Exam #2 Study Guide

Quiz March 29, OI 77-109

1. What was ambiguous about the vampire metaphor, for Biss?

2. What struck Biss as both magical and mundane?

3. Smallpox is now no longer a disease, but a what?

4. Who were the Polio Pioneers? Where is polio still endemic, and why?

5. What are the profound differences between ethyl and methyl mercury?

6. How did Andrew Wakefield cause a "cascade of panic"?

7. Who accused WHO of collusion in 2009?

8. Why does Susan Sontag say public health is difficult to promote in our society?

9. Why does Arthur Caplan say the marketplace model of healthcare is dangerous?

10. When would Biss consider surgery a conservative option?

11. For what is there no credible evidence, "Dr. Bob" notwithstanding?

12. What's Biss's Dad's argument for preventive medicine?

March 27, OI 40-76

1. "Natural" has popularly come to mean what, in the context of medicine?

2. The most unnatural aspect of vaccination is what?

3. What led to the creation of the EPA?

4. What kind of thinking makes no room for ambiguous identities, and what does it threaten?

5. What "troubling dualisms" characterize the vaccination debate?

6. What practice went on in China and India for hundreds of years, to combat smallpox?

7. What metaphor is implied by "inoculation"?

8. What disappointed Biss about the immuno-semiotics conference?

9. What game metaphor does Biss prefer, to describe our immune systems and viral pathogens?

10. What caused the fatal form of croup that has virtually disappeared in this country since the '30s?

11. What caused the spread of puerpal sepsis ("childbed fever")?

12. What would exceed federal food-safety levels for DDT and PCBs at the grocery store, if sold there?

March 20, Brave New World

1.     Define medicalization.

2.     What is social iatrogenesis?

3.     What is a practical example of social iatrogenesis?

4.     Peter Conrad has proposed to consider medicalization in what three respects?

5.     What are the engines of medicalization?

6.     (T/F) The use of pharmaceuticals and medicalization are the same thing.

7.     What aspects of medicalization are not directly connected to the use of drugs?

8.     (T/F)  There are situations of medicalization which do not include the consumption of pharmaceuticals as their main feature.

9.     What situations of medicalization do not include the consumption of pharmaceuticals as their main feature?

10.  Define pharmaceuticalization

11.  Give an example of pharmaceuticalization

12.  What three main causes are proposed to have fostered pharmaceuticalization?

13.  (T/F) Causes of mental illness are often described as etiology unknown.

14.  What are the main consequences of the latest version of the DSM?

15.  Define risks.

16.  Define dangers.

17.  As related to health, risk may be connected to what?

18.  (T/F) It can be easier for political institutions to embrace a clinical and biological definition of a disease instead of addressing the social causes underlying these pathological conditions.

19.  What is lacking in the risk factor model?

20.  Define human enhancement.

March 22, OI 3-39.

1. The stories of Achilles and the dragon imply what about immunity?

2. "A valuable asset placed in the care of someone to whom it does not ultimately belong" is Biss's definition of what? OR, it captures her understanding of what?

3. Our vaccines are now sterile, so anti-vaccine activists' greatest fear is not of bacterial but ____ contamination.

4. What is Dracula about, besides vampires?

5. Who said love is known "by its fruits"?

6. Contributions to the "banking of immunity" give rise to the principle of ____ immunity.

7. What's the most common way that infants contract hep B?

8. What raises the probability that undervaccinated children will contract a disease?

9. Who or what were microbiologist Graham Rook's "old friends"?

10. "There is never enough evidence to prove that an event _____ happen? (can/can't)



March 15, Medical Paternalism

1. What is “autonomy” drawn from vs. “paternalism” being drawn from the role of the father?

2. According to Childress what makes paternalism morally interesting?

3. In what cases should a physician override one person's autonomy?

4.What does Dworkin call liberty in contradiction to liberty as license?

5. what are the two factors of justification often given for paternalistic interventions?

6.What two matters does the duty to respect autonomy involve?

7. What could a policy that affirms “you should care for yourself” be interpreted as?

March 1, Origin 

1. What is evolution?

2. What is entropy?

3. What is the proposed Seventh Kingdom?

4. What happens to humans and technology, according to Edmond Kirsch?

5. What is the price of greatness?

6. Are humans in a symbiotic relationship with technology already?

Rachel Carson

Perhaps the finest nature writer of the Twentieth Century, Rachel Carson (1907-1964) is remembered more today as the woman who challenged the notion that humans could obtain mastery over nature by chemicals, bombs and space travel than for her studies of ocean life. Her sensational book Silent Spring (1962) warned of the dangers to all natural systems from the misuse of chemical pesticides such as DDT, and questioned the scope and direction of modern science, initiated the contemporary environmental movement.

Carson was a student of nature, a born ecologist before that science was defined, and a writer who found that the natural world gave her something to write about. Born in Springdale, Pennsylvania, upstream from the industrial behemoth of Pittsburgh, she became a marine scientist working for the U.S. Fish and Wildlife Service in Washington, DC, primarily as a writer and editor. She was always aware of the impact that humans had on the natural world. Her first book, Under the Sea-Wind (1941) was a gripping account of the interactions of a sea bird, a fish and an eel -- who shared life in the open seas. A canny scholar working in government during World War II, Carson took advantage of the latest scientific material for her next book, The Sea Around Us (1951) which was nothing short of a biography of the sea. It became an international best-seller, raised the consciousness of a generation, and made Rachel Carson the trusted public voice of science in America. The Edge of the Sea (1955) brought Carson’s focus on the ecosystems of the eastern coast from Maine to Florida. All three books were physical explanations of life, all drenched with miracle of what happens to life in and near the sea.

In her books on the sea Carson wrote about geologic discoveries from submarine technology and underwater research -- of how islands were formed, how currents change and merge, how temperature affects sea life, and how erosion impacts not just shore lines but salinity, fish populations, and tiny micro-organisms. Even in the 1950's, Carson’s ecological vision of the oceans shows her embrace of a larger environmental ethic which could lead to the sustainability of nature’s interactive and interdependent systems. Climate change, rising sea-levels, melting Arctic glaciers, collapsing bird and animal populations, crumbling geological faults -- all are part of Carson’s work. But how, she wondered, would the educated public be kept informed of these challenges to life itself? What was the public's "right to know"?

Evidence of the widespread misuse of organic chemical pesticides government and industry after World War II prompted Carson to reluctantly speak out not just about the immediate threat to humans and non-human nature from unwitting chemical exposure, but also to question government and private science's assumption that human domination of nature was the correct course for the future. In Silent Spring Carson asked the hard questions about whether and why humans had the right to control nature; to decide who lives or dies, to poison or to destroy non-human life. In showing that all biological systems were dynamic and by urging the public to question authority, to ask "who speaks, and why"? Rachel Carson became a social revolutionary, and Silent Spring became the handbook for the future of all life on Earth.

http://www.rachelcarson.org/

Why ‘Natural’ Doesn’t Mean Anything Anymore

By MICHAEL POLLAN

It isn’t every day that the definition of a common English word that is ubiquitous in common parlance is challenged in federal court, but that is precisely what has happened with the word “natural.” During the past few years, some 200 class-action suits have been filed against food manufacturers, charging them with misuse of the adjective in marketing such edible oxymorons as “natural” Cheetos Puffs, “all-natural” Sun Chips, “all-natural” Naked Juice, “100 percent all-natural” Tyson chicken nuggets and so forth. The plaintiffs argue that many of these products contain ingredients — high-fructose corn syrup, artificial flavors and colorings, chemical preservatives and genetically modified organisms — that the typical consumer wouldn’t think of as “natural.”

Judges hearing these cases — many of them in the Northern District of California — have sought a standard definition of the adjective that they could cite to adjudicate these claims, only to discover that no such thing exists.

Something in the human mind, or heart, seems to need a word of praise for all that humanity hasn’t contaminated, and for us that word now is “natural.” Such an ideal can be put to all sorts of rhetorical uses. Among the antivaccination crowd, for example, it’s not uncommon to read about the superiority of something called “natural immunity,” brought about by exposure to the pathogen in question rather than to the deactivated (and therefore harmless) version of it made by humans in laboratories. “When you inject a vaccine into the body,” reads a post on an antivaxxer website, Campaign for Truth in Medicine, “you’re actually performing an unnatural act.” This, of course, is the very same term once used to decry homosexuality and, more recently, same-sex marriage, which the Family Research Council has taken to comparing unfavorably to what it calls “natural marriage.”

So what are we really talking about when we talk about natural? It depends; the adjective is impressively slippery, its use steeped in dubious assumptions that are easy to overlook. Perhaps the most incoherent of these is the notion that nature consists of everything in the world except us and all that we have done or made. In our heart of hearts, it seems, we are all creationists.

In the case of “natural immunity,” the modifier implies the absence of human intervention, allowing for a process to unfold as it would if we did nothing, as in “letting nature take its course.” In fact, most of medicine sets itself against nature’s course, which is precisely what we like about it — at least when it’s saving us from dying, an eventuality that is perhaps more natural than it is desirable.Continue reading the main story


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RECENT COMMENTS

Michael Bain May 4, 2015

It’s good that people are actually thinking about "Natural", about Nature. A natural state on our planet, to my mind, is one without human...
Petey Tonei May 4, 2015

The material world is intertwined with the conscious world. On this earth, where life exists, we are interdependent, interconnected. Human...
Mor May 4, 2015

A great article. I confound all my friends by being a vegetarian (at least when I am in the States) and yet being in favor of GMOS, genetic...




Yet sometimes medicine’s interventions are unwelcome or go overboard, and nature’s way of doing things can serve as a useful corrective. This seems to be especially true at the beginning and end of life, where we’ve seen a backlash against humanity’s technological ingenuity that has given us both “natural childbirth” and, more recently, “natural death.”

This last phrase, which I expect will soon be on many doctors’ lips, indicates the enduring power of the adjective to improve just about anything you attach it to, from cereal bars all the way on up to dying. It seems that getting end-of-life patients and their families to endorse “do not resuscitate” orders has been challenging. To many ears, “D.N.R.” sounds a little too much like throwing Grandpa under the bus. But according to a paper in The Journal of Medical Ethics, when the orders are reworded to say “allow natural death,” patients and family members and even medical professionals are much more likely to give their consent to what amounts to exactly the same protocols.

The word means something a little different when applied to human behavior rather than biology (let alone snack foods). When marriage or certain sexual practices are described as “natural,” the word is being strategically deployed as a synonym for “normal” or “traditional,” neither of which carries nearly as much rhetorical weight. “Normal” is by now too obviously soaked in moral bigotry; by comparison, “natural” seems to float high above human squabbling, offering a kind of secular version of what used to be called divine law. Of course, that’s exactly the role that “natural law” played for America’s founding fathers, who invoked nature rather than God as the granter of rights and the arbiter of right and wrong.

“Traditional” marriage might be a more defensible term, but traditional is a much weaker modifier than natural. Tradition changes over time and from culture to culture, and so commands a fraction of the authority of nature, which we think of as timeless and universal, beyond the reach of messy, contested history.

Implicit here is the idea that nature is a repository of abiding moral and ethical values — and that we can say with confidence exactly what those values are. Philosophers often call this the “naturalistic fallacy”: the idea that whatever is (in nature) is what ought to be (in human behavior). But if nature offers a moral standard by which we can measure ourselves, and a set of values to which we should aspire, exactly what sort of values are they? Are they the brutally competitive values of “nature, red in tooth and claw,” in which every individual is out for him- or herself? Or are they the values of cooperation on display in a beehive or ant colony, where the interests of the community trump those of the individual? Opponents of same-sex marriage can find examples of monogamy in the animal kingdom, and yet to do so they need to look past equally compelling examples of animal polygamy as well as increasing evidence of apparent animal homosexuality. And let’s not overlook the dismaying rates of what looks very much like rape in the animal kingdom, or infanticide, or the apparent sadism of your average house cat.

The American Puritans called nature “God’s Second Book,” and they read it for moral guidance, just as we do today. Yet in the same way we can rummage around in the Bible and find textual support for pretty much whatever we want to do or argue, we can ransack nature to justify just about anything. Like the maddening whiteness of Ahab’s whale, nature is an obligingly blank screen on which we can project what we want to see.

So does this mean that, when it comes to saying what’s natural, anything goes? I don’t think so. In fact, I think there’s some philosophical wisdom we can harvest from, of all places, the Food and Drug Administration. When the federal judges couldn’t find a definition of “natural” to apply to the class-action suits before them, three of them wrote to the F.D.A., ordering the agency to define the word. But the F.D.A. had considered the question several times before, and refused to attempt a definition. The only advice the F.D.A. was willing to offer the jurists is that a food labeled “natural” should have “nothing artificial or synthetic” in it “that would not normally be expected in the food.” The F.D.A. states on its website that “it is difficult to define a food product as ‘natural’ because the food has probably been processed and is no longer the product of the earth,” suggesting that the industry might not want to press the point too hard, lest it discover that nothing it sells is natural.

The F.D.A.’s philosopher-bureaucrats are probably right: At least at the margins, it’s impossible to fix a definition of “natural.” Yet somewhere between those margins there lies a broad expanse of common sense. “Natural” has a fairly sturdy antonym — artificial, or synthetic — and, at least on a scale of relative values, it’s not hard to say which of two things is “more natural” than the other: cane sugar or high-fructose corn syrup? Chicken or chicken nuggets? G.M.O.s or heirloom seeds? The most natural foods in the supermarket seldom bother with the word; any food product that feels compelled to tell you it’s natural in all likelihood is not.

But it is probably unwise to venture beyond the shores of common sense, for it isn’t long before you encounter either Scylla or Charybdis. At one extreme end of the spectrum of possible meanings, there’s nothing butnature. Our species is a result of the same process — natural selection — that created every other species, meaning that we and whatever we do are natural, too. So go ahead and call your nuggets natural: It’s like saying they’re made with matter, or molecules, which is to say, it’s like saying nothing at all.

And yet at the opposite end of the spectrum of meaning, where humanity in some sense stands outside nature — as most of us still unthinkingly believe — what is left of the natural that we haven’t altered in some way? We’re mixed up with all of it now, from the chemical composition of the atmosphere to the genome of every plant or animal in the supermarket to the human body itself, which has long since evolved in response to cultural practices we invented, like agriculture and cooking. Nature, if you believe in human exceptionalism, is over. We probably ought to search elsewhere for our values.
nyt, APRIL 28, 2015
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Michael Pollan is the John S. and James L. Knight professor of journalism at the University of California, Berkeley, and the author, most recently, of “Cooked: A Natural History of Transformation.”

Julie Yip-Williams (1976-2018)

Julie Yip-Williams, whose candid blog about having Stage IV colon cancer also described a life of struggles that began with being born blind in Vietnam and her ethnic Chinese family’s escape in a rickety fishing boat, died on Monday at her home in Brooklyn. She was 42.

Joshua Williams, her husband, said the cause was metastatic colon cancer.

Ms. Yip-Williams’s richly detailed blog, which she started writing after receiving her diagnosis in 2013, was more than an account of her siege with cancer. It was also a meditation on love and family as well as a message of openness to her young daughters, Mia and Isabelle, about her illness.

Ms. Yip-Williams wrestled with hope, which she cursed as an “illusory sentiment.”

“Cancer crushes hope, leaving a wasteland of grief, depression, despair and a sense of unending futility,” she wrote in 2014, adding: “Hope is a funny thing, though. It seems to have a life and will of its own that I cannot control through the sheer force of my mind. It is irrepressible, its very existence inextricably tied to our very spirit, its flame, no matter how weak, not extinguishable.”

Her blog, with additional material written by Ms. Yip-Williams, is being turned into a memoir by Random House, which expects to publish it later this year or early next year... (continues)

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CBS Sunday Morning. We want to take a moment now to note the death this past Monday of Julie Yip-Wlliams.

As you may remember, Tracy Smith told Julie's story here on "Sunday Morning"just two weeks ago … a story that was all about living on borrowed time.

Julie was born totally blind in Vietnam, and narrowly escaped a plot hatched by her own grandmother to have her killed on grounds that she had no future.

Julie Yip-Williams.

 CBS NEWS

But at age three, Julie and her family made it to the United States, where a surgeon was able to give her only partial sight, leaving her still legally blind.

Undaunted, Julie Yip-Williams went on to graduate from Harvard Law School, and pursue a corporate career -- only to be diagnosed with colon cancer five years ago.

Still undaunted, Julie underwent every surgery and treatment and clinical trial she could find, to no avail. 

Through it all, she shared her experience in a candid blog, My Cancer Fighting Journey, while also preparing her daughters -- Isabelle, age six, and Mia, eight -- for the day when her borrowed time would run out.

Julie Yip-Williams was just 42 years old.

Quizzes March 27, 29

March 27, OI 40-76

1. "Natural" has popularly come to mean what, in the context of medicine?

2. The most unnatural aspect of vaccination is what?

3. What led to the creation of the EPA?

4. What kind of thinking makes no room for ambiguous identities, and what does it threaten?

5. What "troubling dualisms" characterize the vaccination debate?

6. What practice went on in China and India for hundreds of years, to combat smallpox?

7. What metaphor is implied by "inoculation"?

8. What disappointed Biss about the immuno-semiotics conference?

9. What game metaphor does Biss prefer, to describe our immune systems and viral pathogens?

10. What caused the fatal form of croup that has virtually disappeared in this country since the '30s?

11. What caused the spread of puerpal sepsis ("childbed fever")?

12. What would exceed federal food-safety levels for DDT and PCBs at the grocery store, if sold there?

DQ

• Do you agree that the popular appeal of what is deemed more "natural" is a product of our "profound alienation from the natural world"? 
• Are vaccines unnatural? 
• Comment: "It is only when disease manifests as illness that we see it as unnatural." 42
• Should it bother us that Rachel Carson apparently was wrong about DDT being carcinogenic? 44
• With the apparent gutting of the EPA and other federal regulators now under way, will "the judicious use of chemicals" to fight insect-born diseases etc. still be possible? 45
• Are you comfortable with the idea of being a cyborg? 49
• Are you disproportionately afraid of sharks and oblivious to the dangers of bicycles? Does simply acknowledging such misperceptions help you to overcome them?
•  Is immunity mostly a metaphor? Is it correctly characterized by metaphors of war? Do you agree with the perspective of alt-med practitioners on this point? 57
• Is parenting, with its attendant decisions impacting the future health of children, more "like time travel" than making health decisions for oneself? What do you make of the Star Trek example? Who in the present anti-vaxx scenario is "heroically return(ing) to the past to die"? 66
• Why do you think women healers historically were regarded as witches, albeit "good" ones? Are women fully welcome in the ranks of professional medicine today?
• Are there modern-day equivalents of "heroic" medicine (bleeding etc.)? Does it have a legitimate place in professional practice?
• Are we overly obsessed with "purity" and with avoiding toxicity? Are we never cleaner than our environment at large?
• Should human breast milk be commodified? If so, how should it be regulated?
• Your DQs

Today in Bioethics, Eula Biss plays some more with the vampire theme and her recognition as both a new mother and a patient that "we feed off of each other, we need each other to live," and that the whole mutual dependency framework of our lives is beautifully "aglow with humanity."

One of the troubling and less lovely expressions of humanity is our tendency to panic in the face of unwarranted and unsubstantiated fears. Such was the "cascade of panic" triggered by Andrew Wakefield's discredited study linking the MMR vaccine to autism. "Wealthier countries have the luxury of entertaining fears the rest of the world cannot afford."

Anderson Cooper (vid)... The Vaccine War (Frontline-vid)... Vaccines-Calling the Shots (Nova-vid)

Refusal of immunity "as a form of civil disobedience" is an opportunity of privilege - "a privileged 1% are sheltered from risk while they draw resources from the other 99%." Consider Marin County, for instance... (vid)

The refuseniks who think they're striking a solid blow against inhumane capitalists, especially Big Pharma, are missing a vital point: shared immmunity "is a system in which both the burdens and the benefits are shared across the entire population," hardly standard operating procedure under capitalism. Opting out really looks more like buying in and supporting the status quo, which is to devalue or ignore appeals to ethical principle in favor of (as Susan Sontag said) "the calculus of self-interest and profitability." What an impoverished state of mind and a shrunken state of heart.

And speaking of Dracula, one more time: "medicine sucks the blood out of people in a lot of ways." So maybe Biss's dad was right: "Most problems will get better if left alone." Problems abound, though, if our reason for choosing to leave them alone is an absence of trust in medical practitioners.

Quiz March 29, OI 77-109


1. What was ambiguous about the vampire metaphor, for Biss?

2. What struck Biss as both magical and mundane?

3. Smallpox is now no longer a disease, but a what?

4. Who were the Polio Pioneers? Where is polio still endemic, and why?

5. What are the profound differences between ethyl and methyl mercury?

6. How did Andrew Wakefield cause a "cascade of panic"?

7. Who accused WHO of collusion in 2009?

8. Why does Susan Sontag say public health is difficult to promote in our society?

9. Why does Arthur Caplan say the marketplace model of healthcare is dangerous?

10. When would Biss consider surgery a conservative option?

11. For what is there no credible evidence, "Dr. Bob" notwithstanding?

12. What's Biss's Dad's argument for preventive medicine?

DQ

• Why is it important to remember that "it's not your blood" that you must depend upon, when you need a transfusion?
• Is mutual bodily dependence ugly, beautiful, both, neither,... ?
• If our knowledge gives viral pathogens immortality, how can we effectively regulate them? 83
• What's the best way to combat "vaccine refusal" in the developing world? Is that different from how we should address it here? What would you say to Biss's Vietnamese friend? 87
• Are you worried about nefarious "invisible commercial influences" having an outsized influence on public health policy? Are you persuaded of the "power of the core public health ethos"? 95
• Is refusing immunity a legitimate form of civil disobedience, or a form of elitist self-indulgence?
• Is "shopping around for a doctor" (see cartoon below) ever appropriate?
• What do you think of Biss's critique of capitalism and what it is "really taking from us"? 97
• What do you think of the anesthesiologist's "disgusting" remarks? 102 Were they unethical, inappropriate, or excusable?
• What do you think of Biss's "Dad's "two sentence textbook"? 103
• Should a doctor be concerned with conditions in other docs' waiting rooms? How should they express such concern? 108
• I suggest we brainstorm several other DQs, in small groups during discussion time, and share them with the whole class before leaving today.

Medical Ethics & Me (@medethicsandme)

3/19/17, 12:25 PM “Having raised humanity above the beastly level of survival struggles, we will now aim to upgrade humans into... fb.me/ETqAhy3e

"I'll go shop around for a doctor."

 

When Evidence Says No, But Doctors Say Yes
Years after research contradicts common practices, patients continue to demand them and doctors continue to deliver. The result is an epidemic of unnecessary and unhelpful treatment.by David Epstein, ProPublica February 22, 2017

First, listen to the story with the happy ending: At 61, the executive was in excellent health. His blood pressure was a bit high, but everything else looked good, and he exercised regularly. Then he had a scare. He went for a brisk post-lunch walk on a cool winter day, and his chest began to hurt. Back inside his office, he sat down, and the pain disappeared as quickly as it had come.

That night, he thought more about it: middle-aged man, high blood pressure, stressful job, chest discomfort. The next day, he went to a local emergency department. Doctors determined that the man had not suffered a heart attack and that the electrical activity of his heart was completely normal. All signs suggested that the executive had stable angina — chest pain that occurs when the heart muscle is getting less blood-borne oxygen than it needs, often because an artery is partially blocked.

A cardiologist recommended that the man immediately have a coronary angiogram, in which a catheter is threaded into an artery to the heart and injects a dye that then shows up on special x-rays that look for blockages. If the test found a blockage, the cardiologist advised, the executive should get a stent, a metal tube that slips into the artery and forces it open.

While he was waiting in the emergency department, the executive took out his phone and searched “treatment of coronary artery disease.” He immediately found information from medical journals that said medications, like aspirin and blood-pressure-lowering drugs, should be the first line of treatment. The man was an unusually self-possessed patient, so he asked the cardiologist about what he had found. The cardiologist was dismissive and told the man to “do more research.” Unsatisfied, the man declined to have the angiogram and consulted his primary-care doctor.

The primary-care physician suggested a different kind of angiogram, one that did not require a catheter but instead used multiple x-rays to image arteries. That test revealed an artery that was partially blocked by plaque, and though the man’s heart was pumping blood normally, the test was incapable of determining whether the blockage was dangerous. Still, his primary-care doctor, like the cardiologist at the emergency room, suggested that the executive have an angiogram with a catheter, likely followed by a procedure to implant a stent. The man set up an appointment with the cardiologist he was referred to for the catheterization, but when he tried to contact that doctor directly ahead of time, he was told the doctor wouldn’t be available prior to the procedure. And so the executive sought yet another opinion. That’s when he found Dr. David L. Brown, a professor in the cardiovascular division of the Washington University School of Medicine in St. Louis. The executive told Brown that he’d felt pressured by the previous doctors and wanted more information. He was willing to try all manner of noninvasive treatments — from a strict diet to retiring from his stressful job — before having a stent implanted.

The executive had been very smart to seek more information, and now, by coming to Brown, he was very lucky, too. Brown is part of the RightCare Alliance, a collaboration between health-care professionals and community groups that seeks to counter a trend: increasing medical costs without increasing patient benefits. As Brown put it, RightCare is “bringing medicine back into balance, where everybody gets the treatment they need, and nobody gets the treatment they don’t need.” And the stent procedure was a classic example of the latter. In 2012, Brown had coauthored a paper that examined every randomized clinical trial that compared stent implantation with more conservative forms of treatment, and he found that stents for stable patients prevent zero heart attacks and extend the lives of patients a grand total of not at all. In general, Brown says, “nobody that’s not having a heart attack needs a stent.” (Brown added that stents may improve chest pain in some patients, albeit fleetingly.) Nonetheless, hundreds of thousands of stable patients receive stents annually, and one in 50 will suffer a serious complication or die as a result of the implantation procedure... (continues)

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What the top U.S. health official should be saying on vaccines
Health and Human Services Secretary Tom Price. (Joshua Roberts/Reuters)

During a televised town hall last week, the nation’s top health official was asked whether all children should get immunized for measles and other vaccine-preventable diseases. In his response, Health and Human Services Secretary Tom Price parsed his words carefully. He said state governments (presumably rather than the federal government) “have the public health responsibility to determine whether or not immunizations are required for a community population.”

His response angered many doctors and public-health officials, who say the top U.S. health official failed to give full-throated support for immunizations that prevent disease and protect communities at a time when anti-vaccine sentiment is on the rise.

Paul Sax, an infectious disease specialist at Boston’s Brigham and Women’s Hospital, said Price might have been choosing his words carefully for political reasons. Price, he noted, belongs to the Association of American Physicians and Surgeons, an organization that opposes mandatory immunizations. And there’s Price’s boss, President Trump, who has publicly expressed discredited concerns about vaccine safety.

So Sax decided to write tongue-in-cheek answers for what Price should be saying. The post appeared in the HIV and ID Observations blog published by NEJM Journal Watch... (continues)

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What viruses are in blood transfusions? New study identified 19 human viruses in 42% of study participants. Mindblowing stuff @JCVenter twitter.com/humanlongevity…

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Should 15,000 Steps a Day Be Our New Exercise Target?

A new study of postal workers in Scotland suggests we should aim for far more than the 10,000 daily steps commonly recommended...

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New Vaccine Could Slow Disease That Kills 600 Children a Day

A lower-cost vaccine provides strong protection against rotavirus, a diarrheal disease, and could be particularly useful in poorer countries, researchers said...

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Fewer Americans Would Be Insured With G.O.P. Plan Than With Simple Repeal

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Millions Stand to Lose Addiction Treatment

Treatment for addiction grew with the Medicaid expansion under Obama’s health care act, but millions may lose coverage if the House approves a measure to repeal the Affordable Care Act...

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A New Form of Stem Cell Engineering Raises Ethical Questions

As biological research races forward, ethical quandaries are piling up. In a report published Tuesday in the journal eLife, researchers at Harvard Medical School said it was time to ponder a startling new prospect: synthetic embryos.

In recent years, scientists have moved beyond in vitro fertilization. They are starting to assemble stem cells that can organize themselves into embryolike structures.

Soon, experts predict, they will learn how to engineer these cells into new kinds of tissues and organs. Eventually, they may take on features of a mature human being.

In the report, John D. Aach and his colleagues explored the ethics of creating what they call “synthetic human entities with embryolike features” — Sheefs, for short. For now, the most advanced Sheefs are very simple assemblies of cells... (continues)

A hint of the future arrived in a study published this month by researchers at the University of Cambridge. They built microscopic scaffolding into which they injected a mixture of two types of embryonic stem cells from mice.

This triggered communication by the cells, and they organized themselves into the arrangement found in an early mouse embryo.

While these artificial embryos developed from embryonic stem cells, it may soon become possible to build them from reprogrammed adult human cells. No fertilization or ordinary embryonic development would be required to build a mouse Sheef.
“We need to address this now, while there’s still time,” Dr. Aach said.

Sophia Roosth, a Harvard historian of science who was not involved in the new paper, said she did not think ethicists would have to start from scratch to find rules for these strange new Sheefs. She was optimistic that experts could draw on the many regulations in place for other kinds of research — including cloning, human tissue studies, and even studies on animals.
“I don’t think the baby has to be thrown out with the bathwater,” she said.

Henry T. Greely of Stanford University was less optimistic. While it is important to have a discussion about Sheefs, he said, it may be hard to reach an agreement on limits as enforceable as the 14-day rule.

“Whether you could come to some consensus is really doubtful,” he said.

Even if ethicists do manage to agree on certain limits, Paul S. Knoepfler, a stem cell biologist at the University of California, Davis, wondered how easy it would be for scientists to know if they had crossed them.

Spotting a primitive streak is easy. Determining whether a collection of neurons connected to other tissues in a dish can feel pain is not.
“It gets pretty tricky out there,” Dr. Knoepfler said. “They’ve opened the door to a lot of tough questions.”

	douglas rushkoff (@rushkoff)
3/22/17, 9:19 PM "The Future of Humans: A 2017 Reading List" linkedin.com/pulse/future-h… by @sarita on @LinkedIn

Final solo reports

(Midterm reporters: unless I've indicated otherwise to you, claim 20 runs for your report in your logs and on the scorecard. Those who prepared report slideshows, please post them if you can... via Slideshare.net, perhaps.)

Final solo reports consist of a presentation (with quiz & discussion questions, beginning on April 10-see below*) and two blog post installments. 1st installment due no later than April 24, though you may find it useful for your presentation to post earlier. 2d installment due May 1. Top 3 run-scorers are exempt from a 2d installment, but may still post for extra credit.

Think of it as parts one and two of a single report, with part two including your reaction to any constructive feedback you received to part one.

Don't think of it as a pasted formal paper, but as two related blog posts on a subject of interest to you. Use links instead of footnotes, include relevant graphics, video, anything that'll make it visually as well as thematically interesting.

Choose any relevant topic (check with me if you're not sure). You may continue to explore your midterm report topic, if you wish. Say why the topic interests you, and if you're discussing a particular philosopher/author say what you do or don't agree with in their thought.

Feel free to be creative with the format and approach. For instance, you might wish to "transcribe" an imaginary conversation between yourself and one or more famous philosophers.

Everyone should comment on at least two classmates' 1st report installments, and document that you have done so: include links to the reports you've commented on, in one of your own report posts.

Have fun!==
*T 10 - Final report presentations begin: Vincent, Kimberly, Kyle, Jonathan, Logan.

Th 12 - Chelsea Able, Shay Linell, Kayla Bean, Ana Aponte-Berrios, Cameron Oldham

T 17 - Iman Abdel Khalek, Selwa Kanakrieh, Yazan Musleh, Alex Knight, Kimberly Warren

Th 19 - Zach Nix, Brittney Davis, Tariq McGruder, Clorissa Campbell, Ilija Zecevic

T 24 - Joseph Churchill, Katelyne Tatum, Andrew Bunch. Last class, Exam 3, Final solo report post installment 1 due, turn in personal logs, top three run-scorers identified

T 1 - 2d final solo report blog post due from all but three top run-scorers

Brave New World related to medicalization and pharmaceuticalization

Medicalization: Current Concept and Future Directions in a Bionic Society

Antonio Maturo, Ph.D. in Sociology*

Author information ► Article notes ► Copyright and License information ►

This article has been cited by other articles in PMC.

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Abstract

The article illustrates the main features of the concept of medicalization, starting from its theoretical roots. Although it is the process of extending the medical gaze on human conditions, it appears that medicalization cannot be strictly connected to medical imperialism anymore. Other “engines” of medicalization are influential: consumers, biotechnology and managed care. The growth of research and theoretical reflections on medicalization has led to the proposal of other parallel concepts like pharmaceuticalization, genetization and biomedicalization. These new theoretical tools could be useful in the analysis of human enhancement. Human enhancement can be considered as the use of biomedical technology to improve performance on a human being who is not in need of a cure: a practice that is increasingly spreading in what might be defined as a “bionic society”.

Keywords: Bionic society, Biomedicalization, Human enhancement, Medicalization, pharmaceuticalization, Risk

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Introduction

The manipulation and transformation of human nature by biomedical technology is increasing. As Foucault (1976[10]) stated in the 1970's the sovereign-power of death (of giving death to people) has been replaced by the power of the State to give and improve life: biopower (and the welfare State is the main example of this). According to the Foucauldian scholar Nikolas Rose, molecular manipulation is the main trait of our society:

The “style of thought” of contemporary biomedicine considers life at the molecular level as a group of intelligible vital mechanisms which can be identified, isolated, manipulated, mobilized and recombined in intervention practices which are not constrained by the apparent normativity of a natural vital order (Rose, 2006, p.9[28]).

Therefore, it can be said that we are living in a society which is becoming increasingly bionic. That is, biology and genetics are seen as the main forces which affect human life, with social factors playing a minor role. Medicalization, and its developments, is the main component of the bionic society of today.

Medicalization can be defined as the process by which some aspects of human life come to be considered as medical problems, whereas before they were not considered pathological. In sociology, medicalization is not a “new” concept. Forty years ago Ivan Illich (1973[17]) made an accurate analysis of the iatrogenesis of many illnesses. The word iatrogenesis comes from the ancient Greek and means “originating from a physician/treatment”. According to Illich, social iatrogenesis is the proliferation of diseases caused by the extension of medical categories on everyday life. One practical example of social iatrogenesis given by Illich is the lowering of levels of tolerance for psychological discomfort or sadness, which brought about a steady increase of the diagnosis of depression (Horwitz and Wakefield, 2009[15]). In the same period, Foucault (1976[10]), considered the process of indefinite medicalization to be one of the main features of society. He stressed the role of doctors in deciding what was normal and what was pathological. In the words of Zola:

From sex to food, from aspirins to clothes, from driving your car to riding the surf, it seems that under certain conditions or in combination with certain other substances or activities or if done too much or too little, virtually anything can lead to medical problems (Zola, 1982, p. 49[34]).

In more recent times, Peter Conrad (Conrad, 2007[8]) has proposed to consider medicalization in three respects:

• Conceptual medicalization: When medical lexicon is used to define non-medical entities (for example, the natural drooping of breasts after pregnancy diagnosed as “mammary ptosis”);
• Institutional medicalization: When physicians have the power to steer non-medical personnel – what Eliot Freidson called “professional dominance” (Freidson, 1970[11]; for example, physicians being managers of hospitals without having any academic title in management or business administration);
• Interactional medicalization: When the physician, in interaction with the patient, redefines a social problem into a medical one (for example, homosexuality was listed as a pathology in the DSM until 1983).

Yet, according to Conrad, there are also other “engines of medicalization”. These engines are consumers, biotechnology and managed care.

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Engines of Medicalization

Consumers

Consumers are a factor of medicalization because health is increasingly becoming, and has become, a commodity (Turner, 2004[32]). People are increasingly using medical terminology in order to analyse their own health influenced from watching TV and browsing the internet (Barker, 2008[4]). Also, advertisements encourage people to consider health needs that otherwise they would not have thought about. New social representations of health and illness are emerging, for instance, the representations of idealized beauty and the parallel “treatments” of cosmetic surgery. The body is increasingly considered as a “text” through which people may transmit signals and information (Turner, 2004[32]).

Technology

Technology is a driving factor of medicalization for many reasons. First, new diagnostic tools mean more chances to discover illnesses. Yet, often the risk factors are considered as pathological and therefore treated. Sometimes, the “discovery” of new diseases is done by pharmaceutical firms which also have the “right” treatment (‘disease mongering’).

Managed care

Managed care is also a force of medicalization. For instance, considering depression as a condition caused by a chemical imbalance legitimates a treatment based on pills rather than on expensive psychotherapy (Barker, 2008[4]). On these bases, social problems are transformed into medical ones. In the US, according to Conrad:

It seems likely that physicians prescribe pharmaceutical treatment for psychiatric disorders knowing that these are the types of medical interventions covered under managed care plans, accelerating psychotropic treatments for human problems (Conrad, 2007, p. 141[8]).

In the US, in 1997, laws regulating pharmaceutical advertisement became less restrictive which resulted in the expenditure for prescription drugs ads to increase four times between 1998 and 2007 (Murray, 2009[27]). The increase in advertising has also strongly stimulated disease mongering, which is the “invention of illnesses” (Moynihan e Cassels, 2005[26]). A commonly used strategy in the advertisement for drugs is the overstatement of the risks of certain situations which mislead consumers. People are increasingly encouraged to discover some diseases through a self-diagnosis based on a check-list (Jutel, 2009[18]).

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From Medicalization to Pharmaceuticalization?

The use of pharmaceuticals and medicalization are not the same thing. Some aspects of medicalization are not directly connected to the use of drugs: conceptual and interactional medicalization, for instance (Conrad, 2009[7]). Moreover, there are situations of medicalization which do not include the consumption of pharmaceuticals as their main feature, even if pharmaceuticals have been used in those situations. This is the case of the medicalization of death, the medicalization of pregnancy and the medicalization of beauty. There are even pathological conditions in which the treatment is neither a pharmacological one nor a medical one strictly speaking, but require the patient to comply with a specific regimen or way of life. A typical example of this is coeliac disease, which is caused by a reaction to gliadin, a prolamin (gluten protein) found in wheat. At present, the only effective treatment is a life-long gluten-free diet.

According to Abraham (2010[1]), the socio-cultural aspects of pharmaceutical consumption have peculiar features which cannot be properly analysed by the medicalization framework; therefore, he proposes the concept of pharmaceuticalization. Pharmaceuticalization can be defined as “the process by which social, behavioral, or bodily conditions are treated, or deemed to be in need of treatment/intervention, with pharmaceuticals by doctors, patients or both” (Abraham, 2010, p. 290[1]). Main examples include: the treatment of mood by anxiolytics or antidepressants, treatment of ADHD with Methylphenidate (e.g., Ritalin®) and treatment of erectile dysfunction with Sildenafil citrate (e.g., Viagra®). In addition, even the treatment of heart-disease risk factors with cholesterol-lowering drugs, such as statins, may be considered an example of pharmaceuticalization. It should be noted that all the conditions mentioned above could also be treated in non-pharmaceutical ways – as they were in the past. The treatments could be medical, such as a psychotherapy, or non-medical, such as a change in lifestyle.

Among the factors that have fostered pharmaceuticalization, Abraham proposes to consider three main causes: the political economy of the pharmaceutical industry, the deregulatory state ideology, and consumerism. While the concept of consumerism has already been described, the other two factors deserve particular attention.

Abraham (2010, p. 299-301[1]) describes “deregulatory state ideology” as the pharmaceutical legislation in the EU, North America, Australasia that requires manufacturers to demonstrate the quality, safety and efficacy of their products (but not their therapeutic advance) in order to have a new drug approved by regulatory agencies. Therefore, there can be pharmaceutical innovation without therapeutic advance. As stated by Donald Light:

When pharmaceutical companies say a drug is “effective” or “more” “effective,” they usually mean more effective than a placebo, not more effective than existing drugs. (Light, 2010, p.7[19]).

Pharmaceutical companies are increasingly investing in advertising and marketing and decreasing their financial efforts devoted to research for new therapies (Angell, 2004[2]). As said, an important component of marketing campaigns is advertising: “direct-to-consumer advertising does not simply attempt to sell particular products but strives to reshape consumers’ understanding of their problems into conditions that should be treated by medications” (Horwitz, 2010, p.110-111[13]).

It is not only the loosening of advertising restrictions, marketing campaigns and consumerism that foster pharmaceuticalization and medicalization. Science also plays a great role in legitimising this tendency. For example, as it is shown in the next section, the Diagnostic and Statistical Manual of Mental Disorders, by giving the description of many mental disorders in terms of symptoms, strongly suggests pharmaceutical treatments.

Normality and pathology in mental health

Mental health is likely the most medicalized aspect of human life. Emotions like sadness and shyness, if framed through a pathologizing gaze, can easily be turned into illnesses (Maturo, 2010a[22]). It is hard to believe that 6% of the population in Great Britain meet the criteria for major depressive disorder at any time (Scott and Dikey, 2003[29]) and even harder to believe that more that 5% of Americans suffer from bipolar disorder: “Awareness among general practitioners and psychiatrics that the broad clinical spectrum of bipolar disorders probably affects 5% of the population – rather than the often quoted figure of 1% – is regrettably low” (Smith, Ghaemi and Craddock, 2008, p. 398[31]).

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the commonly used basis for any mental disorder diagnosis. While the first two editions of the DSM were characterized by a strong theoretical view, mainly based on psychoanalysis, DSM-III and, even more, DSM-IV, try to be atheoretical and symptom-based. Thus, in the two last versions of the DSM, the psychiatric nosography became more and more descriptive and standardized, although not value-free (Fulford, 2010[12]). To define an illness, the emphasis was put on symptoms, while causes were neglected. [Of course one may say causes were not neglected; they are simply not known, since ‘etiology unknown’ is still the hall-mark of psychiatry.] The focus of DSM-III and DSM-IV therefore shifted from illnesses to disorders and syndromes – the latter being multiple symptoms. The key-assumption of this “diagnostic psychiatry” is that “overt symptoms indicate discrete underlying diseases. Whenever enough symptoms are present to meet the criteria for a diagnosis, a particular mental disorder exists” (Horwitz, 2002, p. 106[14]). Therefore the main consequences of the latest version of the DSM are reductionism and the proliferation of disorders (by shifting from illnesses to syndromes, the complexity of mental illness is reduced, because it coincides with its symptoms and virtually almost everything may be considered pathological), and the likeliness of pharmaceutical treatment (if disorders become more easily identifiable and cognisable it becomes easier to associate them with a specific therapy, and if the task of psychiatry is to relieve symptoms, then medicines are the best way to do so). This trajectory puts psychiatry together with all the other medical specialties, aligning mental illness with any other kind of biological disease.

It is not possible to demonstrate that corporations are involved in the designing of the DSM, but, in describing the onset of the medicalization of mood, Horwitz and Wakefield present a good point:

There is no evidence that pharmaceutical companies had a role in developing DSM-III diagnostic criteria. Yet, serendipitously, the new diagnostic model was ideally suited to promoting the pharmaceutical treatment of the conditions it delineated (Horwitz and Wakefield, 2007, p.182[16]).

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Risk in the Theoretical Discourse

Presently, the concept of risk seems to be very important in contemporary society. According to many scholars we have passed from a society dominated by dangers to a society dominated by risks.

According to Douglas (1992[9]), risks are the outcome of human actions, while dangers have to do with the unpredictability of nature. If damages can be seen as a consequence of a decision of ours then we can speak about risk; if damages are caused by something overcoming our will, something “external”, then we can speak about danger. To use an extreme example: while in the past, falling ill with cancer was a danger, nowadays, thanks to the screening technology, falling ill with cancer has become a risk of a missed prevention. To view it in a different way, Luhmann (1993[21]) wrote that when man discovered the umbrella, rain was not a danger anymore but a risk. Another important feature of risk is calculability: the word “risk” has its origin in the field of insurance, and therefore one of its main connotations is the likeliness of an event to occur.

Risk and health

In the discourse on health, risk may be connected to the individualization of social problems, biological reductionism, and the shifting borders between normal and pathological. As it will be shown in the next pages, it can be easier for political institutions to embrace a clinical and biological definition of a disease instead of addressing the social causes underlying these pathological conditions. Considering illness as an external risk, the responsibility to avoid it is shifted from social policy to the individual, despite pathology being strongly connected to social and economic conditions. Nowadays, health is increasingly considered an individual responsibility. People should avoid smoking, becoming overweight, and they are also encouraged to push back the ageing process as much as possible. Therefore, prevention is socially constructed as an individual duty. Moreover, huge investments in diagnostics and genetics have led to neglect of social causes of diseases, and to consider them only in biological terms (Clarke and Shim, 2011[6]). Although many researchers have demonstrated that in rich countries social determinants are more influential in health status than an increase in health expenditure, social and economic conditions are seldom mentioned in biomedical discourse on health (Link and Phelan, 2010[20]). It is cheaper, and simpler, to label an unruly child as someone suffering from a chemical imbalance instead of taking other factors into account: the possible unemployment of parents, poverty of the neighborhood, or other issues in the family. If we consider depression as the effect of the lack of serotonin in the brain, instead of the natural and normal answer to a condition of deprivation and stress, we implicitly reject the role of social policy. As Barker puts it:

It is far more politically expeditous to make claims on the welfare state (even the miserly US welfare state) to address discrete medical needs of homeless patients, than it is to fulfil the rights of homeless citizens to housing and employment. Again in the US context, it is more politically palatable to expand State Children's Health Insurance Program (SCHIP) than it is to address what sociological research consistently demonstrates to be the single best predictor of children's current and future health status; namely, social class (Barker, 2009, p. 101[3])

Doing so, an individualistic and neoliberal view of society is legitimised, in which the State has increasingly less responsibilities for citizens’ welfare. Moreover, the emphasis on a healthy lifestyle may be misplaced. There is evidence that the “cause of causes” of illness is the socio-economic status (Link and Phelan, 2010[20]). The connection between lifestyle and health, on which the risk-factor model is based, is only one side of the etiological link between health and society. The risk-factor model's explanation for health inequalities proceeds according to a seemingly persuasive logic: “social conditions are related to health because of their influence on a host of risk factors that lie between social conditions and disease in a chain of causality” (Link and Phelan, 2010, p. 3[20]). What is lacking in the risk-factor model is that social and economic conditions powerfully shape the capacity to modify or eliminate identified risk factors. They put people “at risk of risk”. It is difficult to eat expensive organic food if you are unemployed. Perhaps people are not inclined to jog if they live in an urban sprawl close to the junction. And it is easier to quit smoking if you are a member of Harvard soccer team than a member of a gang in a Brazilian slum.

There are two more features of the idea of risk that should be mentioned. The first one is connected to the threshold. One of the most effective ways to widen the pathological sphere is to alter the threshold level. It is by lowering the threshold at which someone is considered “pre-sick” that prevention has been medicalized. The main examples of the medicalization of prevention is hypertension. Blood pressure rises with age and is one of the several factors that can increase the risk of stroke:

But because blood pressure is amenable to drugs, a world of marketing and guidelines developed around it. What constitute “high” blood pressure is open to opinion, and the US guidelines set by expert panels have periodically lowered the criteria so that millions of more people are labelled as ‘having hypertension’, or now ‘prehypertension’, and being ‘at risk’ of heart disease (Light, 2010, p. 22[19]).

The second feature is a distorted idea of causality. An example of this distortion is the concept of genetization: the tendency to consider genes as the main factor responsible for any kind of condition. In this kind of reductionism: “a complex understanding of the causes of human development is displaced by one in which genes are perceived as the ‘true cause’ of difference” (Shostak and Frese, 2010, p. 419[30]). Research has demonstrated that genes are “our destiny” only in a few cases (Maturo, 2009b[25]).

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Human Enhancement and Biomedicalization

In the debate on medicalization, a new topic has emerged in the last years: the opportunity of using biotechnology – mainly drugs – not to treat pathology, but to enhance normal conditions. Human enhancement can be defined as the use of biomedical technology to improve (physical, cognitive, emotional or social) performance on a human being who does not need any cure (Maturo, 2009a[24]). Human enhancement is part of the concept of biomedicalization proposed by Clarke and Shim (2011[6]). Biomedicalization differs from the concept of medicalization because it takes into consideration the aspect of human enhancement and also the role of pharmaceuticalization in contemporary society (Cipolla, 2010[5]).

Indeed, the topic of human enhancement has everything to do with the shift of medicine, or a section of it, from the treatment of pathologies to the optimization and possibility of going beyond normality: better than well. Some examples of human enhancement are: prosthetic limbs, cosmetic surgery, and emotional and cognitive enhancement through pharmaceuticals. The line between the medicalization of pathologies and the enhancement of normality is blurred, as there are actions carried out at the borders that do not fall into either category. Moreover, it is likely that the enhanceable of today becomes the pathological of tomorrow, which brings about an ever-broader area in which biomedical interventions are required [Figure 1].

Figure 1

Flowchart of paper

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Concluding Remarks: Are we Heading toward a Bionic Society?

The World Health Organization definition's of health as a “state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (WHO, 1946[33]) has been often criticized because it proposes an extremely wide and ambitious concept of health. An edenic idea of health! Instead, it seems that today these three dimensions – body, psyche and society – are fully involved in the medicalization process. Moreover, health should be considered more as a “process”, than a state. A process in which “physical, mental and social well-being” is constructed, maintained and rebuilt. An asyntotic process without an end – as biocorporations and advertising know very well.

As already stated, the expansion of medical categories into social spheres, which were not previously “read” medically, may play a reassuring role. For example, if we think that boisterous children are sick and have neurological problems and chemical imbalances, we allow ourselves to avoid looking at social problems like unemployment, social cohesion in ghettos and integration of the immigrants. A pill which works on serotonin levels is easy to prescribe, and is cheaper and “cleaner” than any social policy. Another example of medical colonization can be seen in food. In supermarkets, shelves of health foods are constantly growing. Food is increasingly advertised, packed and branded in ways which connect it to medical contexts. We have probiotic yoghurt which reduces the risk of ictus, blueberry drinks which improve our vision, and mineral waters which “purify”.

To sum up, the bionic society can be described by at least three intertwining forces:

• A strong emphasis on health as considered by its chemical, neurological and genetic dimensions;
• The extension of medical ways of thinking (not only medical treatments) in areas which were not medicalized previously – or were only partially medicalized – like prevention, cosmetic, nutrition;

A growing pharmaceuticalization which questions the borders between normality, pathology and enhancement, and therefore also between nature and nurture (Maturo, 2010b[23]).

In the near future, it seems that a bionic healthscape could lead to the transformation of social problems into medical problems of the single individual, therefore de-responsabilizing political and social institutions. On the other side, the emphasis on genetics and neurological dimensions might foster fatalism and passivity, leading to the deresponsabilization of the individuals for their health choices. All of this happening in a context where the lines between natural and artificial, normal and pathological, treatment and enhancement, are increasingly blurred.

Take home message

The transformation of human conditions into medical problems is increasing. In the past, medical profession was considered the main driver of this trend. Today other factors should also be taken into consideration: consumerism, managed care, marketing for pharmaceuticals and biotechnology.

The risk of medicalization is to neglect the role of social determinants in shaping human health. A new phenomenon which is emerging is human enhancement, that is, use of biomedical devices to optimise normality (and not to cure illness).[34]

There is a total of  20 quiz questions for a possible 5 runs.

Quiz for 3/20/2018

1.     Define medicalization.

2.     What is social iatrogenesis?

3.     What is a practical example of social iatrogenesis?

4.     Peter Conrad has proposed to consider medicalization in what three respects?

5.     What are the engines of medicalization?

6.     (T/F) The use of pharmaceuticals and medicalization are the same thing.

7.     What aspects of medicalization are not directly connected to the use of drugs?

8.     (T/F)  There are situations of medicalization which do not include the consumption of pharmaceuticals as their main feature.

9.     What situations of medicalization do not include the consumption of pharmaceuticals as their main feature?

10.  Define pharmaceuticalization.

11.  Give an example of pharmaceuticalization.

12.  What three main causes are proposed to have fostered pharmaceuticalization?

13.  (T/F) Causes of mental illness are often described as etiology unknown.

14.  What are the main consequences of the latest version of the DSM?

15.  Define risks.

16.  Define dangers.

17.  As related to health, risk may be connected to what?

18.  (T/F) It can be easier for political institutions to embrace a clinical and biological definition of a disease instead of addressing the social causes underlying these pathological conditions.

19.  What is lacking in the risk factor model?

20.  Define human enhancement.