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Drug ads and other factors are having an impact on clinical practice

By Ed Edelson
HealthDay Reporter
THURSDAY, Feb. 22 (HealthDay News) — Consumers, often egged on by drug ads they see on television and elsewhere, are “medicalizing” what doctors may have previously not considered full clinical problems, experts write in this week’s issue of the journal The Lancet.

The trend has both its upside and downside, experts say.

In the 1970s, the term medicalization “came into being as a critique of the power of doctors, who, in the guise of treatment, were doing things that were bad for people,” said Dr. Jonathan Metzl, associate professor of psychiatry and women’s studies at the University of Michigan.

“The term has expanded greatly in its use. Today, it is used more in connection with the actions of pharmaceutical companies, and we need to understand its effects better,” he said.

Metzl discussed the effects of direct-to-consumer (DTC) drug advertising in one of six essays in the journal, originating from a workshop on medicalization that he helped organize.

“Pharmaceutical advertisements definitely have pushed the boundaries of what is and what is not considered a medical issue,” the expert said.

For example, television advertisements for Cialis, Levitra and Viagra have changed the perception of what it is to be a normal, healthy man, Metzl said. In that way, male sexual performance has been “medicalized.”

Similarly, DTC antidepressant ads that depict depressed women as unable to fulfill their roles in the family have medicalized that issue, Metzl said.

“It’s hard to deal with them, because we are so overwhelmed by these advertisements,” he said. “But I don’t think we should reject them out of hand. We should think of what they say about illness and health.”

On the part of the consumer, such advertisements “can engender useful conversations between doctors and patients,” Metzl said. “And they can encourage doctors to look at cultural issues.”

Other essays touched on different aspects of the issue. For example, Troy Duster, professor of sociology at New York University, wrote about the medicalization of race — specifically, about the approval in the United States of medications designed specifically for black Americans.

“The appearance of racialized drugs on pharmacist’s shelves only increases the need to attend to the myriad social sources of disparities in morbidity and mortality,” Duster wrote. “Although to turn a profit from fighting racial discrimination is difficult, effective medical care requires continued awareness of the complex social dimensions of diseases, such as hypertension and cancer.”

Cindy Patton, professor of sociology and anthropology at Simon Fraser University in Vancouver, Canada, wrote of changes that have occurred in the evolution of treatment of HIV/AIDS because of the new accent on medicalization.

Because of the impact of HIV care on other aspects of health — for example, cardiovascular well-being — HIV-positive patients and their doctors are increasingly aware of trends across a wide variety of medical specialities. In many cases, these specialities — such as virology and cardiovascular disease — used to have little in common, Patton explained.

However, “The distance between biomedical specialties that might once have been bridged mainly by researchers and specialized clinicians now is negotiated mainly by the patients themselves, since their knowledge sets expand and intertwine over time,” she wrote.

We suggest a minimum of two other men and a maximum of seven. You can be the group facilitator. We suggest two guidelines. First, try to be as honest, clear, and specifi c as possible about sexual attitudes, experiences, and feelings. Second, no one-upping, bragging stories, and no put-downs of other group members or women. Here are some suggested topics/questions: How did you learn about sex as a child? Who talked to you? What did you learn? If no one talked to you, where did you get sex information? Whether from parents, school, church, or friends, what was your best, most helpful sex education experience? When did you fi rst experience orgasm/ejaculation? Nocturnal emission (“wet dream”), masturbation, partner sex, or fooling around with other boys? Was it a positive or anxiety-provoking experience? When did you fi rst hear about couple (marital) sex? Did it excite or repel you?

What was your fi rst contact with pornography—Playboy, Internet, or sex stories? Was it exciting, shameful, erotic, guilt-inducing? How old were you at your fi rst partner sexual experience? Was it with a girlfriend, hook-up, prostitute? Did it involve manual or oral sex, rubbing, or intercourse? Was it a good or bad experience? How did you react to negative sexual experiences—contracting an STD, getting a woman pregnant, being sexually abused, being sexually humiliated, being rejected, getting caught masturbating, having an unsuccessful fi rst intercourse? Did you deny it happened, lie about it, or tell no one? In retrospect, how has this negative experience(s) aff ected you sexually? What was your most positive premarital sexual experience? What was the quality of the relationship and the quality of the sex? What were your most positive learnings from this relationship about yourself, women, and sex?