Question one
The society of today has become one where most problems are treated medically. The people gaining from this are mostly the pharmaceutical companies. Some of the doctors’ duties are slowly being replaced by the advertisements on the Internet on how one can know his/her medical condition. The major reason to this is Medicalization by the pharmaceutical companies.
Medicalization
Medicalization is the changing of human problems in the society to an illness or a disorder. There are so many problems in the society that people experience. Doctors have come to change almost all consistent problems into medical illnesses or disorders. An example is the Medicalization of sex, where homosexuality is considered a disorder (Wikholm, 1999). Most abnormal issues in the society are medicalized and treated using medical interventions. Another definition indicates that Medicalization is the assertion process by doctors over what was previously overseen by morality guardians (Wikholm, 1999). Other authors also define it as the transformation of human conditions into treatable disorders (Conrad, 2007).
Consumers Contribution to Medicalization
Not only the doctors cause Medicalization but a conducive environment supports it too. The consumers in this case are the patients, and the advocacy companies or groups. It has been shown that consumers want to have power over their medical care. Consumers choose the health care plans, select health care institutions, and buy health care products and services from the market (Conrad, 2007).
It is also noted that hospitals compete for patients (Conrad, 2005). When health care has been transformed into a commodity to this extent, it means the health care institutions will strive to provide solutions even to the slightest problems in the society to get more patients. This leads to Medicalization. Not many people would strive to look for a solution when some body somewhere in the health care institution already has the solution. Consumers believe the solutions in the health care centers are it. Based on the fact that consumers too strive to take control of their health and have a lot of information about their health, they increase Medicalization (Conrad, 2005).
There are examples which explain how consumers contribute to Medicalization. These are as explained by Conrad. Just as noted before, Medicalization is the transformation of a non-medical problem into a medical problem. Considering the consumers for example. The reason why they contribute much to Medicalization is the belief they have in the medical intervention procedures used to correct the problems. The body of a human being is not a problem, but considering factors such as beauty part of the body becomes a problem (Conrad, 2005).
An example is the breast. Some women view large breasts as a problem and so would like to reduce them. Others view small ones as a problem. The doctors or the physicians for that matter, found out the problem and developed a medical intervention for it. These consumers (women for that matter) create so much demand for medicalized solutions. Medical interventions that have since been created to solve breast size problems are such as liposuction and breast augmentation among others (Conrad, 2005). This is an example of cosmetic surgery, which is an example of how consumers influence Medicalization.
Other cosmetic surgery examples are such as nose jobs and tummy tack procedures. The body has been turned into a medical problem. The body can be a medical problem, but just in the case of an illness. When the body develops some parts as big, it does not recognize those as a problem yet the medical profession capitalizes on this and makes money out of it. Conrad notes that breast augmentation costs $ 3, 000 (2005).
There are other ways in which consumers contribute to Medicalization and not through cosmetic surgery alone. These are through adult ADHD, hGH therapy and response to pharmaceutical advertisements. Inability to tolerate benign problems and mild symptoms has lead to frequent visits to physicians to ask for solutions. Adult ADHD is one of those inabilities. Due to the information that consumers get from the Internet and book sources, they become more aware of the medicalized situations and seek advice from physicians. Some of them even ask for specific treatment since they already read it some where (Conrad, 2005). This creates a large market for medicalized treatments of very mild symptoms and benign problems.
Pharmaceutical industries play apart in this case by making advertisement to different treatment methods for conditions that are non medical. The quest for taking control over the people’s health has lead to more Medicalization since consumer groups are formed to fight for the health of the consumers. These groups for example the National Alliance for the Mentally Ill, CHAAD and the Human Growth Foundation, support medical treatments for human problems. If medical treatments to human problems are medicalized, then with the many problems in human life, everything will be medicalized with time (Conrad, 2005).
Conrad indicates that the consumer advocates are always funded by the pharmaceutical industries. This therefore influences the society’s response to research done by the pharmaceutical industry as the consumer groups will always support them. More people will believe in the research and more Medicalization will be experienced. This should not be the case as these corporations are funded by the consumers too and should care about their health and not supporting a pharmaceutical industry without proper research about the effects of medicalizing all small problems. An example of a very small problem that has been medicalized is the treatment of unhappiness by use of antidepressants (Conrad, 2005).
Examples of Medicalization Driven by Pharmaceutical Companies
Pharmaceutical companies cause Medicalization if more profit can be gained from such conditions to be medicalized. More problems of healthy people are being referred to as illnesses due to the need for money by the pharmaceutical companies (Moynihan et al, 2002). Pharmaceutical companies through the consumer groups and many other corporations undermine the coping ability of people by advertising or creating awareness about benign problems. Pharmaceutical companies cause Medicalization by making advertisement for example about erectile dysfunction in men and trying to offer solutions to it. Since this is a sensitive issue to men, the men look for those drugs or medical treatments to solve the problem. The advertisers know very well that the men are not able to tolerate this problem for long an it reduces there confidence.
The second strategy used to increase Medicalization is the creation of awareness about a disorder before the treatment is released into the market. This creates a market for an already developed, yet not released treatment, for another benign problem (Moynihan et al, 2002). Examples of Medicalization driven by pharmaceutical companies are such as Medicalization of menopause, Medicalization of female sexual dysfunction and of obesity. Distribution of information of such human problems on the interment so that people study and believe they have the problem is the advertisement strategy. The pharmaceutical companies just do all types of marketing to get money.
Personally Observed Medicalization: Medicalization of learning disabilities in children and Medicalization of homosexuality.
How to Teach a Beginning Social Work Student
For a student to be aware of Medicalization, a framework of determining if the presented symptoms in a person are really a disease or not should be used. The student should be made aware of the pharmaceutical industries’ aim to sell more and get more money and so will be involved in medicalizing most of the human conditions. The important part is the introduction to the basic knowledge about Medicalization and the conditions mostly treated as medical yet not.
Question three
Evidence Based Approach
This is an approach meant to assist in decision making. It gives a direction through which a practitioner should take in linking application issues, ethics and evidentiary issues. Evidence Based Practice components are mostly designed to reduce bias as decisions should be fair. They are meant to promote integration of practice and research which is done by researchers, practitioners, educators and administrators (Gambrill, 2006).
The description of an EBP by its originators is that it is a practice and educational paradigm meant to reduce the gaps between research and practice with the aim of maximizing opportunities and reducing harm. According to the originators, professionals need information from which they have a base of making a decision, sure of the effects. This helps them make decisions appropriate for clients depending on what clients value (Gambrill, 2006). This is the importance of Evidence Based Practice paradigm. It is an approach of combining ethical , application and evidentiary issues in decision making to come out with an effective or successful result in any professional practice (Gambrill, 2006).
This kind of decision making is contrary to the authoritative way of decision making which involves decision making based on the traditions of the organization or other criteria such as anecdotal experience and consensus. The originators of EBP consider it an evolving process that improves professional judgment on clients based on information about the characteristics, preferences and circumstances of clients (Gambrill, 2006). Due to the aim of this format (EBP), it has its components designed to reduce bias. A good decision is that which is not bias for if it is then the mission may not be accomplished (Gambrill, 2006).
Evidence Based Practice encourages honesty or rather transparency so that any finding in a research is shared even if it is termed nothing. Other views of Evidence Based Practice indicate that decisions should be made using practice related research as well as the practice guidelines. It is similar to Gambrill’s definition where the practice guidelines are included, but in the later, “the decision should be made based on a practice related research considering the ethical, application and evidentiary issues” is not included (Gambrill, 2006).
Choices to be Made in Adopting an EBP Approach
There are several choices that need to be made in order for an Evidence Based Practice to be adopted. These are; practice and policy research questions and the basis on which they are formulated considering who should formulate them, the expected out comes considering the basis of selection and the person responsible for the selection, the types of evidence to be used for service selection and how to determine their effectiveness, the style of EBP to be used, choices on how the clients should be involved, decisions at the coal face and whoever is to make the decisions, the transparency of the EBP and many others (Gambrill, 2006).
a.) Practice and Policy Research Questions
Since Evidence Based Practice was a replacement to the authoritarian practices, adopting an Evidence Based Practice has to consider how authoritarian practices can be eliminated. In order to adopt an Evidence Based Practice approach, research question which will be used in the study have to be considered. Whoever is to make these decisions is as well of concern. According to the originators, information gathering is obtained from the line of staff and clients. From this characteristic, whoever is to select the questions is determined (Gambrill, 2006). Gambrill notes that it is the clients and the line staff that know the questions that arise in daily practice (2006).
b.) The Basis of Outcome Selection and Who to Select Them
This is another important factor to consider when adopting an EBP approach. When conducting a study, researchers always focus on the expected result of the study as already, there are assumptions. In this case, when adopting the EBP approach, it is important too to focus on the outcomes which are regarded as the indicators of success. The person to select the outcomes is also important in this case and whoever to involve as well (Gambrill, 2006).
An example is when the approach is meant to find a certain treatment to a disorder, then the outcome can be, that 99% of the children got well. This is a positive outcome and should be the target of the being formulated approach. It could also be just aimed at reducing the disease prevalence in young children. The expected outcome would be a reduction in the number of children with the disease (any disease depending on the situation that calls for a decision).
Obstacles to the Integration of EBP
a.) One of the obstacles to integration of EBP is the choice of many to still use authority based practices and policies. Most people would not want to be transparent, to be asked questions which will seem like a challenge to them and would prefer a time tested array of strategies. It is for this reason that this EBP approach is being avoided. The EBP approach is transparent, not authoritative, involves clients and staff, encourages questions on its effectiveness and therefore is a very big challenge to the authoritative practice. This is the reason why in EBP, the person to select the research questions and to select the outcomes is important (Gambrill, 2006).
b.) Self Deception: This is another barrier to implementation of EBP approach. This refers to the belief that the service being provided is effective. It affects the clients, the practitioners and the researchers. These people due to the belief that an approach is effective, may not know if the quality of services are poor since there is a literature to support the effectiveness, therefore cannot be questioned. It is therefore not easy to implement this EBP approach.
Hypothetical Scenarios (Role selected is Nursing)
Based on the requirements of EBP approach according to Gambrill, the research questions should have an outcome, should involve the nurse and the patient, and the expected intervention that can produce an effective outcome. The following are hypothetical scenarios that show example of Evidence Based Practice.
Scenario One: A 55 year old male is brought to the hospital. His medical history indicates 35 years of chronic smoking. Would nicotine replacement therapy be better than Bupropion administration to result in long term abstinence from smoking?
Scenario two: An old man of 85 years was brought to the emergency room vomiting dark brown colored fluid. He was suspected to have Parkinson’s disease and other complications. Considering his age, the severity of the disease and the complications he has, what nursing care and treatment would be appropriate for effective care and treatment? What effective method of treatment and care should be given in this complicated case?
Scenario three: A nine year old girl was brought to the emergency room with diffuse abdominal pain and loss of appetite. She is suspected to be suffering from Appendicitis. What imaging modality would be appropriate to detect this between Ultrasound and CT for her to be given effective treatment?
Considering all these questions, there is a patient (client), what disorder and what intervention to be taken in order to come out with an answer which is the expected outcome. An example of one outcome is the result of the suspected disease, like in the case of the nine year old girl: Appendicitis. The aim is to determine if the case is appendicitis and use an appropriate intervention.
References
Conrad, P. (2005). Shifting Engines of Medicalization. Journal of Health and Social Behavior. 46, 3-14.
Conrad, P. (2007). The Medicalization of Society: On the Transformation of Human Conditions Into Treatable Disorders. Baltimore: JHU Press.
Evidence Based Practice. Retrieved on 20th October, 2008 from:
<<http://www.biomed.lib.umn.edu/learn/ebp/mod01/step1b.html>>.
Gambrill, E. (2006). Evidence-Based Practice and Policy: Choices Ahead. University of Carlifonia: Berkeley.
Moynihan, R., Heath, I. and Henry, D. (2002). Selling Sickness: The Pharmaceutical Industry and Disease Mongering. 324, 886.
Wikholm, A. (1999). Medicalization. Retrieved on 20th October, 2008 from:
<<http://www.gayhistory.com/rev2/words/medicalization.htm>>.
