Health, medicalisation of life and medical market
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Prof (Dr) MA Razaque
The World Health Day is observed every year on the 7th April. On this day let us take a fresh look into our health and health-care attitude. It is still true that 'Health is Wealth". If you are healthy you won't spend on doctor's visit, on laboratory test and medicines. Also you can work hard and earn more. So why should we not care about our health? The World Health Organisation defines health as a state of complete physical, mental and social well-being and not merely the absence of disease. Health is also a state of complete harmony of body, mind and spirit. The human body is composed of 1013 eukaryotic cells ( cells with cytoplasm, cell membrane nuclei, chromosomes etc) and is colonised by 1014 commensals (nonpathogenic bacteria) which constitute the intricate ecosystem called the microbiome of the body and plays a protective role against attack by pathogenic micro-organisms.
We are exposed to about one billion micro-organisms per day (Zhong et al 2018). In most cases our immune system and natural defense mechanism can protect and overcome the insult. Also many of the body's tissues can repair themselves. The task of medicine is to promote health, to prevent disease and to treat the sick, (H.E.Sigirist, 1943). Health care services is not just knowledge, healing and caring, - it is about the plight of the patients, and the power of the doctor, the pharmaceutical manufacturers, the insurance com- panies and the power of the government. Thus there is an interplay of health with the state, society and the public.
Modern life creates various kinds of illusions of permanent positive health and fitness and freedom from sickness. Also different circumstances lead to different facets of life such as pain, fever, stress etc. which are being called dis-ease or illness. These may come in many shades and varying grade illnesses like beauty are in the eye of the worried beholder People see what they want or programmed to see. It is said that there are no diseases per se, but only diseased people (Rosenberg CE et at, 1992).
Some of the illnesses are self- limiting, some may be prevented, and some may be cured while few are fatal in spite of all efforts. Medicine for various reasons is allegedly set on a course to put all aspects of life into the hands of the doctors leading to what has been called the "Medicalisation of life" (I. Illich, 1977). Healthier population is being driven to medicating life events and treating trivial complaints with elaborate procedures and medications. According to John Taylor (1694-1761) a doctor is a man who writes prescription till the patient either dies or is cured by nature.
In this context there is an anecdote –“with treatment common cold subsides in seven days and without treatment in one week" -But the doctors cannot be blamed for doing more because they have to protect themselves against legal actions for negligence and for not doing enough to rule out serious illnesses (thanks to the Consumer Protection Act 1986 !!!). All manners of personal habits, vices and indulgences are redefined as ailments.
Medicalisation has also involved normal life processes such as menstruation, childbirth, menopause and ageing. Birth and dying are becoming routinely hospitalised. For childbirth caesarian delivery has become the norm rather than the exception. CS delivery has its own complication not only in the concurrent pregnancy but also in future pregnancies as well. Moreover, the neonatal micro- biome which is colonised by good microbial communities from the mother's birth canal and faeces following normal delivery is lacking/absent in infants born by caesarian delivery. Also the increased trend of formula bottle feeding in opposed to breast feeding further fail to provide beneficial neonatal microbiome which ultimately increases the risk of viral infection and early onset of asthma (Busch AATM et al 2016). Doctors and “consumers' (patients) alike are creating the sickness anxiety. “Everyone has something wrong with them and everyone can be cured”.
The anxious patients believed that each and every organ of the body could produce many defects and disorders, sometimes leading to medicine mongering and medicalisation. Medicine has become a service industry to fulfil whatever fantasies its clients may want for their bodies. Cosmetic surgeries for normal ageing process, implants and enhancement of certain body parts are becoming popular. I Illich wrote in his book’ Limits to Medicine, 1977’- “Scientific medicine has been creating high expectations of an almost infinite prolongation of healthy and fully functioning life.
Such dreams are unrealistic because all of us must age and die”. What is important is the quality of life. There is no denying the fact that advances in medicine had saved many lives, reduce death rate and increased life span, but with more age-related ailments. Recently doctors became aware that patients were not always grateful to be kept alive if the price of a longer life was extra years of pain and discomfort. To assess this aspect a measurement of quality adjusted life years (QALY) was used-which assumes that “one year of healthy life is worth as few years spent in a state of disease or disability”. QALYs are most beneficial in evaluating treatment options for an individual patient. Patient now expect to be advised rather than instructed on their treatment and be given an opportunity to express their own preferences (Roy Porter, 1996 ).
Few pharmaceutical manufacturers also contribute to the increasing medi- calisation by advertising/marketing products with exaggerated and misleading claims. Medicine and medicalization are also seen serving as an arm of the state through compulsory health insurance and the use of medical records to monitor employment, delin- quency and criminality Political dissidence has been called "sick” and subjected to medical and psychiatric correction, still seen in some countries.
After a consultation, the patient expects a prescription with long list of medicines. If the doctor prescribes only one or two medicines he or she is not a “good doctor”. But it is a fact that every medical consultations don't need pres- cription, they need only assurance and counseling. However, when the sufferers are told that their com- plaints are harmless they are unhappy and unsatisfied thereby visiting many doctors leading to more medicalisation.
A doctor treats his patient with good intention and for the best interest of the patient. But no one can predict when a complication may occur in spite of necessary precautions. It is regarded that doctor are like god but they are not god. They cannot save each and every patient due to various known and unknown factors. Every one of us have our own appointed day. How and when we meet the day may be different such as old age, illness, accidents etc. But it does not mean that the patients be left to their fate. What is essential is the doctor's sincerity, dedication and the humane-touch,- treating the patient as a person and not just “ a case of disease". Medicine is about treating the sick people and not the disease (Hermann Nuthnagel, 1882). According to William Osler a Canadian physician, “a good physician treats the disease, but the great physician must be interested in the person as well as their diseases”. In order to stay ahead in this ever- increasing competitive profession and to attract ‘consumers’ (patients) doctors are selling themselves as commodity and depend entirely on unofficial advertising as re- nowned /famous specialists of so and so (which is against the Hippocratic oath).
In this medical market place, each seller constantly relying on his/her salesmanship could tout their wares, and the choice is left to the anxious patients thereby resulting in more medicali- zation. Doctors should recognize the limits of their professional competence (Asher R, 1972).
Medicalization also spreads because the public collude in it. In some cases the culture of ‘sickness’ offers benefits. For some 'being ill’ became a way of life with social sanction and medical encouragement. Under cover of being ill he/she would be temporarily relieved of family and social, responsibility and stay out of work (Talcott, P 1950). Advanced technologies and availability of many gadgets make our life easy, but at the cost of our health through increased inactivity and sedentary life style which often leads to preventable/life-style diseases such as diabetes, hypertension, heart and lung diseases, cancer etc. Many factors contribute to the rise in these diseases, such as (1) the stress of modern life, (2) the long hours, of work (3) reduced time we spend with our family, (4)the highly processed fast food, (5) alcohol and smoking, (6) lack of physical activity and exercise etc.
CONCLUSION : From the beginning of life to its end, medical advances are creating new dilemmas. The doctor as a healer has been replaced to a varying extent by the doctor as a body technician. Patients need someone who is able to appreciate their distress. Medicine has to make full use of the technology without losing the humane contact, otherwise, in this complex interplaying situation, the doctors, the lawyers and the pharmaceuticals companies may do well even if the patient don't get well. Most of the above diseases may be prevented/avoided/delayed thus minimizing medicalization of our life if we follow the "MY HEALTH" approach (M=maintain ideal body weight with balanced diet, Y: Yoga and yearly medical check-up; H= hypertension control; E = Exercise (walking, jogging, swimming and running) A = avoid alcohol; L= Lower sugar and cholesterols level'; T=Tobacco and smoking quiting, H- Hydration (at least 8 glasses /2 litres of water/day). We should age with grace and die with diginity.
The World Health Day is observed every year on the 7th April. On this day let us take a fresh look into our health and health-care attitude. It is still true that 'Health is Wealth". If you are healthy you won't spend on doctor's visit, on laboratory test and medicines. Also you can work hard and earn more. So why should we not care about our health? The World Health Organisation defines health as a state of complete physical, mental and social well-being and not merely the absence of disease. Health is also a state of complete harmony of body, mind and spirit. The human body is composed of 1013 eukaryotic cells ( cells with cytoplasm, cell membrane nuclei, chromosomes etc) and is colonised by 1014 commensals (nonpathogenic bacteria) which constitute the intricate ecosystem called the microbiome of the body and plays a protective role against attack by pathogenic micro-organisms.
We are exposed to about one billion micro-organisms per day (Zhong et al 2018). In most cases our immune system and natural defense mechanism can protect and overcome the insult. Also many of the body's tissues can repair themselves. The task of medicine is to promote health, to prevent disease and to treat the sick, (H.E.Sigirist, 1943). Health care services is not just knowledge, healing and caring, - it is about the plight of the patients, and the power of the doctor, the pharmaceutical manufacturers, the insurance com- panies and the power of the government. Thus there is an interplay of health with the state, society and the public.
Modern life creates various kinds of illusions of permanent positive health and fitness and freedom from sickness. Also different circumstances lead to different facets of life such as pain, fever, stress etc. which are being called dis-ease or illness. These may come in many shades and varying grade illnesses like beauty are in the eye of the worried beholder People see what they want or programmed to see. It is said that there are no diseases per se, but only diseased people (Rosenberg CE et at, 1992).
Some of the illnesses are self- limiting, some may be prevented, and some may be cured while few are fatal in spite of all efforts. Medicine for various reasons is allegedly set on a course to put all aspects of life into the hands of the doctors leading to what has been called the "Medicalisation of life" (I. Illich, 1977). Healthier population is being driven to medicating life events and treating trivial complaints with elaborate procedures and medications. According to John Taylor (1694-1761) a doctor is a man who writes prescription till the patient either dies or is cured by nature.
In this context there is an anecdote –“with treatment common cold subsides in seven days and without treatment in one week" -But the doctors cannot be blamed for doing more because they have to protect themselves against legal actions for negligence and for not doing enough to rule out serious illnesses (thanks to the Consumer Protection Act 1986 !!!). All manners of personal habits, vices and indulgences are redefined as ailments.
Medicalisation has also involved normal life processes such as menstruation, childbirth, menopause and ageing. Birth and dying are becoming routinely hospitalised. For childbirth caesarian delivery has become the norm rather than the exception. CS delivery has its own complication not only in the concurrent pregnancy but also in future pregnancies as well. Moreover, the neonatal micro- biome which is colonised by good microbial communities from the mother's birth canal and faeces following normal delivery is lacking/absent in infants born by caesarian delivery. Also the increased trend of formula bottle feeding in opposed to breast feeding further fail to provide beneficial neonatal microbiome which ultimately increases the risk of viral infection and early onset of asthma (Busch AATM et al 2016). Doctors and “consumers' (patients) alike are creating the sickness anxiety. “Everyone has something wrong with them and everyone can be cured”.
The anxious patients believed that each and every organ of the body could produce many defects and disorders, sometimes leading to medicine mongering and medicalisation. Medicine has become a service industry to fulfil whatever fantasies its clients may want for their bodies. Cosmetic surgeries for normal ageing process, implants and enhancement of certain body parts are becoming popular. I Illich wrote in his book’ Limits to Medicine, 1977’- “Scientific medicine has been creating high expectations of an almost infinite prolongation of healthy and fully functioning life.
Such dreams are unrealistic because all of us must age and die”. What is important is the quality of life. There is no denying the fact that advances in medicine had saved many lives, reduce death rate and increased life span, but with more age-related ailments. Recently doctors became aware that patients were not always grateful to be kept alive if the price of a longer life was extra years of pain and discomfort. To assess this aspect a measurement of quality adjusted life years (QALY) was used-which assumes that “one year of healthy life is worth as few years spent in a state of disease or disability”. QALYs are most beneficial in evaluating treatment options for an individual patient. Patient now expect to be advised rather than instructed on their treatment and be given an opportunity to express their own preferences (Roy Porter, 1996 ).
Few pharmaceutical manufacturers also contribute to the increasing medi- calisation by advertising/marketing products with exaggerated and misleading claims. Medicine and medicalization are also seen serving as an arm of the state through compulsory health insurance and the use of medical records to monitor employment, delin- quency and criminality Political dissidence has been called "sick” and subjected to medical and psychiatric correction, still seen in some countries.
After a consultation, the patient expects a prescription with long list of medicines. If the doctor prescribes only one or two medicines he or she is not a “good doctor”. But it is a fact that every medical consultations don't need pres- cription, they need only assurance and counseling. However, when the sufferers are told that their com- plaints are harmless they are unhappy and unsatisfied thereby visiting many doctors leading to more medicalisation.
A doctor treats his patient with good intention and for the best interest of the patient. But no one can predict when a complication may occur in spite of necessary precautions. It is regarded that doctor are like god but they are not god. They cannot save each and every patient due to various known and unknown factors. Every one of us have our own appointed day. How and when we meet the day may be different such as old age, illness, accidents etc. But it does not mean that the patients be left to their fate. What is essential is the doctor's sincerity, dedication and the humane-touch,- treating the patient as a person and not just “ a case of disease". Medicine is about treating the sick people and not the disease (Hermann Nuthnagel, 1882). According to William Osler a Canadian physician, “a good physician treats the disease, but the great physician must be interested in the person as well as their diseases”. In order to stay ahead in this ever- increasing competitive profession and to attract ‘consumers’ (patients) doctors are selling themselves as commodity and depend entirely on unofficial advertising as re- nowned /famous specialists of so and so (which is against the Hippocratic oath).
In this medical market place, each seller constantly relying on his/her salesmanship could tout their wares, and the choice is left to the anxious patients thereby resulting in more medicali- zation. Doctors should recognize the limits of their professional competence (Asher R, 1972).
Medicalization also spreads because the public collude in it. In some cases the culture of ‘sickness’ offers benefits. For some 'being ill’ became a way of life with social sanction and medical encouragement. Under cover of being ill he/she would be temporarily relieved of family and social, responsibility and stay out of work (Talcott, P 1950). Advanced technologies and availability of many gadgets make our life easy, but at the cost of our health through increased inactivity and sedentary life style which often leads to preventable/life-style diseases such as diabetes, hypertension, heart and lung diseases, cancer etc. Many factors contribute to the rise in these diseases, such as (1) the stress of modern life, (2) the long hours, of work (3) reduced time we spend with our family, (4)the highly processed fast food, (5) alcohol and smoking, (6) lack of physical activity and exercise etc.
CONCLUSION : From the beginning of life to its end, medical advances are creating new dilemmas. The doctor as a healer has been replaced to a varying extent by the doctor as a body technician. Patients need someone who is able to appreciate their distress. Medicine has to make full use of the technology without losing the humane contact, otherwise, in this complex interplaying situation, the doctors, the lawyers and the pharmaceuticals companies may do well even if the patient don't get well. Most of the above diseases may be prevented/avoided/delayed thus minimizing medicalization of our life if we follow the "MY HEALTH" approach (M=maintain ideal body weight with balanced diet, Y: Yoga and yearly medical check-up; H= hypertension control; E = Exercise (walking, jogging, swimming and running) A = avoid alcohol; L= Lower sugar and cholesterols level'; T=Tobacco and smoking quiting, H- Hydration (at least 8 glasses /2 litres of water/day). We should age with grace and die with diginity.