Map of life expectancy at birth from Global Education Project.

Tuesday, June 01, 2010

Neither good nor bad . . .

it is what it is. Medicalization, that is. I referred a while back to Peter Conrad's "The Medicalization of Society. Now Peter and colleagues have calculated the medical expenses associated with 12 "medicalized" conditions in the U.S.. (Abstract only for the little people.)

Now, you may feel that is a step forward that some of these conditions have been medicalized; you may have your doubts about others. They are: Anxiety Disorders, e.g., "Social Anxiety Disorder," formerly known as shyness; Behavioral disorders including ADD and ones from which I occasionally suffer such as Oppositional Defiant Disorder and Intermittent Explosive Disorder; Body Image Disorders, i.e. people don't like their nose or their tush so they get surgery; Erectile Dysfunction; Infertility; Male Pattern Baldness; Menopause (treated with hormone replacement therapy); Normal pregnancy and delivery; Sadness, now called minor depression and treated with pills; Obesity, formerly known as fatness; Sleep Disorders; and Substance Use Disorders - gradually medicalized since the 1960s and now often treated with pills such as Suboxone and Welbutrin.

Peter and the gang don't find these to be a major contribution to overall medical spending - in the 70s of billions a year, which used to be a lot of money but which is less than 4% of overall medical spending in the U.S. And they don't try to figure out whether we're getting our money's worth for all this. That's actually a very complicated question that has to be analyzed on a case-by-case basis. With respect to some of these, there is a respectable case to be made that much of medical intervention is in fact counterproductive, but those are controversies I'm not going to take on with this post.

What we can say more generally about most of these, however -- and which is more or less what Peter says -- is that turning them into medical conditions puts the focus on the individual who, in one way or another, doesn't fit in to social expectations or has a problem induced by the social environment; and so turns attention away from the social context. Third graders who don't like to sit quietly in rows all day and concentrate silently on boring tasks now have a disease, for which they are fed pills which in any other context are illegal, addictive drugs of abuse. Men and women who undergo normal processes of aging take pills to try to preserve an illusion of youth. People who don't conform to cultural ideals of beauty, or who fear that they do not, undergo painful surgery. And so on.

Does this entirely make sense, or is there a better way?


kathy a. said...

isn't oppositional-defiant a kids-only diagnosis? [otherwise known as teenagerhood.] intermittent-explosive tends to be treated by incarceration, so i don't think you've got that, either.

more seriously, some of these things can benefit from some kind of intervention -- not necessarily a pill. "just get over it" tends not to work well for serious anxiety or for substance problems. pregnancy and delivery are not states i would care to handle without medical assistance.

JMT said...

A few thoughts now that I've had time to look at the article.

I echo Kathy that it seems like there are some sub-categories within the list. Most of them are definitionally negative (I'm avoiding the term pathological); others aren't (say, baldness, menopause, normal pregnancy/delivery, obesity). Baldness and menopause I'd tie together under "deal with it, you're aging." Obesity is complicated; there are obvious health correlates but I think they not so tight as is commonly believed. I have been under the impression that the fat acceptance movement was largely concerned with obesity as a social issue, but I imagine it's broader than that and probably encompasses health in some quarters too.
Pregnancy/delivery is my own area of interest these days. The authors acknowledge in particular that removing pregnancy from any medical care at all (i.e. unassisted home birth) is probably a bad idea. I agree that normal pregnancy/delivery is inappropriately medicalized in the US. I think one problem is that we don't have a good societal category for 'things that are fundamentally normal but open up the possibility of pathology' and so into the hospital birth goes. Put another way, the midwife model of care is anomalous; we don't have other things like it (nor a good understanding of risk) and so we act as though *all* scenarios were worst-case scenarios. My reading on this has been mostly from an anthropological point of view; I wonder what that POV would say about the other 11 conditions. Sorry to babble on.