This sociology course has proved to be incredibly informational overall. At first, I was pretty indifferent about the American healthcare system and its many flaws, despite my interest in the medical field. I had a very general knowledge about certain issues, but it wasn’t until I took this course that I realized how impactful these problems are on the population. When I decided to take this course, it was due to the fact that it was a recommended pre-med course. As the semester progressed, however, I became more and more interested, because there were so many things I had believed to be true that were actually refuted by the information I was learning. Besides the differences in cultural beliefs, I consider myself among the population of average Americans. With this in mind, I can only imagine how uninformed the rest of the population may be.
From medical training to end-of-life care, I have learned that the issues of the American healthcare system can’t be resolved without considering every aspect because they all contribute to each other. This course proved to be very important for any future health professionals or even people who have an interest in public health. By learning about the sociology of healthcare earlier in our education, we can become more aware of the issues before we become a part of them, and therefore be knowledgable enough to resolve them. As much as I hate to say it, I’ve already found myself quoting information from lectures and readings in conversations with both friends and family. I hope that we remember all that we have learned this semester for our future occupations.
Earlier this month, an article was published about the role of supplemental antioxidants in promoting or inhibiting cancer. Research has shown that some antioxidants get rid of “free radicals” that harm cancer cells along with other cells. By attacking these molecules, the article claims that antioxidants may actually help cancer spread rather than promote health. The most recent study, in 2014, found that “antioxidants accelerated the spread of human lung cancer cells implanted in mice, partly by blocking a cancer-fighting gene called p53”. The author also looked into clinical trials dating back to the 90s and these trials corroborated the results from the mice. “In 1994, a large trial reported that supplement-size doses of beta carotene increased the risk of lung cancer in male smokers by 18 percent” and then “a 2011 study of 35,500 men found that large doses of vitamin E increased the risk of prostate cancer by 17 percent”. All of these studies aside, it was also pointed out that “a handful of studies have found that antioxidants inhibit melanoma and other malignant cells growing in lab dishes”. So how do you know which antioxidants to take and when?
This article was particularly interesting to me because my mom is a firm believer in the power of antioxidants, but she’s also a breast cancer survivor. So I can’t help but wonder if antioxidants played a role (no matter how minor) in the progression of her cancer. I think the biggest problem here is figuring out which antioxidants do more harm than good in an ethical manner, since you can’t ethically give people anything that would be detrimental to their health and well-being. Until then researchers will have to rely on animal testing and individual cases that may not apply to the general population.
In chapter 13, Weitz briefly discusses the history of institutional review boards (IRBs). These groups were responsible for reviewing all federally funded research projects involving human subjects, but more recently research is conducted by pharmaceutical companies or other research organizations that have their own contracted commercial IRBs.
Although it is pointed out that there is conflict of interest involved in these commercial IRBs, there’s no mention of who is on these boards. Are they experts in the specific field of research or are they ethics professionals? Are there qualifications for who contributes to the IRBs? If so, how do these qualifications effect members perspectives on the research getting reviewed? In any case, how can bias in favor of the pharmaceutical company or other organization be reduced?
One of the topics covered in the second part of this semester discussed health gradients and the effects of socioeconomic status and race. This topic interested me the most for many reasons, but mainly because I wrote a paper discussing their effects on health, among many other things, and how it affects opportunity. It is commonly believed that minorities make up most of the lower class. This stereotype is portrayed everywhere and especially in media. The immigrant family or minority family is portrayed as struggling to an extent. We have all accepted this as fact, but in class we learned that the lower class is actually made up of more Caucasians. This was shocking to me because this is known by so few and knowing it could possibly change how minority groups experience health care. Discrediting the stereotype with research could aid in bettering the relationship between health care providers and patients because assumptions about background would be less supported.
Another concept I found intriguing was the Hispanic paradox. However, when I thought about it further, it made sense and I found myself comparing it to other cultural groups. The theory behind the Hispanic paradox is that community and familial networking attributes to better health. This is because there are unofficial support systems available to individuals in these communities that other communities may not have. It was still surprising that Hispanics were higher in the health gradient than Caucasians. I agree however that all social groups can learn from the hispanic community about how connections to others contribute to better health. Having a support system when dealing with stress is very important and I think having people you already know helping you, rather than a group of people you’ve just met, benefits health. Otherwise, I feel there wouldn’t be that big of a difference solely due to this attribute when compared to other groups.
I enjoyed learning about race and SES effects on health. I also hope to learn more about how health care providers can help close the gap between different social groups.
In Chapter 2 of Weitz, it is pointed out that modern medicine focuses mainly on tertiary prevention (“minimizing complications among those already ill”). It seems as though primary prevention is more cost-effective in the long run because it focuses on preventing illnesses altogether, which would mean less need for and money spent on medication and prolonged treatments (like dialysis). It would also help decrease premature deaths attributed to controllable factors. Why isn’t there more focus on primary prevention above tertiary and secondary prevention?
When I am asked about my culture I almost never think about my life experience as an American. With almost an entire family of naturalized citizens, my opinions about different aspects of the health care system in the US were always based on comparisons to what I have heard or what I imagined these aspects of health care to be like in my parent’s native country. Essentially I knew that my access to health care now would be very different there than it is here in the US. So I had a pretty positive view of our health care system before beginning this course. I knew there were some flaws to the health care system, but I didn’t really grasp the extent of these problems.
That being said, I decided to take this course because I feel, as a potential health care provider, I should know what kind of occupational environment I’d be joining. The beginning of this course has enlightened me to so many things I never thought about previously. For example, I realized how little power the patient has because of lack of knowledge. As health care consumers we are looking to our sellers (providers and insurance companies) for advice and this dependence limits our ability to make informed decisions about services. The course has also showed me how having such a decentralized system contributes to larger gaps between SES groups. It seems clear to me that some kind of government intervention is necessary to reform healthcare in the US, so it’s surprising to learn that some still support profit-based health care. Especially as we learn about the systems of other countries that have higher quality of life and are less wasteful in terms of resources.
This course has also made me question motives of insurance companies and healthcare providers. When I receive a prescription, I wonder what factored into my provider’s choice in medication. I also wonder about my own insurance plan and what services are covered or considered unnecessary (and who decides). It was very interesting to hear the political opinions on health care in the debate and compare them to what we have learned so far. Overall this course has made me question my previous conceptions of the health care system here in the US and I look forward to developing a better understanding of how health care providers can aid in its reform.
Although there are no definitive rules about whether or not physicians should accept gifts from patients, it is common belief that a physician should decline offers from patients if he/she believes it will compromise the integrity of his/her ability to provide services. Receiving personal gifts from patients may make physicians more inclined to give these patients special treatment. So when is it okay to accept gifts from patients? Is it appropriate to solicit gifts from patients on behalf of medical centers?
In the article, “A New Effort has Doctors Turn Patients Into Donors”, Gina Kolata writes about a survey conducted by Dr. Reshma Jagsi. In the survey of oncologists, “nearly half said they had been taught to identify wealthy patients who might be prospective donors. A third had been asked to directly solicit donations — and half of them refused. Three percent had been promised payments if a patient donated.” The survey’s focus was on leading cancer centers, so it makes sense that they would look for donations to aid research efforts and growth. Could getting physicians involved in asking for donations or even alerting physicians to look for and refer potential donors skew the patient-physician relationship? Quoted in the article, a physician said: “‘I’m asking them to go above and beyond their relationship with me as a patient so I feel like I have to go above and beyond'” and many others seemed to feel the same. It was also pointed out, however, that some patients interested in donating may not know how to go about it and may need guidance. In this way it may be appropriate for healthcare providers to give a push in the right direction. Still, this is not the same as directly asking patients or donations.
The main issue I see with getting doctors involved in this situation is that it contributes to the widening gap between wealthy (and probably insured) patient-consumers and lower SES patient-consumers. Physicians may feel inclined to give more of themselves to a patient when monetary gain (either from the patient or from their employer) is involved. This gives the wealthier patient access to more services and even more options for treatment. This inequality of healthcare service is one of the downsides of a healthcare system based on commercialism and situations like those described in the article may contribute (however small) to this issue.
In chapter 9, Weitz points out that one of the many measures of health care systems is taking into account what services are made available to everyone. It is also pointed out that there are varying definitions on what is essential. Who has the most credibility in determining what is essential? How might physicians, insurance companies, or employers each be biased in their opinions? What types of procedures and services would each group likely promote as essential?