Tuesday, March 11, 2008

So what is Medicalization?


 
Medicalization of Normal Processes

As science and technology advances, age related processes often become medicalized and enter the domain of powerful social establishments like the health industry. When such human experiences come under medical dominion, the experience is said to become medicalized; this entails the definition and treatment of a problem under a medical framework. I argue that the medicalization of biologically predetermined physiological processes, such as the decreased production of testosterone by the gonads in men, should raise concerns about the level of social control which the medical community has exercised when attempting to address health issues. 

To understand how the medical community has become a powerful institution of social control on health issues, a fundamental understanding of medicalization is important. As Conrad states, “medicalization describes a process by which nonmedical problems become defined and treated as medical problems, usually in terms of illnesses and disorders [Conrad, p 104].” This process adopts a medical framework in attempts to comprehend problems and often leads to treatments of the problem through medical interventions [Conrad, p 105]. Medicalization therefore profoundly impacts society because it may put natural stages of life under medical expertise and impose a medical viewpoint to understand problems. 

Male menopause is characterized by the decreased production of testosterone. It has been linked to unwanted physiological side-effects including fatigue, depressed mood, and low sex drive;=. It has been defined by professionals of the Endocrine Society as a medical problem known as “andropause” [Groopman 2002]. The use of a medical term may lead to the assumption that decreased testosterone production in older men is abnormal rather than a part of the general life process. Such ability of the medical profession to define normality is a form of social power worthy of analyzing, especially since the notion of abnormal health may influence men to seek medical attention when it is not necessary. Fundamentally “the key issue remains definitional- the power to have a particular set of (medical) definitions realized in both spirit and practice [Conrad, p 110].”

Medicalization is also characterized by the tendency of medical professionals to claim expertise over a specific condition which can, potentially, put more of every day life under medical scrutiny. Today for example women undergoing pregnancy are expected to receive neonatal care by obstetricians that have expanded their treatments to “prenatal lifestyles, infertility and postnatal interaction with babies [Conrad, p 111].” Another example is the shift that pediatricians have made from becoming “baby feeders” to specializing in behavioral pediatrics, this has “enabled pediatricians to maintain and enhance their medical dominance by expanding their medical territory [Conrad, p 109].” Likewise, older men experiencing menopause will be expected to seek the advice and/or treatment  from endocrinologists who exercise authority over conditions that involve hormonal control. The importance of this realization is that normal human experiences can become medicalized to the extent that only medical experts can appropriately asses the situation. Instead of perceiving testosterone deficiency as a human phenomenon that older individuals experience, people will begin to characterize it as a medical condition requiring special medical evaluation.

To understand the level of social power that the medical community exercises through medicalization, Conrad explains that physicians have medicalized social deviance. They accomplish this by claiming the medical basis of matters such as hyperactivity, madness, alcoholism and compulsive gambling [Conrad, p 107]. By medicalizing social matters, medical professionals have the power to legitimize negative social behavior, such as the case of suspected killers in judicial courts who claim temporary insanity and are therefore exonerated on medical basis [Conrad, p 111]. In extending this concept, the Endocrine Society may have medicalized social deviance in men who reduce their work motivation or become characteristically unpleasant because they are experiencing andropause. In effect, despondency in older men might become an indicator of male menopause rather than a possible indicator of social deviance.

Physicians also play a direct and significant role in the medicalization of social experiences. In analyzing the doctor-patient interaction of medicalization, Kaw argues that medical professionals have medicalized racial features by encouraging cosmetic surgery among Asian American women. For example, in order to avoid the stereotypical physical features of “small” and “slanty” eyes that are often associated with passivity, dullness and lack of sociability, cosmetic surgery offers a corrective or enhancement alternative [Kaw, p 75]. Kaw asserts that plastic surgeons use medical terms to “problematize the shape of their eyes so as to define it as a medical condition [Kaw, p 81].” Their use of technical terms and expressions should be questioned, especially since the power of such language may influence Asian American women to pursue cosmetic surgery when it is not necessary [Kaw, p 82]. Analogously, the Endocrine Society medicalized testosterone deficiency by defining it as Andropause; this helped perpetuate the notion, among older individuals, that if they lack sexual drive or sense depression and fatigue, they should seek medical attention because they are experiencing an acute medical condition rather than a stage in the physiological cycle.

The role played by the health care structures in medicalizing conditions is enhanced by that of the pharmaceutical industry. In order to achieve implementation of a drug in the market, the medicalization of a problem is critical [Conrad, p 111]. Once a medical definition for male menopause was established, the pharmaceutical company further medicalized the problem by launching strong advertisement campaigns aimed at older men and physicians alike, so as to popularize the drug among the general public and medical community [Groopman, 2002]. In a Time magazine advertisement, the industry appealed to the emotions of older men by linking “low sex drive” to the decline of testosterone levels rather than to a life process [Groopman 2002].” In this manner, the pharmaceutical industries' profit based ideology facilitates the medicalization of testosterone deficiency by popularizing conditions that may be exceedingly common among health product consumers. 

Medicalization also changes patients’ ideologies of biomedicine and leads them to believe that biomedicine must not only offer cure for illnesses, but also offer life enhancements. Similar to the way that impotence and hair loss was medicalized by promoting drugs like Viagra to enhance sexual performance, and solutions like Rogaine for hair re-growth, male menopause has been medicalized because it causes low “sex drive” among other general symptoms [Groopman, 2002]. As a consequence, older men will opt to not only seek but demand life enhancements achievable through medicine disregarding the fact that such treatments can be detrimental to health. In fact, Groopman states that known side effect of testosterone therapy include abnormal enlargement of the breasts, testicular shrinkage, congestive heart failure and enlargement of the prostate gland [Groopman, 2002]. Medicalizing a problem can be harmful and deadly, yet medical professionals perpetuate this dangerous behavior by medicalizing conditions that patients may seek to treat for their personal “wellbeing” 

It is important to realize that medicalization is not merely the result of “medical imperialism” but rather the interactive process that involves society and the health community. It includes patients and doctors alike. Nonetheless, awareness of the mechanisms by which the medical community affects society is important because medicine pertains to all health consumers. Male menopause only serves as one of the many examples of life experiences that have become medicalized by the healthcare community.
-Michael Garcia

4 comments:

Lily said...

Bizarrely the male menopause (to give it one of it's many names) is my topic of the moment.

Although over treatment with testosterone can lead to problems such as gynaecomastia, in general the benefit of testosterone replacement in older men far outweighs any negatives.

Low testosterone doesn't only cause a low sex drive, it also leads to problems such as osteoporosis through a lack of aromatisation to oestrogen and a general feeling of lethargy.

If there's a medical treatment available to make older men feel rejuvenated, surely that's a good thing. Testosterone helps to maintain bone and muscle strength which is increasingly important as people get older.

I also feel that the ability to have a full sex life should not be overlooked for older patients. Many studies have shown that sexual fulfilment in older patients leads to an overall improvement in quality of life.

I might be biased as one of my lecturers is a professor who strongly advocates testosterone replacement in older men, but I can definitely see where he's coming from. I would strongly argue that testosterone deficiency in older men is a medical problem. Just because it wasn't seen as one in the past or treated as one doesn't make it any less real.

I really liked this post, it gave some nice food for thought. Keep up the good work :)

Mike G said...

lily,

you hit the nail on the spot. Andropause can be a big problem for some men.

Need not mention how a low sex drive can be a real downer...

I've always been prone to draw treatment-enhancement distinctions when it comes to medical interventions like these. In this particular post, I just wanted to play devil's advocate in lieu of the student who won't question conventional medical practices.

Thanks!

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