Medicalization refers to the idea of defining a normal human behavior as an illness or disorder that requires medical intervention (Conrad 2005, 3). Popular examples include the medicalization of erectile dysfunction, alcoholism, and the diagnosis of attention deficit hyperactivity disorder (ADHD). The term first emerged in the 1960’s when medicine was just beginning to enter the social sphere and become present in everyday life. A reliance on medicine and the emergence of medicalization became present in the treatment of social deviances like homosexuality and alcoholism (Ballard and Elston 2005, 230). The 1970’s and 1980’s saw a rise in the power of the medical profession as the medical jurisdiction expanded and physician influence rose (Conrad 2005, 4). In his book Profession of Medicine, Freidson argues that doctors were acting as moral entrepreneurs in the 1970’s and possessed a cultural monopoly over defining and treating illness (Freidson 1970).
When managed care emerged in the 1990’s, the entire organization of the health care industry was transformed and, thus, medicalization evolved and expanded as well. Peter Conrad argues that three main changes in the health care industry define medicalization today—biotechnology, changing consumer, and managed care. First, biotechnology refers to the growing availability of drugs to treat illness and the growing influence of pharmaceutical companies. This growing availability of drugs contributed to the rise of medicalization (Conrad 2005, 5). Second, consumers have shifted from the role of the passive patient to an active consumer in the health care market as pharmaceutical companies market directly to patients, lessening the role of the health care provider (Conrad 2005, 8). Finally, the emergence of managed care has emphasized profit over patient care by giving doctors incentives to minimize necessary care and by medicalizing certain problems that were previously not in the medical sphere, like obesity, to earn the profits of resulting health care obtained (Conrad 2005, 10). The health care industry today is increasingly driven by commercial and market interests. Medicalization has grown alongside this expanding market by changing social norms surrounding many physical conditions and expanding the reach of the medical field as many new conditions enter the field of medicine.
Many controversies surround the growing idea of medicalization and whether certain conditions require medical intervention. One such controversy that mirrors many others is the use of human Growth Hormone (hGH) in children with idiopathic short stature (ISS). Children with idiopathic short stature are in the lower three percentile for their age and sex but have no growth hormone deficiency, they are essentially just short. If parents are worried about their child being too short, they are able to attain human Growth Hormone (hGH) to help the child gain more height. In 1994, 13,000 children with ISS were treated with hGH (Conrad 2004, 8). While medical attention is not essential for dealing with idiopathic short stature, proponents of hGH argue that using hGH to enhance the growth of these children with ISS helps to address psychological and social problems associated with being short.
Critics of the medicalization of idiopathic short stature argue that this treatment is not very effective for a such a high cost. Human Growth Hormone costs $20,000 per year and must be continued for 3-6 years. This treatment is not covered by insurance because children with ISS are not hormone deficient (Conrad and Leiter 2004, 166). Therefore, is treatment even necessary? Should we be wasting the time of doctors when they could be helping people who are actually suffering? On the other hand, research shows social disadvantages of being short, especially for males. Studies have shown discrimination in hiring and salaries, assumptions around maturity and competence, issues around self-esteem and perceived attractiveness, and problems buying clothes that fit (see Conrad and Potter 2004, 193). The question becomes, should medication be used to ease these psychological and social difficulties? To what extent should we use medical treatment to intervene in socially determined health conditions? Many controversies surrounding medicalization question whether some conditions actually need medical treatment or whether we are wasting our resources.
Image: Human Growth Hormone Injector; source: AP images
The term medicalization is related to the politics of health because it demonstrates the power that institutions can have in shaping the definition of health and the medical world. The evolution of medicalization over the last half of the 20th century has seen different institutions in control of defining and treating health—first the medical profession and now managed care organizations. We have seen medicine become more commercialized and therefore more institutionalized. Our health care system today has become driven by business and profit motive and so the politics surrounding medicalization and who is constructing the definition of “health” is increasingly becoming controlled by non-health care providers. As discussed earlier, the use of human Growth Hormone in children with Idiopathic Short Stature capitalizes on parent anxiety in order to create a physical condition and make a profit over an avoidable drug. This major shift towards the importance of profit causes our health care system to become way more politicized and institutionalized, making the politics of heath something that cannot be overlooked when considering the rise of medicalization in the 21st century.
References:
Ballard, Karen, and Elston, Mary A. 2005. Social Theory & Health. “Medicalisation: A Multi-dimensional Concept.” 3: 228-241. Accessed January 20, 2017. doi: 10.1057/palgrave.sth.8700053
Conrad, Peter. 2005. Journal of Health and Social Behavior. “The Shifting Engines of Medicalization.” 46: 3-14. Accessed January 11, 2017. doi: 10.1177/002214650504600102
Conrad, Peter, and Leiter, Valerie. 2004. Journal of Health and Social Behavior. “Medicalization, Markets and Consumers.” 45: 158-176. Accessed January 22, 2017. http://www.jstor.org/stable/3653830
Conrad, Peter, and Potter, Deborah. 2004. Sociology of Health and Illness. “Human growth hormone and the temptations of biomedical enhancement.” 26: 184-215. Accessed January 22, 2017. doi: 10.1111/j.1467-9566.2004.00386.x
Freidson, Eliot L. 1970. Profession of Medicine: A Study of the Sociology of Applied Medicine. Chicago: University of Chicago Press.
Spencer, Green. HGH-Growing Use. December 20, 2012. Associated Press, Chicago, IL. Accessed January 23, 2017. http://www.APimages.com
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