Vanessa Temple 						Research Paper for Philosophy 432

The Plague of Over-Medicalization

Over the last few decades Westerners have reached towards the medical industry more and more in an attempt to heal themselves which has subsequently resulted in medicalization and finally over-medicalization. The treatments, therapies and medications provided and prescribed by those in the industry do serve a purpose and are quite necessary and valuable in improving quality of life in certain circumstances but things have reached a point whereby people believe they need these in order to be healthy. Once the wheel of a medicalized life starts to turn it can be difficult to reverse. The fact that both adults and children are now more than ever being treated with pharmacological therapy creates a culture of dependence; dependence on pharmaceuticals as the only way to be healthy as well as dependence on an existence that somehow doesn't seem full if a daily regimen of pills is not a component of it.
How we got to this point and the detrimental effects of over-medicalization involve cultural and psychological factors that continue to keep us under the influence of this chronic cycle of misinformation. Our reluctance toward more holistic therapies and the misbelief that hospitals and doctors always provide the best of treatment options is part of and helps to perpetuate this cycle.

The Beginnings of an Epidemic

To first understand this phenomenon it is necessary to know what is meant by the term medicalization. Outspoken doctor, priest and fervent critic of the medical establishment Ivan Illich first coined the phrase in the 1970s. In a 1974 article he said that: “By transforming pain, illness, and death, from a personal challenge into a medical problem, medical practice expropriates the potential of people to deal with their human condition in an autonomous way and becomes the source of a new kind of un-health.” (Illich, “Medical Nemesis*”, pg. 919). He was saying that the medical profession had turned into a “medical Nemesis” by turning their focus toward profits and away from the health of their patients, effectively corrupting the medical care industry to the point where they took away the patient’s autonomy regarding their health. As Dr. Marcella Colbert notes in her paper on these changing perspectives of the medical community, “One account sees human life as a gift, something sacred; the other sees human life as something to be manipulated.” (Colbert, “The Medicalization of Death and Dying”, pg. 228). All of these diagnoses and all of these treatments are really just manipulations of the human body and mind at our own expense, literally.
A good definition, absent the emotive content of Illich’s, is provided by Wikipedia: "Medicalization is the process by which human conditions and problems come to be defined and treated as medical conditions, and thus become the subject of medical study, diagnosis, prevention, or treatment." (http://en.wikipedia.org/wiki/Medicalization). Medicalization multiplied exponentially is over-medicalization and is what defines the current state of healthcare in the United States.
There is a pill and a treatment for seemingly everything and everyone in the modern U.S. Our society does not exclude based on any factor when it comes to over-diagnosing and then over-treating. Dr. Gilbert Welch sees this as an epidemic of sorts and this epidemic is the perfect description of what constitutes over-medicalization and its subsequent effects on the modern world. If you have a little sleeplessness then you’re diagnosed with insomnia; if your legs twitch then you have restless legs syndrome; if you have some sadness then you have depression, and on and on. With developments in diagnosis from increased technology and the ever evolving language of what constitutes these diseases it could be surmised that more than half the population is sick. All of this is, of course, to the advantage of the bottom line of everyone involved in the health industry. (Welch, “What’s Making Us Sick Is an Epidemic of Diagnoses”) So, how did we get this way?

Culture of Fear:

The most important way to understand medicalization is to think about human psychology and the reasons for why we've grown to think that meds are a must. It is reasonable to suggest that most of it stems from fear; fear of being in pain; fear of suffering long into old age and, accordingly, of not living to a ripe old age at all. Ironically, this psychology has led to the creation of a medical industry that with its abundance of diagnoses and treatments has actually lowered the quality of life of many of its patients. This psychology of fear and its inevitable detrimental factors has led us to always be under the thumb of the medical industry, whether we know it or not. Ray Moynihan and Alan Cassels elaborate on this in their book Selling Sickness. The authors note how the pharmaceutical industry has become very skilled at marketing drugs toward healthy people by capitalizing and exploiting, “…our deepest fears of death, decay and disease…” (pg. ix).
To better get at healthy people the industry got into what Vince Parry calls “condition branding” whereby a disease or a condition is created, described and then capitalized on through medications developed specifically for that disease or condition. By doing this the industry is effectively brainwashing people into thinking that these conditions are both real and that they then need to be medicated because of them, thus capitalizing on our culture of fear. (Parry, “The art of branding a condition”)[1] Illich called this “iatrogenesis” whereby people become ill due to the increased stress put on them by the medical industry in situations like the one described above. (Illich, Medical Nemesis, Chapter 2). Our fear is literally making us sick and costing us billions.

Cost:

A major topic of concern regarding medical services and prescriptions is that of cost. It is rather ironic that with healthcare costs in the U.S. skyrocketing over the years that people would stop clinging to their prescription bottles but this isn't so. The U.K. spends around 9 billion pounds yearly on prescriptions while the U.S. spends a staggering 300 billion dollars. (Goldacre, Big Pharma, pg. 243). You don’t have to be a statistician to see just how vast that monetary chasm is.
With all of the prescriptions we are taking one would think that we’d have a healthier population but we don’t. Cancers of all kinds are on the rise as are heart disease and diabetes. These rising rates shouldn’t be accepted at first-glance though because of the over-diagnosing epidemic which is making us seem sicker than we actually are. This has gotten so bad that a resident after being questioned by a doctor about what his definition of a well person would be replied, “A well person”, he said, is “someone who has not been completely worked up”” (Kolata, “If You’ve Got a Pulse You’re Sick”). So, this can make it very hard to compare the numbers regarding treatments and prescriptions between different countries because they are not a proper barometer of how sick a population actually is.

Reluctance for Holistic Therapies:

As Westerners we've always thrown around the phrase 'there's no magic pill' and the fact that we combine the idea of magic with a pill says something about what we consider to be therapeutic and what we don't. We've brainwashed ourselves about pharmaceuticals and modern medical treatments to the point where therapies other than the ones to be found in prescription bottles or in professional medical settings are sub-par and not to be taken too seriously. However, overwhelming evidence points to the effectiveness of ‘alternative treatments’ as we call them.
An exhaustive and highly selective meta-analysis of randomized control trials on acupuncture found that it is truly effective at treating chronic pain. (Multiple Authors, “Acupuncture for Chronic Pain: Individual Patient Data Meta-Analysis”). Though the results are striking and obvious this practice is still not as well accepted as you think one would be that produces significant analgesic effects. A needle being inserted into the skin that achieves true pain killing results is hard for us Westerners to wrap our heads around because we've been raised in a culture that has taken away our ability to think that a therapy that is not grounded, first and foremost, in science and technology can actually be effective. Growing up in a culture where technology has been relegated to a god-like status the difficulty in understanding something that is ancient and not the result of a complicated process in a laboratory can often times be an insurmountable task. As a chronic pain sufferer it took desperation for me to finally try acupuncture and I was completely astonished that I received actual pain relief.
Though the study found positive results there was also this rather puzzling statement in the conclusion section of the study, "Acupuncture is known to have physiologic effects relevant to analgesia but there is no accepted mechanism by which it could have persisting effects on chronic pain." After some thought I came to the realization that they were unable to come to the finding that it does have persisting effects because our entire scientific model is based on something that renders the processes and methods of acupuncture alien and obsolete at best and therefore cannot be properly studied. Our language of pain management is quite different than that of more Eastern methods like yoga and acupuncture and this makes it difficult to form a proper analysis because what we consider to be an "accepted mechanism" is not relatable to theirs. We almost need a medical Rosetta Stone that would allow us to interpret these foreign procedures into our own scientific language.
If a treatment doesn't come from the pharmaceutical industry then we immediately relegate it to the 'quack' category and even with indefatigable proof that many studies such as the one noted above have provided we still drag our feet. More evidence of this can be found in our false perception of the efficacy of hospitals.

Hospitals:

Another example of our reluctance to embrace non-Western medicine can be found simply through the fact that most everything of major medical consequence happens in a hospital today. Some things, like surgery and invasive procedures, should of course be done in a hospital setting but certain others may best be done at home. The most significant of these would be birth and death.
The literature describing the outcomes of home versus hospital births overwhelmingly points to the fact that home births have far less complications than hospital births. The statistics are quite startling when considered from my ‘raised in Western medicine’ perspective. The rates for most infections, post-partum hemorrhaging, lacerations, cord prolapse and retained placenta all show that these happened much more frequently in a hospital setting. There were also less premature and low birth-weight infants at home births. The fact that this data comes from a meta-analysis makes it all the more shocking and impressive. What should be noted is that this study is not all inclusive and that the women giving birth were accompanied by, "...highly trained, regulated midwives who are fully integrated into existing health care systems." (Multiple Authors, “Maternal and newborn outcomes in planned home birth vs planned hospital births: a meta-analysis”).
The authors don't say exactly what this means but from the perspective of this paper I think it is important to point out that though these are home births and they are successful the midwives are trained by Western medicine and so my point is not flawlessly made by this example. However, it would be impossible for a midwife in the developed world to not have been trained by Western medicine and influenced by Western ways to some extent, as they wouldn't be able to do their jobs correctly if they weren't caught up with current practices.
Death should and does figure most prominently in a proper representation of what it is to be part of the American health system in our current era. One rarely if ever hears someone talk about how much they enjoy being in the hospital yet you will often hear about just how much people hate to even have to visit, let alone live in, one. Dr. Welch who described my over-medicalization epidemic for me earlier makes some poignant comments about death in hospitals these days. He says that hospitals are noisy, uncomfortable places where, “The prevailing paradigm is prevention, not comfort”. (Welch, “The medicalization of life”). He notes that the amount of Medicare patients who spend time in an ICU during the last six months of their life has increased by 25% between 1995 and 2005. That is a substantial amount of people having to suffer through the miseries of spending their last days in a hospital.
Palliative end of life care, or hospice, is the alternative to the blunt, unfeeling death a person would experience in a hospital and takes into account the question, “…what is a good death?” (Floriani and Schramm, “Routinization and medicalization of palliative care: Losses, gains and challenges” pg. 295). The authors of this article note how hospice routinely butts heads with the more Western model of medicalized death because it involves, “…an attitude that demanded a more natural death in non-authoritarian and non-bureaucratized institutions, where interpersonal relations were reinforced.” (pg. 297). One can see why this would not agree with a medical establishment that is all about control. They do note that hospice care has become more medicalized and subsequently weakened because of it. If we’re not careful, they say, it too will become a prisoner of the medical establishment. (pg. 302). Hospice care is, sadly, just one of the many facets of healthcare and society as a whole that medicalization has had a detrimental effect on.

Detrimental Effects:

Doctors are not only the perpetrators of medicalization but can also be the unwitting victims. With doctors seeing more and more patients they have less time to review the most recent medical literature and scientific data to see what the most helpful therapies would be and are often left in the dark as to possible new treatments. (Goldacre, Big Pharma, pg. 242, 243). The same goes for prescriptions and doctors are sometimes left prescribing drugs that more recent studies have shown to be ineffective or, at worst, harmful to the patient. (Goldacre, Big Pharma, pg. 5-7). Moynihan and Cassels make a great point about this when it comes to doctors and the marketing of drugs. “…doctors, the people we trust to give us untainted advice about powerful pills, become part of the marketing campaigns for those very same pills, no matter how independently minded they might be-not just helping to sell the medicines, but helping to sell a particular definition of disease that expands the markets for those medicines.” (Selling Sickness, pg. 7). So, doctors, no matter how you look at it, are not the faultless gods we make them out to be and neither are the treatments they prescribe.
Many of these detrimental effects can be found in treatments, such as those for menopause and prostate cancer, which were later found to cause more harm than good to patients only after millions were injured. Even though the literature overwhelmingly points to the lack of beneficial side effects from things like PSA screenings and hormone replacement therapy people continue to get them because of our culture of fear.
The most serious of these would have to be screenings for prostate cancer. The newer tests for prostate cancer reveal more tumors but these are what are called, “…indolent or clinically insignificant cancers…” that will never develop into a serious tumor during the patient’s lifetime. (Multiple Authors, “Overdiagnosis and overtreatment of early detected prostate cancer”). The main point of contention in this debate is the PSA or prostate-specific antigen screening test. The PSA test, though having become the norm for prostate cancer testing, has always been a controversial one due to people in the medical profession debating whether or not it is actually beneficial. The fact that the heightened sensitivity of the test will detect more cancer in more men leads to “treatment morbidity” because the majority of the cancers are of the indolent type and will never actually harm the patient. By “treatment morbidity” the authors mean procedures the men will undergo after the diagnosis, such as surgery and radiation, which can lead to, “substantial adverse effects”; meaning all the possible negative side effects of surgery and radiation. (Hayes and Barry, “Screening for Prostate Cancer With the Prostate-Specific Antigen Test,”). This adds to and continues to perpetuate the psychology of fear whereby men receive a positive cancer diagnosis and plunge headlong into unnecessary treatments that end up ravaging their bodies and decreasing their quality of life. A big chunk of alleviating this fear is education. This meta-study found that men who are more informed about prostate cancer and prostate cancer screenings will benefit more from these procedures. Having honest, open discussions with their doctors helps immensely in keeping themselves properly informed.
The main problem here is that many patients just accept whatever their doctor recommends without questioning because they feel that doctors always know best. While the doctor most likely has the best interest of the patient in mind the doctor is still a fallible human being capable of making mistakes and therefore the patient should take charge of their medical care and educate themselves so as best to facilitate the creation of an ideal decision making process.
An alternative to aggressive treatments following diagnosis of prostate cancer from PSA screenings is what is called ‘watchful waiting’ where the patient undergoes no treatment after the initial diagnosis and is instead closely monitored for changes in symptoms. In the study I cite here many of the men reported that their quality of life wasn’t improved much by the more aggressive treatments and that the doctors pushed these treatments on them, some not even telling them ‘watchful waiting’ was even an option. (Multiple Authors, “Is ‘watchful waiting’ a real choice for men with prostate cancer? A qualitative study”).
As a woman ages she will eventually reach menopause. This natural process, after being medicalized, ended up harming more women than it helped with menopausal hormone therapy or hormone replacement therapy, as it is usually called. A study by the NIH found that these hormones ended up causing urinary incontinence, dementia, stroke, blood clots and heart attacks in certain women. The purported lowered risk for hip fractures and breast cancer hardly seems worth it. (National Cancer Institute, “Menopausal Hormone Therapy and Cancer”). By medicalizing a natural process we ended up doing a fair amount of harm to women who, had they been left untouched, would have just suffered through the symptoms of menopause like women have done for thousands of years. As Moynihan and Cassels note, the industry used an intense campaign of scare tactics and celebrity endorsements to convince women that they absolutely needed hormone replacement therapy and that everything about their lives, including sex, would be devastated without it. (Selling Sickness, pg. 41-44).

Addiction:

Probably the most detrimental effect of over-medicalization is that of addiction. People’s lives and the lives of those close to them are devastated by addiction and the consequential factors that stem from it. Addiction is truly a disease and one that is perpetrated by doctors who haphazardly prescribe drugs that are known to be habit forming and parents whose relaxed attitudes about these drugs has led to a surge in abuse by both adults and children. There is addiction to street drugs and alcohol and then there is addiction to prescription drugs. Not to say that the two are mutually exclusive, as they’re not, but prescription drug addiction is different because of the way in which drugs are obtained and perceived. A brain chemical comparison shows that both street and prescription drugs act on the same brain system. (National Institute on Drug Abuse, “Topics in Brief: Prescription Drug Abuse”).
This is a disturbing trend because it is effecting not only adults but our society’s children as well. Prescription drug abuse has become rampant among teenagers as a 2013 study showed that, “one in four teens has misused or abused a prescription drug in their lifetime-a 33% increase over the past five years.” (Goldberg, ““National Study: Teen Misuse and Abuse of Prescription Drugs Up 33 Percent Since 2008…”). Accompanying and effectively exacerbating this trend is the fact that both parents and teens have a relaxed attitude about prescription drugs as they assume them to be safe mainly because they’re prescribed by doctors. Twenty-percent of parents even admitted giving prescription drugs to their children that weren’t prescribed to them. The science shows though that they can be just as harmful and just as addictive. They have all the risks of street drugs but the fact that they are prescribed as therapies masks their true negative potential on the user. Another nail in this coffin is that these drugs are much more readily available being in the family medicine cabinet and so kids don’t always have to go to a shady drug dealer to get them as they would have to do with street drugs. What’s even more alarming is that teen drug abuse of most other drugs, including marijuana and cocaine, has remained stable while prescription drug abuse has skyrocketed. Prescription drugs have become the new drug of choice of America’s children. (Goldberg, ““National Study: Teen Misuse and Abuse of Prescription Drugs Up 33 Percent Since 2008…”).
Prescription drug abuse in older Americans has risen as well. Studies find that adult baby boomers who became addicted to prescription drugs in their thirties or forties have aged and kept their addictions along for the ride thus increasing the percentage of older addicts. A comment made at the end of this study is from a website devoted to finding rehabilitation services for people seeking treatment for opioid dependence which found that the average patient age was thirty-seven with many being over fifty and coming from states like Florida, “with a large retirement demographic”. (Join Together Staff, “More Older Adults Seek Treatment for Substance Abuse”).
These addictions end up costing society in more than one way. The prescribing rate of oxycodone in New York City rose by 66% in two years and this is an indicator of the increased crime perpetrated by addicts on pharmacies and individuals. (Goodnough, “A Wave of Addiction and Crime, with the Medicine Cabinet to Blame”). Treating addiction and the ripples it creates in society, like increased crime and the need for more rehabilitation services to deal with addicts, is costing us billions each year. “A study published in 2011 in the Clinical Journal of Pain found prescription drug abuse led to $42 billion in costs related to lost productivity, as well as $8.2 billion in criminal justice costs.” (Join Together Staff, “Prescription Drug Abuse Leads to Higher Health Care Premiums, Fraud Group Says”). There are the financial costs but also the costs of pain and suffering, something that is impossible to measure and the consequence we should most worry about.
Not to worry though, the pharmaceutical industry has this covered too, with prescriptions like Subutex, Suboxone and Zubslov. Soboxone and Subutex made about 1.3 billion dollars in 2012 and Zubslov, the newest in line, is expected to bring in at least 500 million dollars in its first year. (Clarke, “FDA Approves Orexo drug to treat opioid addiction.”). The pharmaceutical industry is obviously very skilled at keeping people medicated for as long as possible. Suboxone, the most well-known of these drugs, “safely mimics some of the effects of opioids, while reducing drug cravings, helping to control withdrawal and preventing the same “high” if patients were to abuse opioids while on Suboxone.” (Jojic, “For Painkiller Addicts, Suboxone Means Freedom, Dependence). I really don’t see how these medications are anything more than weak narcotics if the patient is still experiencing a high. This is the industry taking advantage and perpetuating an addiction they started. They have literally enslaved some of us with narcotics and the implications are dire if we continue to let this happen.

Conclusion:

In an enlightening TED talk on medicalization Ivan Oransky said that, “…100,000 people a year -- and that's a conservative estimate -- are dying not because of the conditions they have, but because of the treatments that we're giving them and the complications of those treatments…” (Oransky, “Are we over-medicalized?”). He says, though, that we’ve done this to ourselves by thinking that there has to be a problem and so now on top of the multitudinous things one can be diagnosed with we have ‘pre-conditions’ which are really just silly and do nothing except make us worry more than we already do. He makes the perfect point that we, as a culture, need to stop looking to medicine for all of the answers to our problems. Illich makes an astute observation regarding this behavior: "More health damages are caused by the belief of people that they cannot cope with illness without modern medicines than by doctors who foist their ministrations on patients." (Illich, “The Medicalization of Life”, pg. 77).
Over-medicalization has served to turn patients into victims and those in the medical industry into the worst perpetrators of suffering the world has ever seen. The lengths to which these people go to manipulate and brainwash the population of the U.S. into believing they are ill when they really aren’t and to then medicate and treat them for these illnesses is atrocious. Our lack of knowledge regarding holistic therapies and the true efficacy of hospitals perfectly encapsulates the description of this misinformation. The detrimental effects of this plague of misinformation have resulted in a lowered overall quality life not only for those being mistreated but also for those close to the patients and society as a whole as can be seen with addiction. The most insidious facet of over-medicalization is that people continue to think that the industry has their best interests in mind. The medical industry will continue to capitalize on our cultural psychology of fear so long as we remain uninformed and overmedicated.
We need to learn how we can become more educated about our health in a way that will keep the pillars of public health out of the equation so as to develop a flow of information free of the bias they intentionally leak into most medical literature.  We need to open our eyes to the fact that we are being subjugated by the medical industry and that our pain and suffering will continue to increase so long as we remain uneducated and in denial. We’ve given up control of what is ours by natural right, our bodies, and if we can take back our autonomy then there is hope that we can reverse medicalization. This will take a massive cultural and psychological revolution, a move that will in itself be painful, but if medicalization can be reversed in the process it is worth it. Our culture of fear can finally be useful if we shift our perspective and begin to fear the medical powers that be.

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