Final Thoughts of the Course

As we finish off this course, I realized I have developed a new perspective and outlook on the entire medical system of the U.S.. Having grown up in another country for most of my life, I have always known my own country’s medical system (Taiwan) and thought everything should be like that as it would make things much easier. I also thought in a more than naive way that the U.S. would have a similar system. This course helped me shine a light on what is wrong with the entire medical system of the U.S., but also gave me hope for what little hope there is left. It allowed some thoughts of reform and of change, which provided a rather bleak life with a sort of hopeful outlook. Even as we ended the class talking about end of life care, we managed to squeeze in some happy notes by explaining what we could be doing instead of what we are doing now. In that sense, I don’t see this class as teaching new material as a typical class does, but rather provoking conversations and viewing the world from an outsider view. Instead of teaching the basics, we learned to question the society we live in and what can we do as individuals to improve it. After all, we are going to be future doctors which will have a major impact on the medical field. If we can bring what we learned in this class to our future careers, maybe we really can bring change to the medical field and possibly reform it completely.

In terms of actual teaching, I think Dr. Guseva did a great job explaining many of the past concepts in lecture. She brought her own point of view as well as explained the current trends, and allowed us to think about what we should do to contribute, such as conversations about death. I think discussions were helpful as well, but I would’ve preferred if they went a little faster or more in depth into the lectures that we went over in class. We usually went over the readings which were helpful, but were something we really could’ve done in our own time.

To bring it all into context with what we have been learning about for the past few weeks, I think we really should bring all of what we learned into context to be change, however slight, in the world and change perspectives of how we view healthcare, illnesses, and death. What is rather stigmatizing to think about should not be so, and should be more talked about as the more we stigmatize them, the less we treat people with these certain conditions. This course really has brought a lot of new thoughts to my mind about healthcare and I’m glad I took this course to discuss these thoughts!

A Reflection on the Course

This course has been eye-opening for me. The most interesting idea I have learned is the correlation between socioeconomic status and health outcomes. The Whitehall studies in England produced a result I did not expect. Prior to the course I would have expected wealth to correlate with health but I would not have expected race, education or stress to correlate with health as well.

Another topic I found very interesting was the need for the medical profession to focus on care and the quality of patient life as well as curing the affliction. This idea is one that I have seen in the past when dealing with family members in the hospital. However, I was not aware that the quality of life is not always the primary concern of doctors. This realization had a large impact on me.

A final topic was shown to me in the analytical postings, but I wish it was discussed more in class. Mental health infrastructure is a serious problem that has been around for far too long. A large percentage of the population experiences some form of mental health issue, and there is very little infrastructure to support these patients. Moreover, the majority of homeless people and a large portion of the prison population suffer from a mental illness. I feel that, in the context of a course that is teaching students to address societal medical issues, this would have been a great topic to study in depth.

Loneliness: A New Silent Killer?

http://www.npr.org/sections/health-shots/2015/11/29/457255876/loneliness-may-warp-our-genes-and-our-immune-systems

In the article, “Being Lonely Can Warp Our Genes, And Our Immune Systems”, by Angus Chen, Chen discusses the different ways in which being lonely has been found to affect the human body. Chen even states that loneliness has been linked to diseases such as heart disease, Alzheimer’s disease, cancer. Chen explains that researchers have found that immune systems of lonely people work differently then immune systems of people who are not lonely. Chen states that, “Lonely people’s white blood cells seem to be more active in a way that increases inflammation, a natural immune response to wounding and bacterial infection. On top of that, they seem to have lower levels of antiviral compounds known as interferons.” Chen also states that loneliness causes a higher level of inflammation which could lead to many of these diseases. Steve Cole, a genomics researcher at the University of California backs Chen’s argument, “That explains very clearly why lonely people fall at increased risk for cancer, neurodegenerative disease and viral infections as well.”

Chen goes on to explain how and why loneliness can change our bodies. Cole explains how he tracked 141 people over five years, by measuring how they felt and by drawing their blood. He found that, “In a life-threatening situation, norepinephrine cascades through the body and starts shutting down immune functions like viral defense, while ramping up the production of white blood cells called monocytes.” Cole agreed with this, “”It’s this surge in these pro-inflammatory white blood cells that are highly adapted to defend against wounds, but at the expense of our defenses against viral diseases that come from close social contact with other people.” Chen also explained that during this process lonely people shut down genes that make their body sensitive to cortisol, which lowers inflammation.

With everything I read in the article it seems as if you are a lonely person then your health will suffer dramatically. The evidence that is provided in the article makes sense, however I feel as if it is exaggerated. I feel like this is just another attempt to medicalize a condition to raise profit for a particular group. If everyone who feels lonely read this article they would automatically become panicked and would try to find a solution. Solutions could include medication to stop inflammation, or therapies to become less lonely. This would raise profit for pharmaceutical companies and for psychiatrists, and therapists. I feel that eventually every human emotion and natural response will be medicalized in some way to increase the profit of various parts of health care. Articles like this one are the start to that medicalization process.

Analytical Posting : Treating A.D.H.D

http://well.blogs.nytimes.com/2015/11/23/video-game-is-built-to-be-prescribed-to-children-with-a-d-h-d/?ref=health

Earlier this month, the New York Times published an article describing a new method to treat A.D.H. D. in children. Basically, Akili Interactive Labs is a company that develops “electronic medicine” using high-quality, interactive video games. Recently, they came out with Project: EVO, a computer program “created to improve attention and reduce impulsivity in children with attention deficit hyperactivity disorder.” However, while the creation of a treatment that doesn’t force children as young as three and four to be medicated seems to be a wonderful new development, Project: EVO already sparks some concerns.

On one hand, it’s remarkable that there is a group of cognitive neuroscientists, biomedical scientists and experts in medical devices that is committed to treating children with A.D.H.D. without using drugs in a culture that is constantly using medication solve problems. The theory behind the whole brain training industry that targets children with A.D.H.D. along with adults who are trying to prevent dementia and other age-related cognitive ailments, is that people will be able to improve cognitive functions by using interactive, repetitive, and increasingly difficult exercises to strengthen the brain the same way lifting weights at the gym strengths other muscles in the body. “Electronic medicine,” as opposed to drugs could be a great alternative for parents who worry about side effects of drugs like amphetamine and methylphenidate that are typically used to treat A.D.H.D.

However, the problem with that last point is that doctors are not being encouraged to prescribe electronic treatment over standard drugs; rather, they are to prescribe both to children. Especially considering the video games are recommended for half an hour a day, five times a week for four weeks, they could be more stigmatizing for children and they wouldn’t actually replace the potentially harmful side effects from drugs. Kids who use Project: EVO could also later have an increased dependence on screen time, which is proven to, at times, end up being harmful to the development and health of children.

Also, I can’t help but worry about one more thing in the context of our discussions about the ways in which pharmaceutical companies medicalize illnesses. According to the article, “Shire, which manufactures Adderall, was an early investor in Akili and helped design the recent pilot study.” Shire has a vested interest in seeing increased treatment of A.D.H.D. in order to sell more Adderall. This is clear conflict of interest that could skew reports on the true effectiveness of Project: EVO. Unfortunately, what could be happening here is that a franchise is being made out of the treatment of A.D.H.D. And when business gets in the way of medicine, it is the patients who suffer.

Process Reflection 2

The information that we covered for this exam is more interesting to me personally as compared to the information of last exam because it deals heavily with how socio-economic status affects a person’s health and their susceptibility to illness. Being an immigrant/minority, I found it extremely interesting (and admittedly alarming) how largely the gap between health for minorities and white Americans differ.

Continue reading “Process Reflection 2”

Medicalization of the Medical Setting

In The Rise of the Modern Hospital, Rosenbergon discusses the medicalization of the hospital setting and the hospitalization of physicians and private practice. As mentioned in lecture, he discusses how hospitals transformed into a fully integrated medical setting from a previously personalized, potentially less effective social model. This joining of healthcare directly coincides with other articles discussing over-medicalization, which brings up the question: was the hospitalization of physicians potentially one of the first steps in over-medicalization of society? Though critical to our idea and perceptions of modern day hospitals, did this transformation push hospitals to be too medical for proper health and healing?

Continue reading “Medicalization of the Medical Setting”

Pharmaceutical Marketing and Medical Decisions

In Chapter 9, Marketing, Money, and Medical Decisions, in Groopman’s book, “How Doctors Think”, he illustrates how big pharmaceutical companies influences what becomes medicalized conditions in order to profit off of consumers. These aggressive pharmaceutical marketing leads to unnecessary invasive expensive procedures and financial gain from both the doctor and patient. These pharmaceutical companies tactics include giving gifts and bullying physicians into buying their drugs.

Douglas Watson, an executive in the pharmaceutical industry for 35 years, pushed for “ethical marketing” in which the aim of marketing should be the accurate education of a physician in the side effects and potential benefits of a particular agent. But, most doctors learn about their new products (drugs) from the pharmaceutical industry. Thus, as opposed to just selling the drug, the industry should help in the physicians’ education. Continue reading “Pharmaceutical Marketing and Medical Decisions”

Marketing and Medicalization

In the excerpt “How Doctor’s Think” from Marketing, Money, and Medical Decisions, Jerome Groopman demonstrates how big markets like the pharmaceutical industry largely influence what becomes a medicalized condition by aiming sales tactics at physicians and a patient-consumer audience. Groopman details the experiences of endocrinologist Dr. Karen Delgado and how Big Pharma has pushed their testosterone product by exploiting hormonal related aspects of aging as medicalizable conditions. Pharmaceutical representatives often lobby for the sales of their products by bribery and bullying physicians into changing the way they normally practice and treat patients. Pharmaceutical companies also push for the medicalization of certain profitable conditions by creating ads that are directed to their potential consumers. The advertisements often list vague symptoms that feel applicable to much of the audience and recommends that they ask their doctor about their product. By directing sales tactics at physicians and marketing to potential patients, drug companies wield power in shaping what becomes medicalized and how it can be treated.

Continue reading “Marketing and Medicalization”

Process reflection 2

In October, we moved to the broader discussion of medicine and public health. The discussions on the intersection of gender, SES, race and health conditions are very similar to those I experienced in introductory sociology courses. That is to say, they seem to be the “typical” issues explored. The major difference is the health contexts. But the relationship between medicalization and social control is very interesting to me. Especially, the topic on the shifting engines of medicalization touched various underlying social forces. In the past, medical doctors are the major players of medicalization. They have the power to define and categorize new diseases and provide treatments. They were also portrayed as the dominant roles over patients and other subordinate medical practitioners. While during the recent stage of medicalization, biotechnology, consumer and managed care ascend to become the major forces. Doctors evolved to become the gatekeepers and spokespeople for pharmaceutical companies. This is also related to commercialization and consumerism in healthcare.

But I also suspected the limitations of our study. First of all, sometimes we focus too much on the sociological side of the issues while neglecting the biological or practical reality. As I pointed out in my previous posts, sometimes the teaching materials seem biased and jump to conclusions too soon, e.g. the correlation between stress level and SES and the real reasons behind claimed gender inequality in drug tests. I understand that one main message behind medicalization is that some interest groups use medicalization as a tool to cover bigger social issues and shift the problems to the individuals’ health. However, I don’t think we should assume this “viciousness” without an examination of a specific problem. The second limitation is related on the first one, but with a focus on the structure and format of the course. Certainly there are a lot of issues to be discussed in this course and our discussion time is always too short for that. But I am not very sure that a very light touch on each question and then moving to another one is the best approach. Also, I really hope we have more conflicting voices in lectures and in discussion sessions. I wish to see more about how the pharmas/doctors/policy makers defend themselves against everything of which we accused them.

Lastly, this is a great course and I really enjoy the process. Although I proposed a few possible limitations, I have to say that this is a very informative course and that Professor Guseva and Rebecca are truly helpful.

Excerpts from “How Doctors Think”

In the NPR broadcast that included excerpts from Jerome Groopman’s “How Doctors Think”, Groopman talks about the nature of rounds with medical students. When he was a medical student, rounds was a time to learn not only diagnostic information but also a time to observe their superiors and how they conducted themselves. Now that Groopman is the one conducting the rounds, he has seen a shift in the purpose of rounds. The old way of conducting rounds was criticized and therefore the way Groopman conducts rounds now is solely focused on diagnostic information. Students are taught to follow a set of algorithms and practice guidelines organized into decision trees. Groopman draws attention to this issue because the consequences it has for patients with issues that do not fit into these decision trees. This shift in focus made me think of how this might impact how a condition may become medicalized. If a condition isn’t recognized as a part of one of these decision trees, how could it ever become medicalized? For a condition to be medicalized it has to be excepted by a medical profession as legitimate but these decision trees only allow for a finite amount of diagnoses and treatments.