The medicalization of everyday life

bad science coverDr.  Ben Goldacre, a British doctor writing in his weekly Bad Science column in The Guardian last fall, told this disturbing cautionary tale:

“In 2007, the British Medical Journal published a large, well-conducted, randomised controlled trial, performed at lots of different locations, run by publicly-funded scientists.  It delivered a strikingly positive result.  It showed that one treatment could significantly improve children’s anti-social behaviour. The treatment was entirely safe, and the study was even accompanied by a very compelling cost-effectiveness analysis.

“But did this story get reported as front page news? Was it followed up on the health pages, with an accompanying photo feature, describing one child’s miraculous recovery, and an interview with an attractive happy mother with whom we could all identify? 

“No. This story was unanimously ignored by the entire British news media, despite their preoccupation with anti-social behaviour, school performance and miracle cures, for one very simple reason: the research was not about a pill. It was about a cheap, practical parenting programme!”

And if it’s just a regular, non-drug, non-medical kind of treatment for bratty kid behaviour – like a cost-effective parenting programme – it’s not going to make money for anybody the way that a diagnosis of oppositional defiant disorder can.

I love this WebMD clinical definition of oppositional defiant disorder, by the way:

“In toddlers, temperamental factors, such as irritability, impulsivity, and intensity of reactions to negative stimuli, may contribute to the development of a pattern of oppositional and defiant behaviours in later childhood.”

(Irritability? Impulsivity? Intense reactions to negative stimuli? If those were actual contibutors, according to my admittedly non-scientific observations as the parent of former toddlers, every second kid at St. Christopher’s Montessori preschool should have been institutionalized and on Ritalin).

What does make money, at any rate, is taking a normal, everyday event or personality trait, and then re-defining it as pathology by ‘medicalizing‘ it into a condition that must now be treated medically.  Brilliant marketing and make-work strategy.

However, even aside from Big Pharma – who stand to gain the most from medicalizing virtually everything – many experts join Dr. Goldacre in lamenting the evolution of some clinical practices that may actually have little medical justification. For example, Dr. Thomas Szasz, in his controversial 2007 book called The Medicalization of Everyday Life, argues that routine neonatal circumcision is one practice that demonstrates how contemporary culture has unfortunately bought into medicalizing practice.

“Routine neonatal circumcision is not justifiable on health grounds (e.g. prevention of cancer or infection), is ethically and medically on a par with female genital mutilation, and, hence, is an essentially religious ritual that is legitimized as a medical practice to serve ideological, political, and religious interests.”

Dr. Szasz reserves his harshest criticism for psychiatrists, even though he is one himself.

He accuses his profession in general of protecting people from having to assume responsibility not only for their own health but also for the behaviours that make them ‘ill’, literally or figuratively.

He is well-known for his famous conclusions that mental illness is a harmful myth, that his own chosen profession of psychiatry is not a bona fide medical specialty, and that psychiatrists are not medical experts. You can guess his opinion on the use of insanity as a legal defense.

He maintains that whenever someone is viewed as being sick (ill, diseased) or their behaviour is viewed as the product of sickness (illness, disease), then that behaviour is now viewed as not really under the person’s rational control.

He lists resulting “deep harms” of not viewing people as the responsible authors of their own behaviour, such as the Catholic Church’s initial internal response to child-abusing priests.

“As a consequence, medicalized individuals are viewed as less responsible for their behaviour and as more fitting candidates for being the object of treatment by others. Such individuals are now classified in a way that enlists various practices to deal with them. For example, sick people fall within the domain of medical practice.

“People want a therapist-in-chief who is both physician and priest, an authority that will protect them from taking responsibility. Pandering politicians assure people that their maladies are ‘no-fault diseases’, promise them a ‘patient’s bill of rights’ and stupefy them with an inexhaustible torrent of prescription drugs and propaganda.”

Meanwhile, back in the U.K., Dr. Goldacre (who claims that he rarely even identifies himself as a medical doctor because he believes that “arguing from authority”  is one of the biggest problems in the way that science is misrepresented by the media) offers this tidy history of his profession in a Bad Science column that he also calls The Medicalization of Everyday Life:

“Before 1935, doctors were basically useless. We had insulin, morphine for pain relief – a drug with superficial charm, at least – and we could do operations fairly cleanly, although with huge doses of anaesthetics, because we hadn’t yet sorted out well-targeted muscle-relaxant drugs. Then suddenly, between the 1930s and the 1970s, science poured out an almost constant stream of miracle cures.

“Everything we associate with modern medicine happened in that time: antibiotics, dialysis, transplants, intensive care units, heart surgery, every drug you’ve ever heard of, and more.

“For people who were ill, the difference was spectacular. If you got TB in the 1920s you died, pale and emaciated, in the style of a romantic poet. If you got TB in the 1970s, then in all likelihood you would live to a ripe old age. You might have to take rifampicin and isoniazid for months on end – they’re not nice drugs, and the side effects make your eyeballs and urine turn pink – but if all goes well, you would live to see inventions unimaginable in your childhood.”

Dr. Goldacre particularly laments disease mongering, which is what drug companies have had to do because all the good diseases are already taken. Disease mongering goes like this, says the good doctor:

“Because they cannot find new treatments for the diseases we already have, the pill companies have instead had to invent new diseases for the treatments they already have.

“Recent favourites include social anxiety disorder (a new use for SSRI antidepressant drugs), female sexual dysfunction (a questionable diagnosis in women), the widening diagnostic boundaries of restless legs syndrome, and even something called night eating syndrome.”

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11 thoughts on “The medicalization of everyday life

  1. More and more, I can’t help but believe that the “cure” to so much of what ails us lies in prevention, via good ol’ healthy diet and exercise.

    Thanks for another thought-provoking article, and for opening my eyes to the notion that I may be suffering from “night eating syndrome,” while my husband no doubt experiences regular “restless leg syndrome.” We’ll have to get properly diagnosed, and get some pills for our ailments – STAT! 🙂

  2. I have just finished reading this book. It is a real eye-opener. Highly recommended. Thanks for bringing this book and its author to our attention here. I really like your website – it’s a real education here.

  3. I HAVE Restless Leg Syndrome. It is hereditary in my family. I don’t know what “the widening diagnostic boundaries” of RLS means, because only recently have the diagnostic criteria for the disorder even been standardized. There are only four of them, and my family’s symptoms fit them perfectly. Either a person fits all four criteria or they don’t. And if they don’t, they don’t have RLS.
    Please refer to the Restless Legs Syndrome Foundation for more information.

    • Hello Natalie,

      Dr. Goldacre (and many others) are not saying that RLS doesn’t exist.

      Their point is that the pharmaceutical industry (notably GlaxoSmithKline) began promoting awareness of RLS back in 2003 to help sell more of its drug, ropinirole. GSK began with press releases about its paid presentations at the American Academy of Neurology meeting describing early trial results of using ropinirole for the treatment of RLS. Two months later, GSK issued a new press release entitled “New survey reveals common yet under-recognized disorder—restless legs syndrome—is keeping Americans awake at night” about an internally funded and unpublished study.

      You might be interested to learn that the Restless Legs Syndrome Foundation you recommend is heavily subsidized by GlaxoSmithKline.

      As the journal Public Library of Science Medicine concludes in its April 2006 report, “Giving Legs to Restless Legs: A Case Study of How The Media Helps Make People Sick”:

      “The market for RLS treatment gets enlarged in two ways:
      – by narrowing the definition of health so normal experiences get labeled as pathologic
      – by expanding the definition of disease to include earlier, milder, and pre-symptomatic forms

      “In a large 2004 Johns Hopkins study reported in the Archives of Internal Medicine, only 7% of subjects being treated for RLS reported all four RLS diagnostic criteria, and only 2.7% reported moderately or severely distressing symptoms two or more times per week (i.e., the group for whom medical treatment might be appropriate).

      “Media coverage of RLS (33 published articles about RLS reviewed by PLoS Medicine) exaggerated the prevalence of disease and the need for treatment, and failed to consider the problems of over-diagnosis. About half of these articles reported that the syndrome is under-diagnosed by physicians (“…relatively few doctors know about restless legs. This is the most common disorder your doctor has never heard of”) and under-recognized by patients (“…many people can suffer in silence for years before it is recognized”). One-quarter of articles encouraged patient self-diagnosis and suggested people ask their doctor whether restless legs might explain various problems (including insomnia, daytime fatigue, attention deficit disorder in children, and depression).

      In essence, the media seemed to have been co-opted into the disease-mongering process.”

      You can read the rest of the Public Library of Science Medicine report here.

      • Dear Carolyn,
        First, I want to thank you for taking the time to respond to me!

        I appreciated the information on what you were talking about concerning “disease mongering”; I now understand what you were talking about.

        My biggest concern, of course, is for people like me, who suffered daily (or maybe I should say nightly) for decades before any doctor took notice or engaged with what I was trying to tell them. My brother and I fall into the severe category — we suffer nightly, and often during the day as well — and neither one of us responded to Requip. As a result, he’s on Hydrocodone (?) and I’m on Xanax, but neither one of us experience full relief.

        As a patient, I would encourage further research into finding the physiological basis of the symptoms, refining diagnostic criteria and finding more effective treatments. I also do believe there are people who suffer but do not speak up — when I was a child and teenager, I said nothing because I thought it was normal — my symptoms were much milder at the time, and only lasted about 1/2 an hour.

        Now, in my 60’s they can keep me squirming in agony for 6 – 8 hours. One of the reasons I started asking doctors for relief was because I read about it in the media — they are not totally useless! The RLS Foundation has been useful to me, if only for confirming that I do fit the four criteria exactly. So unless doctors specifically ask about the problem, I don’t think that it will be properly diagnosed without public education.

        It’s actually a mixed bag, isn’t it?

        • Hi Natalie – you are so right. It IS a mixed bag! I am a heart attack survivor, and I have seen the same irony in cardiac circles. There are those in mid-heart attack who are being sent home from the E.R. (as I was!) with misdiagnoses ranging from indigestion to anxiety to menopause. At the same time, we see Big Pharma trying to push their statin cholesterol drugs onto more and more people – including those who are at very low risk for ever having a cardiac event. I even heard a cardiologist joke (I think he was joking?) that we should just put statin drugs into our drinking water! That’s an example of “disease mongering” at its finest. And how tragic that those who need and deserve medical treatment can be ignored, while drug companies are looking to expand sales to healthy people who don’t need treatment but are demanding it based on those expensive “ask your doctor” ads.

        • Well, it took me years to realize I have RLS. No doctor ever asked me, they treated me as a psychological problem. I discovered RLS and the name of the disease by googling my symptoms. And a short period later I helped my mother to recognize that she has RLS too. I have a more or less milder form, but nevertheless it stops me from sleeping well almost every night – if at all. Levodopa helps, but I try to not take it, because I do not want to get into the state to need the more powerful drugs – because they all have severe secondary effects.
          So yes, I do understand the problems of commercial interests and pharmacological industries. But I also do insist that more public education about those little diseases are highly needed.

  4. Now that everyone has been taking the old drugs with the quoted side effects that no one listens to, there need to be new drugs to combat the diseases caused by the old drugs (with new side effects). Can somebody say DNA manipulation? However, that said, what about all the waste from Big Pharma production plants? Where does it go? Question is: what will I do when the pain gets too intense in an operation, I can’t sleep at night, or my sex life stinks?

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