This WHO report might shift the definition of herpes

According to WHO’s first global estimates of herpes infection, more than 3.7 billion people under the age of 50 – or 67% of the population – are infected with herpes simplex virus type 1 (HSV-1). The “herpes” we know as an STD is genital herpes caused by HSV-2. WHO’s latest journal article highlights that HSV-1 is also an important cause of genital herpes.

HSV-1 causes lesions on the lips or around the mouth commonly referred to as cold sores or fever blisters. It’s primarily transmitted by oral-to-oral contact. Both oral and genital herpes viruses can sometimes be spread, even when you do not have mouth sores or blisters.

This report should raise concerns on the unequal distribution of healthcare and necessary infrastructure resources. Based on WHO’s data, we can found that the rate of infection is significantly higher in regions such as Africa and South-East Asia than regions such as the US. Fewer people in high-income countries are becoming infected with HSV-1 as children, likely due to better hygiene and living condition. One implication of policy making is to provide more access to hygienic water as well as other resources to underdeveloped regions. At the same time, public education is also important because most people get infected as children. For example, some parents chew food for their children and pass the virus to them.

HSV-1 infected disease is also a good example for illnesses affected by social factors. According to WHO, though the virus is highly infectious and incurable, symptoms such as blisters only occur when the patients’ immune system is under stress. Some people, if they get a lot of sun exposure, they’ll get an outbreak, or women during pregnancy or when they have their menstrual periods.

The high estimated proportion of the herpes infection has significant effects. Even in the region that has the lowest rate (Americas: 178 million women (49%), 142 million men (39%)), nearly half of people under 50 are infected. This undermines what we define as an illness. There have been such comments from the public as: “It is not herpes; it is cold sores” or “Everyone is infected”. These comments surely exaggerate the facts. However, it reflects how the big number can reduce people’s definition of a certain illness. If over 99% of the adults are infected with HSV-1 worldwide, would it still be recognized as an illness or simply an accepted impairment in our immune system.

We need to acknowledge that, people who are infected with herpes, even the HSV-1, are stigmatized in most societies. Will the new WHO findings promote the de-stigmatization of the diseases? Due to the high infection rate? WHO has stated that “People with orolabial herpes symptoms may face social stigma, and can experience psychological distress as a result.” On the other hand, this finding may evoke panics among the public and accentuate the stigmatization on sexual activity as general. For example, on the website of Centers for Disease Control and Prevention, several suggestions were given. “The only way to avoid STDs is to not have vaginal, anal, or oral sex.” “If you are sexually active, you can do the following things to lower your chances of getting herpes: Being in a long-term mutually monogamous relationship with a partner who has been tested and has negative STD test results.” Not only do those suggestions emphasize the isolation of infected population but also propose a preferred way of conducting sex. This a good example how the disease and they way people perceive it can shape the public’s view on sex and certain sexual conduct such as multiple partners.

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If obesity is a disease, then what?

This news article is in the form of a discussion about the medicalization of obesity. In the lectures, we have talked about how the medicalization of a condition can be stigmatizing or de-stigmatizing, and in this case, people who participate in this discussion argue that it can be both. Some think that while obese people will be no longer viewed as deficient or incapable because they have the medical condition to blame. But others think that the medicalization of obesity as a disease leads to serious body image issues because it labels being overweight as something to be seriously looked down on.

Another point made about obesity is that it is medicalized (or should be medicalized) as a predisease, since it does not kill anyone but it leads to higher morbidity and mortality. Being obese increases the risk of coronary artery disease for example, but no one has ever died from obesity itself.

While this argument is valid, it does not contribute to the question of whether obesity should be medicalized or not. Labeling obesity as predisease is in itself another debate, because many conditions, deviances such as some values that are higher than normal, are labeled as predisease and cause lifelong use of some medications.

One point that I found very interesting and thought-provoking was that whether the medicalization of obesity makes a difference in “recovery”. The article shows data that “no more than 5 to 10 percent of obese people succeed in losing weight and keeping it off”. This suggests that even with the application of some medications, the number of people who can stop being obese is surprisingly low.

“The “significant negative consequence” they foresee, however, is thus put in a different light: Most of the already obese will not be able to lose weight, and any relief from societal stigma will be valuable.”

This statement from the article thus highlights the pointlessness of many forms of medicalization. If a medicalized condition that is major like obesity can do no good in public health, then there must be many more conditions whose medicalization is more harmful than beneficial.

http://www.nytimes.com/2014/03/03/opinion/if-obesity-is-a-disease-then-what.html?_r=0

De-stigmatizing depression: Could depression be caused by an infection or an inflammatory disease?

Prior to the availability of antidepressant medications, doctors were freely performing drastic lobotomies (excisions of white matter connections between gray matter regions in the brain) on patients in an attempt to cure them from mental disorders such as depression and schizophrenia. Psychiatrists were also extracting decayed teeth and removing organs such as tonsils, testicles, ovaries, and colons to treat the insane. Throughout medical history, both physicians and researchers have continuously attempted to track down a unique etiology of depression based on scientific evidence in order to welcome and legitimize patients’ symptoms.

In the article titled “Could depression be caused by an infection?”, researchers now posit that the unique etiology of depression may be related to infection and inflammation of the brain and body. Specifically, Dr. Turhan Canli claimed that depression should be thought of as an infectious disease. Studies in notable journals have shown that certain infections in the brain, such as those caused by the parasite Toxoplasma gondii, may cause mood disturbances that are considered to be a symptom of depression. Dr. Canli notes that a plethora of other pathogens, including Borna disease virus, Epstein-Barr, and varicella zoster (the virus that causes chickenpox), have been associated with mental illnesses. Similarly, an observational study that looked at the medical records of over 3 million people who had suffered from infections acquired a 62 percent increased risk of developing depression or bipolar disorder. In addition to infections, Dr. Canli also believes that autoimmune activity that is triggered by the pathogens may also contribute to mental disorders. At first glance, Dr. Canli’s statement may seem a bit far-fetched, but there is clearly some solid evidence to bolster his claim.

Furthermore, there is also research being conducted to study the relationship between the immune system and the brain in order to elucidate the etiology of depression and other mental disorders. Numerous studies have demonstrated that there is continuous cross-talk between the nervous system and immune system. Recently, researchers at the University of Virginia discovered a network of vessels that directly connected the immune system to the brain that may contribute to certain neurological and psychiatric conditions. Psychiatrists believe that both infection and autoimmune activity result in inflammation, which may be associated with depression. Currently, there is no cause and effect between inflammation and mental disorders, but researchers are hard at work trying to find a plausible mechanism. For instance, Dr. Roger McIntyre believes that psychiatric illnesses disturb the “immune-inflammatory system”. He states, “Throughout evolution our enemy up until vaccines and antibiotics were developed was infection. Our immune system evolved to fight infections so we could survive and pass our genes to the next generation. However, our immune-inflammatory system doesn’t distinguish between what’s provoking it.” It is true that our body systems do not discriminate between different stressors, be it sleep deprivation, grief, or poor academic performance; the immune-inflammatory system stays activated in order to protect us, which may lead to chronic depression and other disorders. Although a conclusion is not yet set in stone, many leading psychiatrists believe that finding a pathological explanation rooted in infections and inflammation may be useful for treating patients with depression.

As we discussed in class, medicalization has the power to either increase or decrease the stigma associated with a particular medical condition in a defined cultural society. With depression, it has largely been de-stigmatized as a result of mental health awareness programs for patients and, as the article demonstrates, support from the medical profession to discover a unique etiology that may be associated with the condition. While the medical model of illness seeks a biological explanation to treat individuals with depression, the sociological model of illness claims that depression is caused by a combination of social and biological causes. Nevertheless, it is beneficial to the patients suffering from depression that the medical profession is open to studying depression as a result of a unique etiology, because it encourages patients to seek help and to be transparent about their mental issues. In reality, there is always a constant shift in how certain conditions are viewed by society depending on how much scientific evidence there is to legitimize it.

Article: Could Depression Be Caused by an Infection?

You Don’t Know What You Don’t Have Until It’s Gone

I feel a lot of the topics we covered this time is more real to me. Yes, we all need and have health insurance, but I never dealt with it on my own. I never met or knew of anyone who could not attain health coverage. I did not get sent to another country for surgery because it is cheaper. However, the topics we cover now can be seen in everyday life, and past experiences.

Continue reading “You Don’t Know What You Don’t Have Until It’s Gone”

To Judge and Be Judged

We have talked about stigmatisms surrounding illnesses and how much of it comes from the public, aside from our own personal views. Many symptoms that may be easily brushed off by one person can be worrisome to another. The latter person would have to face the decision of either viewing those symptoms collectively as an illness, or ignore it and continue with his usual routine.

Society has become more accepting of various illnesses, and even go one step ahead as to prevent possible illnesses and/or creating illnesses that, to the rest of the population, seem normal and of no concern. Admitting to having a certain disorder could possibly be beneficial. One may earn more sick leaves, be given more leeway, and have the ability to blame their behavior on the disorder (out of their control). Still, the majority would still be under the judgmental eye of society, feeling as if they are not “normal.” In this article, Corrigan, Druss, and Perlick cover the topic of mental illness: how society feels towards it, and how the person who has it must live and cope with it.

Continue reading “To Judge and Be Judged”

Women and Health: The Stigma of Pain

I recently read an article dealing with gender issues, consisting of the treatment of women’s pain by doctors and hospitals. Apparently women’s pain isn’t taken as seriously as men’s pain. My question ties in with differences in gender and the stigmatization of women’s health. Women are viewed as having less tolerance to pain, being more emotional, and  being less rational as opposed to men. It can be also said that women experience more abdominal and pelvic pain more often, so the hasty decision of doctors could be to a common ailment as opposed to a more serious problem. So when it comes to women’s health, why is it viewed in a rather stigmatized and unimportant part of the field of health?

How Doctors Take Women’s Pain Less Seriously

Medicalization of Beauty?

In the “Tall Girls” article by Joyce M Lee, a statement that really stuck out to me was: “problem of excessive height in otherwise normal girls is evident”.  This statement consisted of two damaging words “problem” and “excessive”. This statement made it apparent to me that these young girls who had a negative view on their bodies probably believed this because of the lack of support from the adults present in their lives.

Why do we constantly interfere with biology in order to achieve our morphed sense of beauty even though we know it is not healthy? What is the lasting effect of medicalization on the youth who are taught to believe “normality” can only be achieved and not ascribed?

Stigma and Illness

In the article “The Social Construction of Illness: Key Insights and Policy Implications” Conrad and Barker discuss the impact stigma can have on an individual with an illness. One of the most interesting portions of this article and something I believe most people do not think about is the metaphorical connotations associated with certain illnesses and how this can affect those afflicted with the disease. Conrad and Barker give the example of the metaphor of “obesity as sinful” and how this would either deter or encourage an individual’s support towards public policies aimed at reducing obesity. It seems counter intuitive that the negative connation associated with an illness would make people less likely to want to help lessen the prevalence of this illness, since it would seem as if people would want to reduce the prevalence of an illness they view with such disdain. I think if people would be discouraged to support public policies aimed at reducing certain illnesses, the people with these illnesses would end up like those who are coping with illness experience that is discussed later in the article. Barker and Conrad describe these people managing chronic illness as becoming “increasingly cut off from the routines of conventional life—unable to work, spend time with family, socialize with friends, or move about freely. Thus, the foundation on which a sense of self is based can be lost, there is nothing to look forward to, and nothing to do; time is experienced as unchanging.” This seems like a depressing but likely fate for those who have no support for their illness due to the negative conations associated with this illness. All in all, this makes me wonder if the negative connation associated with an illness would be more likely to discourage or encourage others from supporting approaches to reduce the illness or help those with the illness cope? Would cultural and religious difference impact the decision to support public policies?

The effect that social factors and stigmatized views have on the development of illnesses

Conrad et al. in “Construction of Illness: Key Insights and Policy Implications” I find it interesting that the concept of social constructionism addresses the fact that the same disease can affect people is different ways, depending on their culture and social systems.

I remember reading another article a few months back that compared the rate of breast cancer recovery in members of families from different cultures. The study found that members of Hispanic families who suffered from breast cancer had a higher chance of recovering and overcoming this disease that patients who belonged to other cultures. This made me think about the concept of the Hispanic paradox that we have been talking about in class. I honestly do not know how reliable this study is, because I think many other variables should have been taken into account. However, I think it is an interesting example of how cultural factors (in this case, family support) can affect the disease of a person.

This week’s article also mentioned how in some cultures there is a stigma to some diseases, such as HIV/AIDS. Talking from my personal background, I grew up in a Latin-American country where I believe this disease is still a “taboo” subject to talk about. I agree with the article when it says that it is more difficult in these scenarios for patients to get access to treatment; there is shame and embarrassment associated with the disease, so the patients are less likely to tell others and/or seek for help. I wonder about if, in the case of HIV, patients are even more immunocompromised because of the stress generated by living in countries/societies where this disease is more stigmatized.

Social Construction

In Peter Conrad and Kristin Barker’s article, they explain the concept of social constructionism and say that “the emphasis is on how meanings of phenomena do not necessarily inhere in the phenomena themselves but develop through interaction in a social context.” In other words, the disease itself may have an entirely different meaning than the illness, based on social context, cultural differences, lack of knowledge, and different perceptions. They also claim that a “stigmatized illness can make an illness much more difficult to treat and manage” and then go into the example about HIV/AIDS and how people are less likely to seek help for their condition. Because technology heavily influences social behavior and experiences today, do you think this has anything to do with how we view illnesses and diseases? Technology, especially the Internet, allows information to be public, available, and accessible as well, so is it bad that all this excess information is available since the public is able to interpret it however they want to? Should we be focusing on educating and reducing the stigma in society instead of giving out all this information to the public?