and in the entertainment media, in the latter half of the 20th century.

Today’s ads amplify people’s cultural expectations, or even
change them, he says in the new essay –for instance, erectile dysfunction
drug ads that are featured prominently at sporting events as well as on TV play to men’s perceptions of what it is to be a normal, healthy man. The same goes for antidepressant ads showing women who are able to fulfill their roles and duties as mothers.

What people do in response to these ads is another aspect to the medicalization issue, Metzl says. Studies have shown that patients who go to their doctors and ask for a medicine they saw in an advertisement are likely to get it – which, of course, is part of the reason the blitz of ads has escalated every year since the U.S. Food &
Drug Administration relaxed the rules for them in 1997.

But this has led to a kind of tension in the interaction between doctors and patients that is new, Metzl notes, as physicians try to decide whether to say
yes or no to each request. The fact that physicians themselves are exposed to
the same ads, and are part of the same society as their patients, further complicates the issue.

The answer for U.S. doctors, and for the British and European doctors who may soon find themselves in the same position as their American counterparts, may be to bring the social issues directly into their conversations with patients,
Metzl explains. “If a problem is being medicalized, we need to look at what else we can do as physicians besides blaming drug companies, and talk to patients about what else they need to be aware of and what may be driving theirresponse to an ad,” he says. “Doctors and patients shouldn’t mindless follow the suggestions of drug ads, but they should talk about the options and the expectations that they have, and how realistic those expectations may be and then decide whether the medicine is right.”

In addition to Metzl and Hertzig, the essay section features writings by Nancy
Tomes, of the history department at the State University of New York at Stony
Brook, writing on patient empowerment and the dilemmas of today’s medicalization; Nikolas Rose of the London School of Economics, who looks at the history and future of medicalization; Troy Duster of New York University, who examines the medicalization of race including medicines that are being aimed at members of certain ethnic groups; and Cindy Patton of Simon Fraser University in Vancouver, who looks at the specific issue of medicalization in the treatment of HIV/AIDS.

The workshop that led to the writing and publication of the essays was funded by grants from the University of Michigan, the Charles Engelhard Foundation, and Bates College.

Lancet, Vol. 368, Feb. 24, 2007