Estimating the costs of medicalization
ABSTRACT Medicalization is the process by which non-medical problems become defined and treated as medical problems, usually as illnesses or disorders. There has been growing concern with the possibility that medicalization is driving increased health care costs. In this paper we estimate the medical spending in the U.S. of identified medicalized conditions at approximately $77 billion in 2005, 3.9% of total domestic expenditures on health care. This estimate is based on the direct costs associated with twelve medicalized conditions. Although due to data limitations this estimate does not include all medicalized conditions, it can inform future debates about health care spending and medicalization.
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ABSTRACT: Background Health care outcomes used in service evaluation and research tend to measure morbidity and mortality. This is the case even in maternity care, where most women and babies are healthy. Salutogenesis theory recognises that health is a continuum, with explicit inclusion of wellbeing as well as illness and pathology. This offers the potential to reframe the outcomes and therefore, the focus of, maternity care research and provision. Aim The aim of this study was to identify how salutogenesis has been defined and used in maternity care research undertaken with healthy women. Method A scoping review was undertaken, using a formal pre-defined search strategy. Inclusion criteria encompassed research papers relating to the maternity episode up to one year after birth, using salutogenesis or any of its associated concepts, focused on healthy women, and written in a language which any of the members of the group could understand. The search was undertaken in two phases (Database inception-April 2011 and May 2011 -February 2013). Included studies were subject to narrative analysis. Findings Eight papers met the inclusion criteria. They covered seven topics, spanning the antenatal, intrapartum and postnatal periods. Only two papers employed both positive health orientation and explicit use of Antonovsky's theory. The remaining studies used discrete aspects of the theory. Conclusion Salutogenic framing is rarely used in maternity care research with healthy participants. An increase in research that measures salutogenically orientated outcomes could, eventually, provide a balance to the current over-emphasis on pathology in maternity care design and provision worldwide.Sexual & reproductive healthcare: official journal of the Swedish Association of Midwives 09/2014; 6(1). DOI:10.1016/j.srhc.2014.09.001 · 1.25 Impact Factor
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ABSTRACT: There has been much discussion in academic conferences and sport policy-makers with respect to the role of anti-doping (McNamee and Møller 2011; Hanstad, Smith and Waddington 2008). Put simply, there is a potential schism between the overarching function of anti doping — is it first and foremost a sports-related issue, or is it more generally to be understood as a public health issue? (Møller et al. 2009)? It is clear that these two aspects are not mutually exclusive such that the question cannot simply be a case of which should be its focus. Sports are, after all, social practices, engaged in by hundreds of millions of people. What goes on in these practices, to the extent that it affects the health of its participants, must also be a public health issue, irrespective of its (disputed) significance. Nevertheless, one particularly problematic aspect of present anti-doping policy relates to the existence of what are often and variously referred to as “social drugs”, “recreational drugs” or “substances of abuse”, in the list of prohibited methods and substances that comprise “doping” as defined the global body responsible for anti-doping: the World Anti-Doping Agency (WADA). The focus of this article is whether and how the presence of Cannabinoids on the Prohibited List (PL) is justified or not. Many scholars, scientists, and key actors in anti-doping policy — in confidential interviews — have argued that it should not be included. They argue that the presence of Cannabinoids is present on the Prohibited List merely as an extraneous and unwelcome function of governmental intrusion on sport and not because of any coherent anti-doping policy. In effect, it is thought to be a political intrusion that is paternalistic and, in effect, a “moral policing” of high-profile athletic populations. They argue, moreover, that the criterion, which facilitates Cannabinoids’ inclusion on the PL (that it is against the “Spirit of Sport”), is conceptually vague and should be removed. They believe this will negate the presence of Cannabinoids on the PL. In short, they seem to be arguing that Cannabinoid use ought not be thought of as “doping”. In this article, I argue to the contrary — that Cannabinoids should be retained on the Prohibited List; that its use may be thought of as doping; and that the Spirit of Sport criterion, though vague, is still a defensible criterion for the demarcation of “doping”. To achieve this, I critically discuss the legitimacy of Cannabinoid inclusion in the light of contemporary literature on “enhancement”, and introduce the findings of a recent empirical investigation into anti-doping policy with a sample of international key actors in anti-doping policy. In the first section, I describe the definition of doping and the current state of policy flux in anti-doping, then I set out the extant and the proposed criteria for a method or substance to be considered doping (i.e., for inclusion on the Prohibited List). I review then one bioethical critique of the Spirit of Sport criterion (Foddy and Savulescu 2010), and a recent challenge by an internationally recognised group of scholars and scientists working in the field of anti-doping (the International Network of Humanistic Doping Research) to remove the criterion. I then included narrative data from key actors on the international scene of anti-doping such as Heads of National Anti-Doping Organisations, Heads of Medicine and Science in Anti-Doping Organisations, and senior members of the World-Anti Doping Agency (WADA), before arguing against their position and for the status quo. Following the Ben Johnson scandal at the 1988 Seoul Olympics, the subsequent Dubin enquiry and the Tour de France scandal in 1998, the IOC established a working group to formulate a robust and independent international body to regulate doping in sport. In consequence, the WADA was set up. Following a UNESCO convention, signed by nearly all nation-states in the world, the World Anti-Doping Code (WADC) came into effect in 2003. It was agreed that WADA would be funded jointly by nation...01/2012; 4(4):374-392.
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ABSTRACT: Mental disorders, especially depression, have been increasingly described as a growing burden to global public health. Critics argue, however, that the use of mental health surveys, underlying these descriptions, tends to overestimate the prevalence of mental disorders by not distinguishing everyday experiences of distress from pathological conditions. This medicalization of public health is believed to narrow the focus of public health practices. The aim of this thesis is twofold. The first objective is to describe and analyze experiences with antidepressant treatment for depression as expressed in adverse drug reaction (ADR) reports from patients, i.e. “consumers reports.” A second goal is to conduct a theoretical discussion, by looking at broad societal changes, and analyzing the consequences of mental ill health as a significant public health problem. Special attention will be given to medicalization. Reports of suspected adverse reactions regarding antidepressant mediations were submitted from 2002 to 2009 to an open Internet-based reporting system in Sweden. These were analyzed according to common psychiatric reactions and narrative experiences. Furthermore, a literature overview in a broad and general sense was performed to underpin a theoretical discussion on health, public health, mental ill health and medicalization. The main findings of this thesis were that patients reporting to an open Internet-based system in Sweden seemed, to a large extent, to experience psychiatric ADR symptoms of mental disturbances (sometimes severe), which affected them in many different ways, especially during discontinuation. These reports also suggested a negative doctor-patient interaction from the patient’s perspective. Risks leading to increased medicalization as a result of overdiagnoses of depression were found. Pharmaceuticalization resulting from overprescribed antidepressants was also deemed problematic. According to a theoretical discussion on public health and medicalization, increased medicalization as a result of excessive diagnosing risks individualizing mental problems and may divert the focus from the social and political context of public health. According to patient reports, there seems to be a potential problem as to how patients are diagnosed with depression and prescribed antidepressant medication in the medical encounter. Increased drug treatment risks lead to increased health care costs and potential harm from adverse drug reactions. Overdiagnosis and overtreatment may in turn lead to diminished trust in the health system. If depression is going to be viewed as a growing public health problem, it, therefore, calls for a distinction between ill health problems that are medical and those that are not. Arguments for increased medication must be related to a possible danger of medicalizing social problems and life crises.03/2014, Degree: Doctor of Philosophy in Medical Science