December 5, 2016
A Look At Medicalization
By Michael D. Shaw
In 2007, Brandeis University sociologist Peter Conrad’s book, The Medicalization of Society: On the Transformation of Human Conditions into Treatable Disorders, was published. The work expanded on a series of earlier publications and journal articles by the author, who has been studying this phenomenon since 1975. According to Conrad, “Medicalization describes a process by which non-medical problems become defined and treated as medical problems, usually in terms of illness and disorders.”
The bulk of the book is devoted to four chapters he calls “cases,” all of which have interesting titles:
1. Extension: Men and the Medicalization of Andropause, Baldness, and Erectile Dysfunction
The latter two conditions were—until recently—considered to be consequences of the normal aging process. Andropause, the purported male counterpart to menopause, is tied into lowered testosterone levels. With pharmaceutical drugs available for all of these conditions, extension of some of that youthful virility is now possible. Notably, sildenafil (for erectile dysfunction) started off as a failed angina drug, but clinical trial subjects did observe a most desirable side effect.
2. Expansion: From Hyperactive Children to Adult ADHD
Conrad explains how attention-deficit/hyperactivity disorder, causing “bad behavior” in kids, morphed into a sort of generic underperformance in adults—even adults who by all rights would be considered high-achieving and successful. Most of these adults are self-diagnosed, and for whatever reason are dissatisfied with aspects of their lives. Are they forgetful or easily distracted? Take a drug.
Ironically, Dr. Alan Zametkin, a psychiatrist at the National Institute of Mental Health, who helped raise interest in adult ADD in the first place, laments that it has become a cottage industry. “People who are jumping into this field of adult ADD don’t have any track record. Whenever they see anyone with an attention problem, they call it ADD. Even procrastination is now said to be a sign of attention deficit disorder.”
3. Enhancement: Human Growth Hormone and the Temptations of Biomedical Enhancement
This concerns the matter of human growth hormone, including its being prescribed to shorter children. The issue is raised as to what may constitute acceptable risk for treatment of disease, may not be an acceptable risk for enhancement. Is idiopathic shortness of stature, in a healthy individual, a disease?
Conrad avers that “Using biomedical enhancements may perpetuate a sense of inadequacy.” He adds: Such enhancements reside “…at the crossroads of our cultural belief in self-improvement, an individual’s desire to get ahead of the competition, our faith in medical solutions to human problems, and the economic drive and market-making of the biotechnology industry.”
4. Continuity: Homosexuality and the Potential for Remedicalization
In this case, homosexuality became de-medicalized, as it became de-stigmatized. However, given the growth in genetic research—including interest in a so-called “gay gene”—Conrad posits that it could be re-medicalized anew.
As UConn professor Michael Fendrich observed in his book review: “…Conrad argues that physicians and their professional societies are no longer central forces in the process [of medicalization]. Instead, they function more peripherally as gatekeepers for the treatments that are facilitated by new medications, stimulated by the consumer demand that is created by direct-to-consumer advertising, and reimbursed by managed care.”
A reaction to rampant medicalization is the “Less Is More” series of articles, featured in JAMA Internal Medicine, launched in 2010. As expressed by authors Deborah Grady and Rita Redberg in the initial piece: “[The series] will highlight situations in which the overuse of medical care may result in harm and in which less care is likely to result in better health.”
The first topic covered was the serious adverse effects of proton pump inhibitors—including increased rates of fractures, Clostridium difficile infection, and an increased risk of pneumonia. The latest subject is the spurious construct of “prediabetes.”
In “Prediabetes Risk in Adult Americans According to a Risk Test,” the authors find that a widely promoted web-based risk test would label more than 73 million Americans, including more than 80% of those older than 60 years, as being at high risk for “prediabetes,” a condition never heard of 10 years ago.
Per an editorial note from Dr. Redberg: “We suggest a better approach to preventing the epidemic of obesity and its multiple health-related complications is emphasis on healthful diet, weight loss when appropriate, and increased physical activity at all levels—by schools, the medical profession, and public health and governmental agencies.”
But Rita, don’t you realize that there is way more money in disease than in health?