The medicalisation of society was a term introduced by sociologists and philosophers to argue against medical power to interpret normal circumstances like menstruation, pregnancy, aging and even death as medical problems. Foucault argued against the medicalisation of what was termed as deviant sexual behaviour (he was a sadomasochist) and mental illness. While a lot of this remains true, it is the medical profession which is now concerned about the public turning to medicine and science to solve all problems. This term has indeed caused such harm to medicine that it gave impulse to complimentary practices (not a bad idea in many cases), and to alternative practices (many of which cause harm). A recent programme on television tried to demonise the drug Omeprazole, which we use to block excess acid produced in the stomach, and to recommend an alternative made of honey and goat’s milk. It was emphasised that it had to be goat’s milk (and not cow’s) and that the honey had to be of a special kind, the name of which I forget. No studies were produced of course to show how effective this was other than the statements of the person recommending them. I believe he was honest because in fact such products reduce symptoms, but they do not cure diseases such as peptic ulcers, and to say so without proper analysis is criminal.
This strategy against the medical profession is justified to a certain extent because of abuses which occur. But there are sham doctors and other lay people who do a six-week course in nutrition and call themselves nutritionists. Others may be biologists-turned-nutritionists. A client of mine, who since then died of breast cancer, was told, by one of these, to stop all her chemotherapy and follow his advice on diet. The point is that it is not “medicine” as such, and neither the profession (which strives for evidence-based-practice based on accepted quantitative and qualitative methods and the repeatability of studies) which is to blame. It is those who are taking a ride on medicine these days and practice stuff for which they are not duly qualified. Some health care professionals go beyond the realm of their profession, and many other lay people, who are not even professional, give medical advice. There is ample advice on the media, for example, on skin care (to sell products), hair growth, obesity, menopausal symptoms, diet, the alternative (rather than complimentary role) of yoga and other practices. Everyone speaks to us about our health. Beauticians and hairdressers may verge into the realm of dermatology; nutritionists giving dietary advice as a panacea to all cures, and so on. Medicalisation, even if it started with the medical profession which philosopher and priest Ivan Illich so much wrote about, has now gone into the hands of self-made experts.
The paradigm has indeed changed. Society has rejected spirituality and religion, notwithstanding that medical studies have shown that people who adhere to a religion not only find solace but indeed are more peaceful and have fewer symptoms at the end of life or in dealing with a chronic disorder, to faith in pills and robotics. A person nowadays walks into a clinic “healthy” for a check-up and walks out “with a disease” because the doctor found high blood pressure. It is not the blood pressure itself however, which is the illness, it is what this rise of pressure in the arteries can cause in the long-term – heart attacks, strokes, and so on. The same goes for diabetes, cholesterol and other conditions. The person who feels sick or has an illness because she has one of these conditions is being affected not by the doctor who made the diagnosis. The doctor would have explained that it is only something to keep under control. But it is the constant bombardment, with good intentions of course that we get on the media. We forget that often these programmes are sponsored by those who want to sell a product, which they say will make you feel better.
And therefore, we have medicalised obesity, menopause, period pains, hair growth, aging, dying, ADHD and alcoholism. Homosexuality managed to detach itself from being medicalised (in fact the medicalisation was an aid to this as it lifted it from having been criminalised before). Even sadomasochism cannot be described as a medicalised condition. This is not to say it is normal; neither that it ought to be moral. But the persons who indulge in this behaviour in private are perfectly normal people you may know. Why they are like that only their upbringing, experience or perhaps genetics can explain. But again, geneticisation is a form of medicalising a condition. When we say something is genetic it does not mean it is an illness. It is simply a trait. However, many diseases, including diabetes, are genetically related and therefore medicine has a moral obligation to follow up.
Does this mean we ought to control the advancement of medicine? Of course not! My father just had a valve inserted through an artery – a miracle which saved his life and which did not exist when I qualified. These advancements are necessary. The irony is that the doctor who did it told me that he had done the procedure on a foreigner, who proudly told him, that his job was aiding people to sue doctors. Nevertheless, in dire circumstances he sought the very people he made a living of slandering.
It is true that pharmaceutical companies may try to invent another drug, as happened with Omeprazole to the evolution of Esomeprazole, the cost-benefit of which may be doubtful. They have to survive. But do you blame the medical profession in trying to give something which is albeit a little better. However, while doctors pride on their independence they are also controlled by standards of care and have an obligation to society not to squander resources. Is that MRI really necessary? Do we really need to give the new drug in this particular case?
Sometimes we have to stop and talk to people who come in “wanting” a CT scan in hospital. Many people nowadays think they have cancer when they feel a pain; think they have a heart attack if they get a pain in their arm, which they actually know was due to the stressful work they did. As people we seek reassurance continuously. As doctors, it is our role to give it. Illness is an assault on the patient and a lot goes into preventive medicine. But we have to be gatekeepers as well so that these tests are done only when appropriate.
If anything has been medicalised it is death. We see death as the enemy or as “losing” a battle. We are all going to die. But at the end of my life I would like my doctors to discuss with me and plan ahead rather than, for the sake of my relatives, be seen as “doing their best” and trying out something else, when they know deep down that it is futile.
People have come to see medicine as some sort of magic. While we enjoy Grey’s Anatomy; this is all fiction. There is no doctor in the world that I have heard of, who performs cardiovascular surgery, neurosurgery, gynaecology and so much else. Perhaps a future android.
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This article is his personal opinion and does not represent the opinion of any committee or Board he serves on.
Pierre Mallia is Professor of Family Medicine and Patients’ Rights and teaches at the University of Malta. He chairs the Bioethics Research Programme of the Faculty of Medicine and Surgery. He also chairs the Bioethics Consultative Committee