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Life? There’s a Pill for That

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Burden S. Lundgren
September 19, 2019

Attention deficit hyperactivity disorder, pre-menstrual syndrome, panic disorder, chronic fatigue syndrome alcoholism, addiction, obesity, anxiety. None of these were in existence as named medical conditions a few generations ago. Are these new diseases and therefore subject to medical treatment, or are they something else? Who decides? How many other, “Diseases” might, in fact, be considered simply as life problems?  Is simple deviance from a norm automatically subject to medical intervention?

Although there is a substantial community of alternative and complementary practitioners and other professionals (e.g., psychologists, clinical social workers, physician assistants, advanced practice nurses) who are allowed to diagnose, physicians remain the conventional professionals who diagnose and treat disease—and, more importantly, the decision-makers as to what constitutes disease. The physician supply in the United States has escalated rapidly—from 14.8 per 10,000 people in 1970 to 25.9 per 10,000 in 2016. Are all these physicians inventing more diagnoses so they will have more to do? They would deny that, and the Association of Medical Colleges (AAMC) projects a physician shortage of nearly 122,000 physicians by 2032 mainly driven, they say, by a growing, aging population.  

The basket of medical diagnoses comes and goes through time. Extinct 19th century medical diagnoses include hysteria, neurasthenia (still a diagnosis in China and other countries), chlorosis and masturbation. Nineteenth century sins included alcoholism and homosexuality both of which were medicalized in the next century with the latter de-medicalized in the 1970s. Most childbirths in the Western world are attended by healthcare professionals although most childbirths are perfectly normal and could actually be accomplished alone or with the assistance of family or friends. Is childbirth a medical event just on the chance that something could go wrong—although that’s seldom the case?

Many call the medicalization of life conditions, “Disease mongering,” promoted largely, but not exclusively, by pharmaceutical companies seeking to extend their markets. The more diagnoses, questionable or not, that can be treated with drugs, the greater the profits. Do we have diseases looking for drugs or drugs looking for diseases or—as is so often the case – syndromes? Are the companies creating diseases as is possibly the case with Glaxo’s drug for restless legs syndrome and Pfizer’s for fibromyalgia, two conditions still not accepted by many physicians? It’s not that these conditions may not exist, but the aggressive marketing of drugs for non-medically defined conditions does, at the least, raise questions of conflict of interest. Is a disease a disease because a drug company says it is?

We could superimpose a map of the opioid epidemic over a map of the states most affected by poverty and its associated ills—joblessness, hopelessness, homelessness, domestic violence, poor nutrition, lack of education—and come up with a good match. Setting aside the role of the pharmaceutical companies, were the physicians in these areas treating pain or attempting to ease the social ills in their regions? Often health care professionals, with the best of intentions, find themselves confronted with problems they feel ill prepared to address. It was not too long ago that battered women who showed up in emergency rooms found themselves patched up and sent out. Assault was not considered a medical concern. When I was teaching, my students—mainly health care professionals—were indignant about people who kept showing up at their hospitals because they were, “Lonely.” In fact, loneliness is a marker for premature mortality. But is it medical? Should medical professionals be responsible for addressing it? Health care professionals, like most people, are frustrated by problems they can’t solve. If they can write a scrip that will make a patient feel better, they are likely to do so. And 21st century patients are used to a pill for everything and will often demand one if not offered.     

Social medicine, defined by Merriam Webster as the, “Organized investigation of social, genetic and environmental factors influencing human disease and disability and promotion of methods of prevention of disease and health measures protective of individual and community,” was born in the mid-19th century at the same time that the practice of medicine was becoming a narrowly focused science. With its wide-screen look at health and disease, the description could well serve as that of public health. Indeed, many in public health have embraced what the World Health Organization terms “The social determinants of health,” while others have complained that that kind of broad definition is limitless and therefore useless as a science.

Medical boundaries are porous and shift over time while siloed administrative bureaucracies do not. Those that deal with medical services do not routinely cross over with those providing social services. But both private and public sectors are beginning to look at the relationships between the two. Some hospital systems looking to avoid punishment for readmissions from insurers are looking to identify and address community factors that contribute to those readmissions. Studies have shown that there is a substantial medical cost benefit for crossover programs such as using Medicare funds to provide meals for beneficiaries who need them or using Medicaid funds to house the homeless. Sometimes the best medicine is food and shelter.       


Author: Burden S Lundgren, MPH, PhD, RN practiced as a registered nurse specializing in acute and critical care.  After leaving clinical practice, she worked as an analyst at the Centers for Medicare and Medicaid Services and later taught at Old Dominion University in Norfolk VA.  She has served as a consultant to a number of non-profit groups.  Presently, she divides her time between Virginia and Maryland. She can be reached at [email protected]

 

 

 

 

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