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Winskill P, Dhabangi A, Kwambai TK, Mori AT, Mousa A, Okell LC. Estimating the burden of severe malarial anaemia and access to hospital care in East Africa. Nat Commun 2023; 14:5691. [PMID: 37709763 PMCID: PMC10502125 DOI: 10.1038/s41467-023-41275-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 08/29/2023] [Indexed: 09/16/2023] Open
Abstract
Severe malarial anaemia can be fatal if not promptly treated. Hospital studies may under-represent the true burden because cases often occur in settings with poor access to healthcare. We estimate the relationship of community prevalence of malaria infection and severe malarial anaemia with the incidence of severe malarial anaemia cases in hospital, using survey data from 21 countries and hospital data from Kenya, Tanzania and Uganda. The estimated percentage of severe malarial anaemia cases that were hospitalised is low and consistent for Kenya (21% (95% CrI: 7%, 47%)), Tanzania (18% (95% CrI: 5%, 52%)) and Uganda (23% (95% CrI: 9%, 48%)). The majority of severe malarial anaemia cases remain in the community, with the consequent public health burden being contingent upon the severity of these cases. Alongside health system strengthening, research to better understand the spectrum of disease associated with severe malarial anaemia cases in the community is a priority.
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Affiliation(s)
- Peter Winskill
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College, London, W2 1PG, UK.
| | - Aggrey Dhabangi
- Child Health and Development Centre, Makerere University College of Health Sciences, Kampala, Uganda
| | - Titus K Kwambai
- Division of Parasitic Diseases and Malaria, Global Health Center, Centers for Disease Control and Prevention, Kisumu, Kenya
| | - Amani Thomas Mori
- Health Economics Leadership and Translational Ethics Research Group (HELTER), Department of Global Public Health and Primary Care, University of Bergen, Arstadveien 17, 5009, Bergen, Norway
- Muhimbili University of Health and Allied Sciences, P.O. Box, 65001, Dar es-Salaam, Tanzania
| | - Andria Mousa
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, UK
| | - Lucy C Okell
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College, London, W2 1PG, UK
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Williams HC. On the definition of dermatological disease. Part 1: conceptual frameworks. Clin Exp Dermatol 2022; 47:1805-1811. [PMID: 35633083 PMCID: PMC9795908 DOI: 10.1111/ced.15279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2022] [Indexed: 12/30/2022]
Abstract
Little attention is paid to disease definition in dermatology and how such definitions come about, yet defining a disease is a fundamental step upon which all subsequent clinical management and prognostic judgements depend. Developing diagnostic criteria is also a critically important step for research purposes so that studies referring to groups of people can be compared in a meaningful way. This short review introduces the concepts of regressive and progressive nosology, and how definitions of a dermatological disease can evolve in a useful way as knowledge about that disease increases. It also highlights the dangers of panchrestons - names that try to explain all yet end up explaining very little. It also considers approaches to disease definition, such as whether a binary yes/no or continuous approach is more appropriate. Conceptual frameworks including essentialistic vs. nominalistic approaches using the biomedical or biopsychosocial perspectives are articulated. The review then illustrates hazards of underdiagnosis and overdiagnosis, and introduces the notion of 'disease mongering' - the selling of disease in order to promote the use of medicines. The review concludes with a reaffirmation of the importance of defining dermatological disease, and why any new diagnostic criteria must be shown to increase predictive ability before they are assimilated into clinical practice and research.
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Affiliation(s)
- Hywel C. Williams
- Centre of Evidence Based Dermatology, Population and Lifespan Sciences, School of MedicineUniversity of NottinghamNottinghamUK
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3
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Bombak AE, Adams L, Thille P. Drivers of medicalization in the Canadian Adult Obesity Clinical Practice Guidelines. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2022; 113:743-748. [PMID: 35838981 PMCID: PMC9481752 DOI: 10.17269/s41997-022-00662-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 06/13/2022] [Indexed: 06/15/2023]
Abstract
The new Canadian Adult Obesity Clinical Practice Guidelines frame higher body weight as a chronic, relapsing disease requiring comprehensive medical treatment pathways. In this commentary, we will demonstrate how a process called pharmaceuticalization is informing the new guidelines. We join those questioning the normalization of industry and medical collaboration and interrogate whether the new guidelines meaningfully address stigma.
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Affiliation(s)
- Andrea E Bombak
- Department of Sociology, University of New Brunswick, 3 Bailey Drive, P.O. Box 4400, Fredericton, New Brunswick, E3B 5A3, Canada.
| | - Louise Adams
- Flourish Kirribilli, 13/1 Broughton St, Kirribilli, NSW, 2061, Australia
| | - Patricia Thille
- Department of Physical Therapy, College of Rehabilitation Sciences, University of Manitoba, Room R131 - 771 McDermot Ave., Winnipeg, MB, R3E 0T6, Canada
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4
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Handelsman DJ. History of androgens and androgen action. Best Pract Res Clin Endocrinol Metab 2022; 36:101629. [PMID: 35277356 DOI: 10.1016/j.beem.2022.101629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- David J Handelsman
- Professor of Reproductive Endocrinology and Andrology, ANZAC Research Institute, University of SydneyHead, Andrology Department, Concord RG Hospital, Australia.
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Andrade G, Redondo MC. The need for "gentle medicine" in a post Covid-19 world. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2021; 24:475-486. [PMID: 34415502 PMCID: PMC8377702 DOI: 10.1007/s11019-021-10046-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/14/2021] [Indexed: 05/24/2023]
Abstract
As it has historically been the case with many pandemics, the Covid-19 experience will induce many philosophers to reconsider the value of medical practice. This should be a good opportunity to critically scrutinize the way medical research and medical interventions are carried out. For much of its history, medicine has been very inefficient. But, even in its contemporary forms, a review of common protocols in medical research and medical interventions reveal many shortcomings, especially related to methodological flaws, and more importantly, conflicts of interests due to profit incentives. In the face of these problems, we propose a program of "gentle medicine". This term, originally formulated by philosopher Jacob Stegenga, describes a form of medicine in which physicians intervene less than they currently do. As part of this general program, we advance a series of reform recommendations that could be enacted both by medical staff in their everyday practice, but also by public health officials and policymakers.
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Abstract
Androgens are potent drugs requiring prescription for valid medical indications but are misused for invalid, unproven, or off-label reasons as well as being abused without prescription for illicit nonmedical application for performance or image enhancement. Following discovery and first clinical application of testosterone in the 1930s, commercialization of testosterone and synthetic androgens proliferated in the decades after World War II. It remains among the oldest marketed drugs in therapeutic use, yet after 8 decades of clinical use, the sole unequivocal indication for testosterone remains in replacement therapy for pathological hypogonadism, organic disorders of the male reproductive system. Nevertheless, wider claims assert unproven, unsafe, or implausible benefits for testosterone, mostly representing wishful thinking about rejuvenation. Over recent decades, this created an epidemic of testosterone misuse involving prescription as a revitalizing tonic for anti-aging, sexual dysfunction and/or obesity, where efficacy and safety remains unproven and doubtful. Androgen abuse originated during the Cold War as an epidemic of androgen doping among elite athletes for performance enhancement before the 1980s when it crossed over into the general community to become an endemic variant of drug abuse in sufficiently affluent communities that support an illicit drug industry geared to bodybuilding and aiming to create a hypermasculine body physique and image. This review focuses on the misuse of testosterone, defined as prescribing without valid clinical indications, and abuse of testosterone or synthetic androgens (androgen abuse), defined as the illicit use of androgens without prescription or valid indications, typically by athletes, bodybuilders and others for image-oriented, cosmetic, or occupational reasons.
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Affiliation(s)
- David J Handelsman
- ANZAC Research Institute, University of Sydney, Sydney, Australia.,Andrology Department, Concord Hospital, Sydney, Australia
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Handelsman DJ. The Illusory Case for Treatment of an Invented Disease. Front Endocrinol (Lausanne) 2021; 12:682620. [PMID: 35116001 PMCID: PMC8803734 DOI: 10.3389/fendo.2021.682620] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 11/05/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- David J. Handelsman
- ANZAC Research Institute, University of Sydney, Sydney, NSW, Australia
- Andrology Department, Concord Hospital, Sydney, NSW, Australia
- *Correspondence: David J. Handelsman,
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Anhäuser M, Wormer H, Viciano A, Rögener W. [A modular model for quality assessment in medical and nutritional journalism]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020; 64:12-20. [PMID: 33263773 PMCID: PMC7772168 DOI: 10.1007/s00103-020-03254-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 11/10/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES The quality of medical articles in journalism has a central role in informed decision-making by patients as well as by political, economic and social players, but also to general "health literacy". Therefore, quality standards that take into account basic scientific and journalistic principles, but are also scalable to specific health-related topics (such as medicine, nutrition and environment) are particularly relevant. MATERIALS AND METHODS Starting from an internationally established catalogue in the framework of the "media doctor project", criteria for good medical journalism were analysed, reclassified and completed on the basis of theoretical concepts and practical applicability. In parallel, existing criteria from medical journalism were transferred to an adapted criteria catalogue for reporting on nutrition. RESULTS A consensus was reached on a catalogue of criteria modularised into general journalistic, general science journalistic and specific medical journalistic aspects, which is published here for the first time in a scientific paper. With some rare exceptions, quality criteria for medical journalism could be well adapted to nutritional topics. Based on the two catalogues, further media contributions have been regularly evaluated. CONCLUSIONS The advanced modularisation of the criteria catalogues facilitates their applicability and possibly their extension to other disciplines and for use by medical doctors as well as by laypersons. While medical journalism is strongly oriented towards the criteria of scientific evidence, the role of academic studies and experts versus anecdotal evidence should be further investigated for nutritional journalism.
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Affiliation(s)
- Marcus Anhäuser
- Institut für Kommunikations- und Medienwissenschaft, Universität Leipzig, Nikolaistraße 27-29, 04109, Leipzig, Deutschland
| | - Holger Wormer
- Institut für Journalistik, Lehrstuhl Wissenschaftsjournalismus, Technische Universität Dortmund, 44221, Dortmund, Deutschland.
| | - Astrid Viciano
- Institut für Journalistik, Lehrstuhl Wissenschaftsjournalismus, Technische Universität Dortmund, 44221, Dortmund, Deutschland
| | - Wiebke Rögener
- Institut für Journalistik, Lehrstuhl Wissenschaftsjournalismus, Technische Universität Dortmund, 44221, Dortmund, Deutschland
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Analysis of Carcinoma of the Esophagus Patients Between Upfront Surgery vs. Neoadjuvant Therapy Followed by Surgery. Indian J Surg 2020. [DOI: 10.1007/s12262-020-02156-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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10
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Pande MNR, Amarante PDDC, Baptista TWDF. [This elusive unknown quantity: reflections on the prescription of psychotropic drugs in early childhood]. CIENCIA & SAUDE COLETIVA 2020; 25:2305-2314. [PMID: 32520275 DOI: 10.1590/1413-81232020256.12862018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 09/25/2018] [Indexed: 11/22/2022] Open
Abstract
The scope of this article is to study aspects related to prescription habits and the use of psychoactive drugs in early childhood. It takes as a starting point the bibliographical survey carried out on the BVS and Scielo databases on epidemiological and clinical research in Brazil regarding the use of psychotropic drugs in children under six years of age. Based on international literature, it highlights the increase in the number of children diagnosed with mental and behavioral disorders, as well as the respective prescription of psychotropic drugs. It discusses the predominantly off-label character of psychoactive drugs for children under six years of age, the heterogeneous use of prescriptions and polypharmacology, pointing to an ethical paradox regarding clinical research in this age group. It concludes that the use of psychotropic drugs in early childhood is as yet not well known in Brazil, and epidemiological studies are urgently needed in this area.
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Affiliation(s)
- Mariana Nogueira Rangel Pande
- Laboratório Estudos e Pesquisas em Saúde Mental e Atenção Psicossocial, Escola Nacional de Saúde Pública Sérgio Arouca (ENSP), Fundação Oswaldo Cruz (Fiocruz). Av. Brasil 4036, Manguinhos. 21040-361, Rio de Janeiro, RJ, Brasil.
| | - Paulo Duarte de Carvalho Amarante
- Laboratório Estudos e Pesquisas em Saúde Mental e Atenção Psicossocial, Escola Nacional de Saúde Pública Sérgio Arouca (ENSP), Fundação Oswaldo Cruz (Fiocruz). Av. Brasil 4036, Manguinhos. 21040-361, Rio de Janeiro, RJ, Brasil.
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Baker DA. Four Ironies of Self-quantification: Wearable Technologies and the Quantified Self. SCIENCE AND ENGINEERING ETHICS 2020; 26:1477-1498. [PMID: 31970596 DOI: 10.1007/s11948-020-00181-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 01/14/2020] [Indexed: 06/10/2023]
Abstract
Bainbridge's well known "Ironies of Automation" (in: Johannsen, Rijnsdorp (eds) Analysis, design and evaluation of man-machine systems. Elsevier, Amsterdam, pp 129-135, 1983. https://doi.org/10.1016/B978-0-08-029348-6.50026-9) laid out a set of fundamental criticisms surrounding the promises of automation that, even 30 years later, remain both relevant and, in many cases, intractable. Similarly, a set of ironies in technologies for sensor driven self-quantification (often referred to broadly as wearables) is laid out here, spanning from instrumental problems in human factors design (such as disagreement over physiological norms) to much broader social problems (such as loss of freedom). As with automation, these ironies stand in the way of many of the promised benefits of these wearable technologies. It is argued here that without addressing these ironies now, the promises of wearables may not come to fruition, and instead users may experience outcomes that are opposite to those which the designers seek to afford, or, at the very least, those which consumers believe they are being offered. This paper describes four key ironies of sensor driven self-quantification: (1) know more, know better versus no more, no better; (2) greater self-control versus greater social control; (3) well-being versus never being well enough; (4) more choice versus erosion of choice.
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Affiliation(s)
- D A Baker
- The Center for Science, Technology, and Society, Missouri University of Science and Technology, 500 W 14th St, HSS 135, Rolla, MO, 65409, USA.
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Civitelli G, Tarsitani G, Rinaldi A, Marceca M. Medical education: an Italian contribution to the discussion on global health education. Global Health 2020; 16:30. [PMID: 32268908 PMCID: PMC7140347 DOI: 10.1186/s12992-020-00561-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/23/2020] [Indexed: 10/29/2022] Open
Abstract
BACKGROUND In Italy an important contribution to the spread of global health education (GHE) grew from the establishment and work of the Italian Network for Global Health Education (INGHE). INGHE gave a national shared definition of global health (GH), grounded in the theory of determinants of health, inspired by a vision of social justice, and committed to reduce health inequities. The aim of this article is to share with the international community INGHE's point of view on Medical Education. METHODS To express its view of medical education at the national level, INGHE established a dedicated commission, which elaborated a first draft of the document and then shared and discussed it with all other members. RESULTS INGHE elaborated a paper where it explained the need to change medical education in order to prepare future health professionals for the challenges of the globalized and unequal world. In this article the authors summarize the experience of INGHE and share with the international community its document. CONCLUSIONS The authors believe it is necessary now, more than ever, to insert this new approach to health at social and academic levels. Students should play a fundamental role in the spread of GHE, and activities related with GHE could be considered an important part of the third mission of universities to promote social justice.
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Affiliation(s)
- Giulia Civitelli
- Public Health and Infectious Diseases Department, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy.
- Italian Network for Global Health Education (INGHE), Rome, Italy.
- Italian Society of Migration Medicine (SIMM - Società Italiana di Medicina delle Migrazioni), Rome, Italy.
- Caritas Medical Area, Rome, Italy.
| | - Gianfranco Tarsitani
- Public Health and Infectious Diseases Department, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
- Italian Network for Global Health Education (INGHE), Rome, Italy
| | - Alessandro Rinaldi
- Public Health and Infectious Diseases Department, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
- Italian Network for Global Health Education (INGHE), Rome, Italy
- Italian Society of Migration Medicine (SIMM - Società Italiana di Medicina delle Migrazioni), Rome, Italy
| | - Maurizio Marceca
- Public Health and Infectious Diseases Department, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
- Italian Network for Global Health Education (INGHE), Rome, Italy
- Italian Society of Migration Medicine (SIMM - Società Italiana di Medicina delle Migrazioni), Rome, Italy
- Italian Society of Medical Education (SIPEM - Società Italiana di Pedagogia Medica), Rome, Italy
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Werder O, Holland K, Munro J. Communication's role in overcoming challenges for obesity prevention partnerships. Health Promot Int 2020; 35:205-216. [PMID: 30805614 DOI: 10.1093/heapro/daz005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
With obesity rates growing worldwide calls have increased to coordinate efforts in nationwide partnership models. Yet, the necessity for professional partnerships has brought into sharper focus a problem in jointly communicating obesity and its prevention. Following a social representation framework and using episodic interviewing of members from different professions directly or indirectly involved in obesity prevention, this report critically analysed concepts and communicative approaches held by those professional areas. Key findings included different perspectives about communication orientations, namely distribution of responsibility, control and communication goals. This suggests that the profession-specific world-views prevented respondents from communicating with members from other professions. We conclude that health communication experts bring unique skills to bring together professional teams to not only develop a common language and conceptual framework but also facilitate a sense of inclusion and personal accomplishment.
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Affiliation(s)
- Olaf Werder
- Department of Media and Communications, The University of Sydney, Sydney, NSW, Australia
| | - Kate Holland
- Faculty of Arts and Design, University of Canberra, Canberra, NSW, Australia
| | - Jay Munro
- Department of Media and Communications, The University of Sydney, Sydney, NSW, Australia
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Jutel A. Diagnosis: a critical social reflection in the genomic era. CIENCIA & SAUDE COLETIVA 2019; 24:3619-3626. [DOI: 10.1590/1413-812320182410.34502018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 02/11/2019] [Indexed: 11/22/2022] Open
Abstract
Abstract Diagnosis is a pivotal tool for the work of medicine as they categorise and classify individual ailments via a generalised schema. However diagnosis is also a profoundly social act, which reflects society, its values and how it makes sense of illness and disease. Considering diagnosis critically, as well as practically, is an important job of the sociologist. This paper reviews how a social model can provide a critical tool for viewing diagnosis in the genomic era. It explores how the formulation of diagnosis, be it via genetic explanations or microbiological ones, are the product of social discovery, negotiation, and consensus.
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Jha P, Kumar D, Dikshit R, Budukh A, Begum R, Sati P, Kolpak P, Wen R, Raithatha SJ, Shah U, Li ZR, Aleksandrowicz L, Shah P, Piyasena K, McCormick TH, Gelband H, Clark SJ. Automated versus physician assignment of cause of death for verbal autopsies: randomized trial of 9374 deaths in 117 villages in India. BMC Med 2019; 17:116. [PMID: 31242925 PMCID: PMC6595581 DOI: 10.1186/s12916-019-1353-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 05/28/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Verbal autopsies with physician assignment of cause of death (COD) are commonly used in settings where medical certification of deaths is uncommon. It remains unanswered if automated algorithms can replace physician assignment. METHODS We randomized verbal autopsy interviews for deaths in 117 villages in rural India to either physician or automated COD assignment. Twenty-four trained lay (non-medical) surveyors applied the allocated method using a laptop-based electronic system. Two of 25 physicians were allocated randomly to independently code the deaths in the physician assignment arm. Six algorithms (Naïve Bayes Classifier (NBC), King-Lu, InSilicoVA, InSilicoVA-NT, InterVA-4, and SmartVA) coded each death in the automated arm. The primary outcome was concordance with the COD distribution in the standard physician-assigned arm. Four thousand six hundred fifty-one (4651) deaths were allocated to physician (standard), and 4723 to automated arms. RESULTS The two arms were nearly identical in demographics and key symptom patterns. The average concordances of automated algorithms with the standard were 62%, 56%, and 59% for adult, child, and neonatal deaths, respectively. Automated algorithms showed inconsistent results, even for causes that are relatively easy to identify such as road traffic injuries. Automated algorithms underestimated the number of cancer and suicide deaths in adults and overestimated other injuries in adults and children. Across all ages, average weighted concordance with the standard was 62% (range 79-45%) with the best to worst ranking automated algorithms being InterVA-4, InSilicoVA-NT, InSilicoVA, SmartVA, NBC, and King-Lu. Individual-level sensitivity for causes of adult deaths in the automated arm was low between the algorithms but high between two independent physicians in the physician arm. CONCLUSIONS While desirable, automated algorithms require further development and rigorous evaluation. Lay reporting of deaths paired with physician COD assignment of verbal autopsies, despite some limitations, remains a practicable method to document the patterns of mortality reliably for unattended deaths. TRIAL REGISTRATION ClinicalTrials.gov , NCT02810366. Submitted on 11 April 2016.
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Affiliation(s)
- Prabhat Jha
- Centre for Global Health Research, St Michael's Hospital and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | - Dinesh Kumar
- Department of Community Medicine, Pramukhswami Medical College, Anand, Gujarat, India
| | - Rajesh Dikshit
- Centre for Cancer Epidemiology, Tata Memorial Centre, Mumbai, India
| | - Atul Budukh
- Centre for Cancer Epidemiology, Tata Memorial Centre, Mumbai, India
| | - Rehana Begum
- Centre for Global Health Research, St Michael's Hospital and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Prabha Sati
- Centre for Global Health Research, St Michael's Hospital and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Patrycja Kolpak
- Centre for Global Health Research, St Michael's Hospital and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Richard Wen
- Centre for Global Health Research, St Michael's Hospital and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - Utkarsh Shah
- Department of Community Medicine, Pramukhswami Medical College, Anand, Gujarat, India
| | | | | | - Prakash Shah
- Centre for Global Health Research, St Michael's Hospital and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Kapila Piyasena
- Centre for Global Health Research, St Michael's Hospital and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Tyler H McCormick
- Department of Statistics, University of Washington, Seattle, USA.,Department of Sociology, University of Washington, Seattle, USA
| | - Hellen Gelband
- Centre for Global Health Research, St Michael's Hospital and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Samuel J Clark
- London School of Hygiene & Tropical Medicine, London, UK.,Department of Sociology, Ohio State University, Columbus, USA
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Mosconi P, Roberto A, Braga F, Napoli L, Anelli M, Colombo C. Choosing Wisely Italy: online survey on opinions and behaviors of 1006 people and 355 volunteers of healthcare advocacy associations. Eur J Public Health 2019; 29:396-401. [PMID: 30462202 DOI: 10.1093/eurpub/cky236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND In the framework of 'Doing more does not mean doing better - Choosing Wisely Italy' health professionals, general population and healthcare advocacy associations are widely involved. PartecipaSalute-Mario Negri IRCCS and Altronconsumo organized a survey in order to assess the opinions and behaviors of people toward unnecessary tests and drugs. METHODS An online survey was distributed by Altroconsumo to a voluntary panel of 6304 Italian citizens covering the whole of the country and by PartecipaSalute-Mario Negri IRCCS through the PartecipaSalute website, e-mail lists, website articles, lay journals and Facebook. RESULTS In all 1006 people reached by Altroconsumo, and 355 volunteers of healthcare advocacy associations reached by PartecipaSalute responded. Respondents usually decides on their treatment together with the physician, respectively 50% for general population and 64% for volunteers of healthcare advocacy associations. The respondents are aware of the question of over-use of drugs and tests (80%), more often among the volunteers of healthcare advocacy associations (86%). Over-use is considered a problem mostly for economic reasons among the general population, while in the advocacy associations the risks for patients' health is considered more important. CONCLUSION These findings suggest that patients do not always ask for more, especially if they receive an answer to their questions and clarifications about unnecessary treatments. There is a need for further understanding of the factors influencing decision-making aimed at achieving good care. Engaging the public and patients at all levels of healthcare is essential for a valuable use of health resources.
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Affiliation(s)
- Paola Mosconi
- Laboratory for Medical Research and Consumers Involvement, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Anna Roberto
- Laboratory for Medical Research and Consumers Involvement, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Franca Braga
- Department of Public Health, Food and Health Competence Center, Altroconsumo, Milan, Italy
| | - Lucia Napoli
- Statistical Surveys Department, Altroconsumo, Milan, Italy
| | - Marco Anelli
- Statistical Surveys Department, Altroconsumo, Milan, Italy
| | - Cinzia Colombo
- Laboratory for Medical Research and Consumers Involvement, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
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Sundwall DN. David Sundwall Comments. Am J Public Health 2019; 109:847-848. [DOI: 10.2105/ajph.2019.305113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- David N. Sundwall
- David N. Sundwall is with the Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City
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18
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Smith R. My Personal Experience of Orthodox Psychiatry and Alternative Approaches. JOURNAL OF RELIGION AND HEALTH 2019; 58:693-707. [PMID: 30570694 DOI: 10.1007/s10943-018-00748-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Ruth Smith's incisive and moving account of her experiences with orthodox psychiatry as delivered by the UK National Health Service sets the scene for this special section. She gives a detailed description of her own twelve years' experience as a Carer to her daughter, diagnosed with psychosis at age 24 years. She explains how they struggled to comply with the psychiatric services and cope with the, often traumatic, treatment provided to them. Clearly, we need to do better, but how? Smith explains how her study of critical texts and research papers on the subject helped to form her own critical viewpoint.
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Affiliation(s)
- Ruth Smith
- , 35 Channings, 215 Kingsway, Hove, East Sussex, BN34FT, UK.
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19
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Pearson CA. Cynthia Pearson Comments. Am J Public Health 2019; 109:846-847. [DOI: 10.2105/ajph.2019.305101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Cynthia A. Pearson
- Cynthia A. Pearson is with the National Women’s Health Network, Washington, DC
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20
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O'Hanlon CE. What kills us and what moves us: A comparative discourse analysis of heart disease and breast cancer. Digit Health 2019; 5:2055207619844865. [PMID: 31069103 PMCID: PMC6495432 DOI: 10.1177/2055207619844865] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 03/28/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction Heart disease kills nearly 300,000 US women annually, while approximately 40,000 US women die of breast cancer. Breast cancer online patient communities are well known for their high engagement and emotional support. This exploratory study compared social media discourse on breast cancer with discourse related to heart disease. Methods Computer-assisted text analysis of two corpora composed of Twitter posts using #BreastCancer and #HeartDisease hashtags from December 2013 to December 2014. Lexical analysis (word and hashtag level) used AntConc software and lexicogrammatical analysis (style and stance) was conducted with DocuScope. Results The #BreastCancer corpus consisted of 592,046 posts, 57% of which were not original to the user (retweets). #HeartDisease had 269,769 posts (13% retweets). Social media discourse about #BreastCancer and #HeartDisease drew attention to women, new developments, appeals for help and disease risks. The #BreastCancer corpus incorporates gendered language and associations with art and activism, while posts about #HeartDisease were discussed scientifically in concert with other diseases. The #BreastCancer corpus uniquely included community-specific initialism hashtags. Stance analysis of the #BreastCancer corpus revealed more socially oriented posts, marked by language of constructive reasoning, inclusive language and abstract thought, while #HeartDisease corpus posts were more scholarly, used contingent and oppositional reasoning, language from institutional and academic registers, citations and meta-discourse. Conclusion The #HeartDisease social media community is less engaged, and content is less specific to both the disease and individual experience than #BreastCancer. Cultivating a women-focused heart disease online community might replicate some of the #BreastCancer community’s successes.
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Affiliation(s)
- Claire E O'Hanlon
- Greater Los Angeles Health System, US Department of Veterans Affairs, Los Angeles, CA, USA.,RAND Corporation, Department of Economics, Sociology and Statistics, Santa Monica, CA, USA
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21
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Wolfe F, Schmukler J, Jamal S, Castrejon I, Gibson KA, Srinivasan S, Häuser W, Pincus T. Diagnosis of Fibromyalgia: Disagreement Between Fibromyalgia Criteria and Clinician-Based Fibromyalgia Diagnosis in a University Clinic. Arthritis Care Res (Hoboken) 2019; 71:343-351. [PMID: 30724039 DOI: 10.1002/acr.23731] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 08/14/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Recent studies have suggested that fibromyalgia is inaccurately diagnosed in the community, and that ~75% of persons reporting a physician diagnosis of fibromyalgia would not satisfy published criteria. To investigate possible diagnostic misclassification, we compared expert physician diagnosis with published criteria. METHODS In a university rheumatology clinic, 497 patients completed the Multidimensional Health Assessment Questionnaire (MD-HAQ) and the 2010 American College of Rheumatology preliminary diagnostic criteria modified for self-administration during their ordinary medical visits. Patients were evaluated and diagnosed by university rheumatology staff. RESULTS Of the 497 patients, 121 (24.3%) satisfied the fibromyalgia criteria, while 104 (20.9%) received a clinician International Classification of Diseases (ICD) diagnosis of fibromyalgia. The agreement between clinicians and criteria was 79.2%. However, agreement beyond chance was only fair (κ = 0.41). Physicians failed to identify 60 criteria-positive patients (49.6%) and incorrectly identified 43 criteria-negative patients (11.4%). In a subset of 88 patients with rheumatoid arthritis (RA), the kappa value was 0.32, indicating slight to fair agreement. Universally, higher polysymptomatic distress scores and criteria-based diagnosis were associated with more abnormal MD-HAQ clinical scores. Women and patients with more symptoms but fewer pain areas were more likely to receive a clinician's diagnosis than to satisfy fibromyalgia criteria. CONCLUSION There is considerable disagreement between ICD clinical diagnosis and criteria-based diagnosis of fibromyalgia, calling into question ICD-based studies. Fibromyalgia criteria were easy to use, but problems regarding clinician bias, meaning of a fibromyalgia diagnosis, and the validity of physician diagnosis were substantial.
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Affiliation(s)
- Frederick Wolfe
- Arthritis Diseases Center, National Data Bank for Rheumatic Diseases, and University of Wichita School of Medicine, Wichita, Kansas
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22
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Coll-Benejam T, Bravo-Toledo R, Marcos-Calvo MP, Astier-Peña MP. [Impact of overdiagnosis and overtreatment on the patient, the health system and society]. Aten Primaria 2018; 50 Suppl 2:86-95. [PMID: 30563626 PMCID: PMC6837148 DOI: 10.1016/j.aprim.2018.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 07/30/2018] [Accepted: 08/06/2018] [Indexed: 11/30/2022] Open
Abstract
The medical activity displays a set of skills aimed at improving the health status of people. In this way, diagnoses are made, choices of tests and treatments are made, and decisions are made about what to do and what not to do that affect the lives of patients. In this article, we propose a reflection on overdiagnosis and overtreatment in relation to the factors that promote it and the impact they have on society, on the functioning of the health system and also directly on patients. Finally, we make some proposals on how to address this overuse considering that primary care is a privileged place to adapt and minimize the impact of the actions of the health system on the health of citizens and reduce the incidents of patient safety linked to the overdiagnosis and inappropriate use of tests and treatments that do not add value to the health of patients.
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Affiliation(s)
- Txema Coll-Benejam
- Grupo de Trabajo de Seguridad del Paciente de la semFYC; Dirección de Atención Primaria de Menorca, Servicio Balear de Salud
| | - Rafael Bravo-Toledo
- Grupo de Trabajo de Seguridad del Paciente de la semFYC; Centro de Salud Linneo, Servicio Madrileño de Salud, Madrid, España
| | - María Pilar Marcos-Calvo
- Grupo de Trabajo de Seguridad del Paciente de la semFYC; Centro de Salud Casetas, Servicio Aragonés de Salud, Zaragoza, España
| | - María Pilar Astier-Peña
- Grupo de Trabajo de Seguridad del Paciente de la semFYC; Centro de Salud Tauste, Servicio Aragonés de Salud, Zaragoza, España; Wonca World Working Party On Quality and Safety (WWPQS); Wonca Europe Working Party on Quality and Safety (EquiP).
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López-Rodríguez JA. [Overdiagnosis in health sciences: A scope review for Mental Health conditions]. Aten Primaria 2018; 50 Suppl 2:65-69. [PMID: 30268492 PMCID: PMC6837043 DOI: 10.1016/j.aprim.2018.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 08/01/2018] [Indexed: 11/28/2022] Open
Abstract
Objetivo El objetivo de esta revisión es actualizar el estado del arte de las diferentes formas de sobreutilización, sobrediagnóstico y sobretratamiento dentro de la salud mental. Método Se realizó una revisión narrativa utilizando las fuentes de datos de Medline hasta 2018 y se seleccionaron estudios en humanos donde el sobrediagnóstico era objeto de tratamiento en el desarrollo del artículo porque se centrase en su discusión o se abordase como tema principal, no aquellos en los que se mencionase de forma somera. Resultados Se obtuvieron más de 200 referencias relacionadas con sobrediagnóstico y sobretratamiento en Salud Mental, de las cuales 40 fueron revisiones narrativas. Las principales se relacionaron con el estudio de criterios diagnósticos más que con la estimación de la sobreutilización médica en Salud Mental. Trastornos de ansiedad y depresión, trastorno bipolar y trastorno por déficit de atención e hiperactividad agrupan el mayor número de referencias en este ámbito. Conclusiones La variedad en la terminología y la dificultad de la objetivación en Salud Mental hacen de este campo un nicho para el sobrediagnóstico.
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Affiliation(s)
- Juan A López-Rodríguez
- Grupo de Trabajo de Salud Mental de la semFYC; Unidad de Apoyo a la Investigación, Gerencia de Atención Primaria de Madrid, Madrid, España; Centro de Salud General Ricardos, Madrid, España; Departamento de Medicina, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, España; Red Temática de Investigación Cooperativa en Salud-Red de Investigación en Servicios en Salud en Enfermedades Crónicas (RETICS-REDISSEC), Instituto de Salud Carlos III, Madrid, España.
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Banerjee S, Dash SK. Disease awareness advertising (DAA) in emerging economy: A comparison between views of consumers and pharmaceutical professionals. Health Mark Q 2018; 35:134-150. [PMID: 30321128 DOI: 10.1080/07359683.2018.1490554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Research on effectiveness of DAA is limited. Existing researches explore impact of DAA only on relationship between drug manufacturers and consumers. However, in reality, pharma marketing revolves around three major stakeholders: the pharmaceutical companies, physicians and consumers. Pharmaceutical professionals on behalf of drug manufacturers have last mile connectivity with end users and they are an important stakeholder in this entire marketing relationship network. So, it is important for marketers to capture views of pharma professionals in addition to physicians and consumers. The current research evaluates views of consumers and pharmaceutical professionals about effectiveness of unbranded DAA for product message communication.
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Affiliation(s)
- Saikat Banerjee
- a Indian Institute of Foreign Trade-IIFT , New Delhi , India
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Abstract
Mettant fin à une crise de l’innovation dont la réalité fait l’objet de débats, les innovations pharmaceutiques récentes, résultats d’un encastrement de raisons scientifiques, industrielles, financières, politiques et économiques, aboutissent à une diversification des portefeuilles de produits des industriels de la pharmacie au niveau mondial et à un fort intérêt, de leur part, pour des produits dits de niche (thérapies ciblées, maladies rares, etc.). Ces nouvelles molécules sont mises sur le marché à des prix beaucoup plus élevés que par le passé. En l’absence d’informations fiables sur les coûts supportés par les industriels, et sachant que des niveaux de marge très élevés ont été observés, ces prix suscitent des interrogations légitimes. Celles-ci sont également motivées par l’absence de relation entre le prix et le bénéfice thérapeutique de ces nouvelles molécules. En France, face à des niveaux de dépenses susceptibles de fragiliser la soutenabilité financière du système de protection sociale, les autorités publiques ont jusqu’à présent toujours privilégié des interventions sur les prix ou les conditions et volumes de remboursement, conformes aux modes de régulation existants. D’autres modes de régulation (recours à la licence d’office, achat groupé, etc.) pourraient dans le futur être employés dans un souci croissant d’efficience des dépenses publiques. Les difficultés rencontrées pour réguler un secteur industriel profondément transformé, appellent à une réforme des systèmes d’évaluation et de régulation nationaux.
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Tesser CD. Why is quaternary prevention important in prevention? Rev Saude Publica 2017; 51:116. [PMID: 29211199 PMCID: PMC5708264 DOI: 10.11606/s1518-8787.2017051000041] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 01/12/2017] [Indexed: 11/24/2022] Open
Abstract
Quaternary prevention consists in the identification of persons at risk of excessive medicalization and their protection against new unnecessary interventions, avoiding iatrogenic damages. Here, we argue about the importance of quaternary prevention in specific primary and secondary prevention. The recent great development of preventive medicine, biomedicalization of risks and their treatment as if they were diseases, and the powerful influence of the commercial interests of pharmaceutical industries on the production of medical-sanitary knowledge alter classifications, create diseases and pre-diseases, lower cutoff points, and erase the distinction between prevention and healing. This situation converts larger amounts of asymptomatic persons into sick individuals and diverts clinical attention and resources from sick persons to the healthy, from older adults to young persons, and from the poor to the rich. Quaternary prevention facilitates and induces the development and systematization of operational knowledge and guidelines to contain hypermedicalization and the damages of preventive actions in professional care, especially in primary health care.
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Affiliation(s)
- Charles Dalcanale Tesser
- Universidade Federal de Santa Catarina. Centro de Ciências da Saúde. Departamento de Saúde Pública. Florianópolis, SC, Brasil
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Schwartzberg E, Barnett-Itzhaki Z, Grotto I, Marom E. Strategies for patient empowerment through the promotion of medicines in Israel: regulatory framework for the pharmaceutical industry. Isr J Health Policy Res 2017; 6:50. [PMID: 28962636 PMCID: PMC5622432 DOI: 10.1186/s13584-017-0175-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 09/24/2017] [Indexed: 11/20/2022] Open
Abstract
The correct and rational use of medications can have a positive direct impact on disease outcomes, as well on the utilization of the health system resources. Unfortunately, 50% of the patients do not take their medications as prescribed, largely due to lack of patients’ understanding of their medical condition, as well as the lack of reliable medicine information. There are multiple strategies implemented in many countries to tackle this challenge including: disease awareness campaigns (DAC) to raise the public awareness to specific diseases, direct-to-consumer advertisement (DTCA) to raise the public awareness to prescription medicines, specific treatments and over-the-counter (OTC) products to improve the accessibility of patients to specific medicines. Prior to 2013, the Israeli policy prohibited prescribing medication advertising and prevented the flow of information from pharmaceutical companies to the patient. In the last five years, the Pharmaceutical division in the Israeli Ministry of Health, as part of the “empowering the patient” agenda, has taken new innovative approaches to raise public awareness to diseases, medications and appropriate usage, as well as promotion of information to improve patient adherence to the prescribed medication. This paper elaborates on the aforementioned strategies implemented in developed countries, and specifically focuses on newly implemented strategies and regulations in Israel regarding pre- and post-prescription information, to improve patient appropriate utilization and adherence to medication.
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Affiliation(s)
- Eyal Schwartzberg
- Pharmaceutical & Enforcement Divisions, Ministry of Health, 39 Yirmiyahu St, Jerusalem, Israel.,Ben-Gurion University of the Negev, Beer sheva, Israel.,Arnold and Marie Schwartz College of Pharmacy, Long Island University, Brooklyn, USA
| | - Zohar Barnett-Itzhaki
- Public Health Services, Ministry of Health, Jerusalem, Israel. .,Bioinformatics department, school of life and health science, Jerusalem College of Technology, Jerusalem, Israel.
| | - Itamar Grotto
- Ben-Gurion University of the Negev, Beer sheva, Israel.,Public Health Services, Ministry of Health, Jerusalem, Israel
| | - Eli Marom
- Pharmaceutical & Enforcement Divisions, Ministry of Health, 39 Yirmiyahu St, Jerusalem, Israel
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Sholl J. The muddle of medicalization: pathologizing or medicalizing? THEORETICAL MEDICINE AND BIOETHICS 2017; 38:265-278. [PMID: 28674861 DOI: 10.1007/s11017-017-9414-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Medicalization appears to be an issue that is both ubiquitous and unquestionably problematic as it seems to signal at once a social and existential threat. This perception of medicalization, however, is nothing new. Since the first main writings in the 1960s and 1970s, it has consistently been used to describe inappropriate or abusive instances of medical authority. Yet, while this standard approach claims that medicalization is a growing problem, it assumes that there is simply one "medical model" and that the expanding realm of "the medical" can be more or less clearly delineated. Moreover, while intended to establish the reality of this growing threat, this research often requires making arbitrary or unjustified distinctions between different practices. To better clarify the concept of medicalization, I will focus more on capturing the variety of medical practices than on the sociological aspects of medical discourse. In doing so, I will explore the distinction between medicalization and pathologization, a distinction that is often overlooked and that brings with it many conceptual and practical implications. After defining these terms, I will use some examples to show that while pathologizing is closely tied to medicalizing, both can occur independently. I will then further develop this distinction in terms of the different individual and social effects of these practices.
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Affiliation(s)
- Jonathan Sholl
- Department of Philosophy and History of Ideas, Aarhus University, Jens Chr. Skous Vej 7, 8000, Aarhus, Denmark.
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Liguori G, Belfiore P, D'Amora M, Liguori R, Plebani M. The principles of Health Technology Assessment in laboratory medicine. Clin Chem Lab Med 2017; 55:32-37. [PMID: 27341564 DOI: 10.1515/cclm-2016-0371] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 05/26/2016] [Indexed: 11/15/2022]
Abstract
The Health Technology Assessment (HTA) is a multi-professional and multidisciplinary evaluation approach designed to assess health technology in the broadest sense of the term, from its instruments to the rearranging of its organizational structures. It is by now an established methodology at national and international levels that involves several medical disciplines thanks to its versatility. Laboratory medicine is one of these disciplines. Such specialization was subjected, in recent years, to deep changes even from an organizational standpoint, in order to meet the health needs of the population, making them as effective and cost-effective as possible. In this regard, HTA was the tool used to assess implications in different areas.
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Vargas-Peláez CM, Soares L, Rover MRM, Blatt CR, Mantel-Teeuwisse A, Rossi Buenaventura FA, Restrepo LG, Latorre MC, López JJ, Bürgin MT, Silva C, Leite SN, Mareni Rocha F. Towards a theoretical model on medicines as a health need. Soc Sci Med 2017; 178:167-174. [PMID: 28226302 DOI: 10.1016/j.socscimed.2017.02.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 10/31/2016] [Accepted: 02/10/2017] [Indexed: 01/29/2023]
Abstract
Medicines are considered one of the main tools of western medicine to resolve health problems. Currently, medicines represent an important share of the countries' healthcare budget. In the Latin America region, access to essential medicines is still a challenge, although countries have established some measures in the last years in order to guarantee equitable access to medicines. A theoretical model is proposed for analysing the social, political, and economic factors that modulate the role of medicines as a health need and their influence on the accessibility and access to medicines. The model was built based on a narrative review about health needs, and followed the conceptual modelling methodology for theory-building. The theoretical model considers elements (stakeholders, policies) that modulate the perception towards medicines as a health need from two perspectives - health and market - at three levels: international, national and local levels. The perception towards medicines as a health need is described according to Bradshaw's categories: felt need, normative need, comparative need and expressed need. When those different categories applied to medicines coincide, the patients get access to the medicines they perceive as a need, but when the categories do not coincide, barriers to access to medicines are created. Our theoretical model, which holds a broader view about the access to medicines, emphasises how power structures, interests, interdependencies, values and principles of the stakeholders could influence the perception towards medicines as a health need and the access to medicines in Latin American countries.
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Affiliation(s)
- Claudia Marcela Vargas-Peláez
- Programa de pós-graduação em Farmácia, Universidade Federal de Santa Catarina, Campus Universitário Trindade - Florianópolis, Santa Catarina, Brazil; WHO Collaborating Centre for Pharmaceutical Policy & Regulation, Utrecht Institute for Pharmaceutical Sciences (UIPS), David de Wied Building, Universiteitsweg 99, Utrecht, The Netherlands.
| | - Luciano Soares
- Programa de Pós-Graduação em Saúde e Meio Ambiente, Universidade da Região de Joinville - Univille, Rua Paulo Malschitzki, 10 - Bom Retiro, Joinville, Santa Catarina, Brazil.
| | - Marina Raijche Mattozo Rover
- Programa de pós-graduação em Farmácia, Universidade Federal de Santa Catarina, Campus Universitário Trindade - Florianópolis, Santa Catarina, Brazil.
| | - Carine Raquel Blatt
- Departamento de Farmacociências, Universidade Federal de Ciências da Saúde de Porto Alegre, Rua Sarmento Leite, 245 - Cidade Baixa, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Aukje Mantel-Teeuwisse
- WHO Collaborating Centre for Pharmaceutical Policy & Regulation, Utrecht Institute for Pharmaceutical Sciences (UIPS), David de Wied Building, Universiteitsweg 99, Utrecht, The Netherlands.
| | | | | | | | - José Julián López
- Departamento de Farmacia, Universidad Nacional de Colombia, Carrera 30 No. 45-03, Edificio 450, Oficina 214, Bogotá D.C., Colombia.
| | | | - Consuelo Silva
- Escuela Latinoamericana de Postgrados (ELAP) - Universidad de Artes y Ciencias Sociales (Arcis), Erasmo Escala 2728, Santiago, Chile.
| | - Silvana Nair Leite
- Programa de pós-graduação em Farmácia, Universidade Federal de Santa Catarina, Campus Universitário Trindade - Florianópolis, Santa Catarina, Brazil.
| | - Farias Mareni Rocha
- Programa de pós-graduação em Farmácia, Universidade Federal de Santa Catarina, Campus Universitário Trindade - Florianópolis, Santa Catarina, Brazil.
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Bokhof B, Junius-Walker U. Reducing Polypharmacy from the Perspectives of General Practitioners and Older Patients: A Synthesis of Qualitative Studies. Drugs Aging 2016; 33:249-66. [PMID: 26915076 DOI: 10.1007/s40266-016-0354-5] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Polypharmacy, common in elderly multimorbid adults, leads to increased iatrogenic health risks. Yet, no consistent approach to stopping medicines exists in primary healthcare. OBJECTIVES Our objective was to synthesize qualitative studies exploring the perspectives and experiences of general practitioners (GPs) and older patients in reducing polypharmacy and to discover approaches already being practiced. METHODS We conducted a search in the PubMed, Cochrane Library, Web of Science Core Collection, and Scopus databases to identify qualitative studies in the primary care setting addressing multimorbid older patients and polypharmacy reduction. The seven-step model of meta-ethnography allowed for cross-interpretation between studies considering their original context and developing theories. RESULTS A total of 14 studies from the perspectives of patients (n = 6) and providers (n = 8) were included, although discontinuing medicines only occurred as a sub-theme in patient studies. Emerging key concepts for patients were experimenting with medicines, attitudes and experiences towards medicines, necessity of prioritizing treatments, relationship to GP, and system-related contributors. For GPs, they covered assumptions about elderly patients, interface prescribing problems, evidence-based guidelines, failure to meet the challenge of complex decision-making, and solutions. DISCUSSION Complex medication regimens and uncertainties in decision making are challenges for both GPs and patients. For patients, symptom experiences with medicines, relationship with their prescriber, and fragmented care are at the forefront; for GPs, it is the decision-making responsibility in the context of unsuitable guidelines, time constraints, and deficient multidisciplinary co-operation. Heuristics such as prioritizing and individualizing treatments and relaxation of guidelines emerged. These strategies require professional awareness of the problem and establishing a trusting, patient-centered consultation style and supportive work conditions.
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Affiliation(s)
- Beate Bokhof
- Institute of General Practice, Hannover, Lower Saxony, Germany.
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Tesser CD, Norman AH. Differentiating clinical care from disease prevention: a prerequisite for practicing quaternary prevention. CAD SAUDE PUBLICA 2016; 32:e00012316. [PMID: 27783750 DOI: 10.1590/0102-311x00012316] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 07/20/2016] [Indexed: 11/22/2022] Open
Abstract
This article contends that the distinction between clinical care (illness) and prevention of future disease is essential to the practice of quaternary prevention. The authors argue that the ongoing entanglement of clinical care and prevention transforms healthy into "sick" people through changes in disease classification criteria and/or cut-off points for defining high-risk states. This diverts health care resources away from those in need of care and increases the risk of iatrogenic harm in healthy people. The distinction in focus is based on: (a) management of uncertainty (more flexible when caring for ill persons); (b) guarantee of benefit (required only in prevention); (c) harm tolerance (nil or minimal in prevention). This implies attitudinal differences in the decision-making process: greater skepticism, scientism and resistance towards preventive action. These should be based on high-quality scientific evidence of end-outcomes that displays a net positive harm/benefit ratio.
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Affiliation(s)
- Charles Dalcanale Tesser
- Centro de Ciências da Saúde, Universidade Federal de Santa Catarina, Florianópolis, Brasil.,Centro de Estudos Sociais, Universidade de Coimbra, Coimbra, Portugal
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The 2013 cholesterol guideline controversy: Would better evidence prevent pharmaceuticalization? Health Policy 2016; 120:797-808. [PMID: 27256859 DOI: 10.1016/j.healthpol.2016.05.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 05/10/2016] [Accepted: 05/12/2016] [Indexed: 01/08/2023]
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Camargo R, Ried N. Towards a genealogy of pharmacological practice. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2016; 19:85-94. [PMID: 25956710 DOI: 10.1007/s11019-015-9648-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Following Foucault's work on disciplinary power and biopolitics, this article maps an initial cartography of the research areas to be traced by a genealogy of pharmacological practice. Pharmacology, as a practical activity, refers to the creation, production and sale of drugs/medication. This work identifies five lines of research that, although often disconnected from each other, may be observed in the specialized literature: (1) pharmaceuticalization; (2) regulation of the pharmaceutical industry; (3) the political-economic structure of the pharmaceutical industry; (4) consumption/consumerism of medications; (5) and bio-knowledge. The article suggests that a systematic analysis of these areas leads one to consider pharmacological practice a sui generis apparatus of power, which reaches beyond the purely disciplinary and biopolitical levels to encompass molecular configurations, thereby giving rise not only to new types of government over life, but also to new struggles for life, extending from molecular to population-wide levels.
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Affiliation(s)
- Ricardo Camargo
- Faculty of Social and Juridical Sciences, Universidad de Talca, Santa Elena 2222, San Joaquín, Santiago, Chile.
| | - Nicolás Ried
- Nucleus on Biopolitics and Ideology (NIBI), Universidad de Chile, Pío Nono Nº 1, Providencia, Santiago, Chile
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Tesser CD, Pezzato LM, Silva END. Medicalização social e odontologia: possíveis aproximações. SAUDE E SOCIEDADE 2015. [DOI: 10.1590/s0104-12902015136108] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A medicalização social transforma experiências e características pessoais em objetos de trabalho dos profissionais de saúde, gerando dependência progressiva de saberes/práticas profissionalizados. Apresenta-se um ensaio propondo uma aproximação do tema da medicalização social com o campo da odontologia, com ênfase nas práticas profissionais, contextualizado na contemporaneidade brasileira, no mercado privado e no Sistema Único de Saúde. Apontam-se pontos importantes para a formação e a pesquisa, dado ser este um tema de alta relevância e grande atravessamento com os saberes e práticas profissionais. Tópicos como: mercantilização das práticas, expansão das especialidades odontológicas e estéticas em odontologia, pouca exploração do campo de cuidado (e do potencial dos profissionais auxiliares), "motores" do processo (reducionismo biológico, poder da mídia e da propaganda, manipulação da legitimidade científica, abusos preventistas e de sobretratamento), incipiente exploração das terapias complementares, dentre outros, são sinteticamente abordados, oferecendo uma aproximação crítica geral e algumas possibilidades de análise e desenvolvimento investigativo, conceitual e empírico do tema.
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Nagata T, Suzuki F, Teo AR. Generalized social anxiety disorder: A still-neglected anxiety disorder 3 decades since Liebowitz's review. Psychiatry Clin Neurosci 2015; 69:724-40. [PMID: 26121185 DOI: 10.1111/pcn.12327] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/25/2015] [Indexed: 11/26/2022]
Abstract
In the 3 decades since Liebowitz's review of 'a neglected anxiety disorder,' controversy and challenges have remained in the study of social anxiety disorder (SAD). This review examines evidence around the classification and subtyping of SAD, focusing on generalized SAD. Substantial discrepancies and variation in definition, epidemiology, assessment, and treatment of generalized SAD exist as the international literature on it has grown. In East Asian cultures in particular, study of taijin kyofusho has been important to a broadened conceptualization of SAD into generalized SAD. Despite important progress with biological and other studies, many challenges in the understanding of generalized SAD will remain in the years to come.
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Affiliation(s)
| | - Futoshi Suzuki
- Department of Child and Adolescent Psychiatry, Nagoya University Hospital, Aichi, Japan
| | - Alan R Teo
- VA Portland Health Care System and Oregon Health & Science University, Oregon, USA
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Giami A. Between DSM and ICD: Paraphilias and the Transformation of Sexual Norms. ARCHIVES OF SEXUAL BEHAVIOR 2015; 44:1127-38. [PMID: 25933671 DOI: 10.1007/s10508-015-0549-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The simultaneous revision of the two major international classifications of disease, the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases, serves as an opportunity to observe the dynamic processes through which social norms of sexuality are constructed and are subject to change in relation to social, political, and historical context. This article argues that the classifications of sexual disorders, which define pathological aspects of "sexually arousing fantasies, sexual urges or behaviors" are representations of contemporary sexual norms, gender identifications, and gender relations. It aims to demonstrate how changes in the medical treatment of sexual perversions/paraphilias passed, over the course of the 20th century, from a model of pathologization (and sometimes criminalization) of non-reproductive sexual behaviors to a model that reflects and privileges sexual well-being and responsibility, and pathologizes the absence or the limitation of consent in sexual relations.
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Affiliation(s)
- Alain Giami
- Inserm, CESP Centre de recherche en Epidémiologie et Santé des Populations, U1018-Team 7: Gender, Sexuality, Health, 82 rue du Général Leclerc, 94276, Le Kremlin Bicêtre, Cedex, France,
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38
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Tippett E. Medical Advice from Lawyers: A Content Analysis of Advertising for Drug Injury Lawsuits. AMERICAN JOURNAL OF LAW & MEDICINE 2015; 41:7-48. [PMID: 26237982 DOI: 10.1177/0098858815591508] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This study examined the medical information contained in a sample of television ads soliciting consumers for lawsuits against drug and medical device manufactures. Almost all such ads involved drugs or devices that have not been recalled and remain on the market. These ads raise important public health questions because they may influence the prospective medical decisions of viewers. The ads contained extensive descriptions of serious adverse events associated with the drugs or devices but almost uniformly failed to disclose information relating to the likelihood of such events. They also failed to effectively advise viewers to consult a doctor. Results also identified a subset of ads that mimicked public service announcements, claiming to be. a "medical alert" "consumer alert" or "FDA warning" at the start of the ad. Most such ads did not disclose the attorney source of the advertising until the final few seconds.
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Purwar P, Bambarkar S, Jiwnani S, Karimundackal G, Laskar SG, Pramesh CS. Multimodality management of esophageal cancer. Indian J Surg 2014; 76:494-503. [PMID: 25614726 PMCID: PMC4298001 DOI: 10.1007/s12262-014-1163-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 08/26/2014] [Indexed: 12/16/2022] Open
Abstract
Esophageal cancer is a morbid disease with a grim prognosis. The outcomes of treatment even in non-metastatic disease undergoing potentially curative surgery are poor with 5-year survival ranging from 20 to 35 %. Several multimodality treatment options have been investigated in well-conducted randomised trials and meta-analyses evaluating both neoadjuvant and adjuvant therapies. However, there is still lack of uniform practice in the management of operable esophageal cancer. We review the current evidence for multimodality treatment of esophageal cancer, critically analysing the evidence supporting the use of each strategy, the pros and cons of each approach and discuss our approach in management. Neoadjuvant chemotherapy or chemoradiotherapy are currently the standard of care in localised esophageal cancer.
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Affiliation(s)
- Pallavi Purwar
- />Thoracic Oncology Disease Management Group, Department of Surgical Oncology, Tata Memorial Centre, Mumbai, 400012 India
| | - Supriya Bambarkar
- />Thoracic Oncology Disease Management Group, Department of Surgical Oncology, Tata Memorial Centre, Mumbai, 400012 India
| | - Sabita Jiwnani
- />Thoracic Oncology Disease Management Group, Department of Surgical Oncology, Tata Memorial Centre, Mumbai, 400012 India
| | - George Karimundackal
- />Thoracic Oncology Disease Management Group, Department of Surgical Oncology, Tata Memorial Centre, Mumbai, 400012 India
| | - Sarbani Ghosh Laskar
- />Thoracic Oncology Disease Management Group, Department of Radiation Oncology, Tata Memorial Centre, Mumbai, 400012 India
| | - C. S. Pramesh
- />Thoracic Oncology Disease Management Group, Department of Surgical Oncology, Tata Memorial Centre, Mumbai, 400012 India
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40
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Coon ER, Quinonez RA, Moyer VA, Schroeder AR. Overdiagnosis: how our compulsion for diagnosis may be harming children. Pediatrics 2014; 134:1013-23. [PMID: 25287462 DOI: 10.1542/peds.2014-1778] [Citation(s) in RCA: 132] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Overdiagnosis occurs when a true abnormality is discovered, but detection of that abnormality does not benefit the patient. It should be distinguished from misdiagnosis, in which the diagnosis is inaccurate, and it is not synonymous with overtreatment or overuse, in which excess medication or procedures are provided to patients for both correct and incorrect diagnoses. Overdiagnosis for adult conditions has gained a great deal of recognition over the last few years, led by realizations that certain screening initiatives, such as those for breast and prostate cancer, may be harming the very people they were designed to protect. In the fall of 2014, the second international Preventing Overdiagnosis Conference will be held, and the British Medical Journal will produce an overdiagnosis-themed journal issue. However, overdiagnosis in children has been less well described. This special article seeks to raise awareness of the possibility of overdiagnosis in pediatrics, suggesting that overdiagnosis may affect commonly diagnosed conditions such as attention-deficit/hyperactivity disorder, bacteremia, food allergy, hyperbilirubinemia, obstructive sleep apnea, and urinary tract infection. Through these and other examples, we discuss why overdiagnosis occurs and how it may be harming children. Additionally, we consider research and education strategies, with the goal to better elucidate pediatric overdiagnosis and mitigate its influence.
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Affiliation(s)
- Eric R Coon
- Division of Inpatient Medicine, University of Utah School of Medicine, Primary Children's Hospital, Salt Lake City, Utah;
| | - Ricardo A Quinonez
- Baylor College of Medicine, San Antonio Children's Hospital, San Antonio, Texas
| | - Virginia A Moyer
- American Board of Pediatrics, Maintenance of Certification and Quality, Chapel Hill, North Carolina; and
| | - Alan R Schroeder
- Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, California
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Gabriel JM, Goldberg DS. Big pharma and the problem of disease inflation. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2014; 44:307-22. [PMID: 24919306 DOI: 10.2190/hs.44.2.h] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Over the course of the past decade, critics have increasingly called attention to the corrosive influence of the pharmaceutical industry on both biomedical research and the practice of medicine. Critics describe the industry's use of ghostwriting and other unethical techniques to expand their markets as evidence that medical science is all-too-frequently subordinated to the goals of corporate profit. While we do not dispute this perspective, we argue that it is imperative to also recognize that the goals of medical science and industry profit are now tightly wed to one another. As a result, medical science now operates to expand disease definitions, lower diagnostic thresholds, and otherwise advance the goals of corporate profit through the redefinition and expansion of what it means to be ill. We suggest that this process has led to a variety of ethical problems that are not fully captured by current critiques of ghostwriting and other troubling practices by the pharmaceutical industry. In our conclusion, we call for physicians, ethicists, and other concerned observers to embrace a more fundamental critique of the relationship between biomedical science and corporate profit.
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[Quaternary prevention: containment as an ethical necessity]. An Pediatr (Barc) 2014; 81:396.e1-8. [PMID: 24907862 DOI: 10.1016/j.anpedi.2014.04.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 04/22/2014] [Accepted: 04/29/2014] [Indexed: 11/21/2022] Open
Abstract
The growing capacity of medicine to generate more iatrogenic events than ever, and the risk of unsustainability of health systems have led to new prevention concept: quaternary prevention aimed at restraining medicalization. Quaternary prevention is essential in the phenomenon called disease mongering, which could be translated as commercialization of disease. Encouraging this sort of prevention and halting the consequences of disease mongering requires the development of all the institutional potential for prevention, as well as all the personal willingness for restraint; it involves separating us from the unnecessary auspices of industry, being critical of our work, not being maleficent, respecting the principle of justice as managers of the limited public resources and making ourselves feel responsible for the social cost resulting from medical decisions. From this point of view, this work analyses neonatal screening, developments in the area of neonatology and primary health care.
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43
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Tasso A, Gavaruzzi T, Lotto L. What is in a Name: Drug Names Convey Implicit Information about Their Riskiness and Efficacy. APPLIED COGNITIVE PSYCHOLOGY 2014. [DOI: 10.1002/acp.3033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Alessandra Tasso
- Department of Human Studies; University of Ferrara; Ferrara Italy
| | - Teresa Gavaruzzi
- Department of Developmental Psychology and Socialization; University of Padova; Padova Italy
| | - Lorella Lotto
- Department of Developmental Psychology and Socialization; University of Padova; Padova Italy
- Center for Cognitive Neuroscience; University of Padova; Padova Italy
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Smith J, Blake M. Infant food marketing strategies undermine effective regulation of breast-milk substitutes: trends in print advertising in Australia, 1950-2010. Aust N Z J Public Health 2014; 37:337-44. [PMID: 23895476 DOI: 10.1111/1753-6405.12081] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE This study addresses the issue of whether voluntary industry regulation has altered companies' marketing of breast-milk substitutes in Australia since the adoption of the World Health Organization (WHO) International Code on the Marketing of Breast-milk Substitutes 1981. METHODS Print advertisements marketing breast-milk substitutes were systematically sampled from the Australian Women's Weekly (AWW) magazine and the Medical Journal of Australia (MJA) for the 61 years from 1950 to 2010. RESULTS Breast-milk substitute advertising in both the MJA and the AWW peaked and began declining before the introduction of the WHO Code in 1981. Although there was almost no infant formula advertising in AWW after 1975-79, other breast-milk substitute advertising has been increasing since 1992, in particular for baby food, toddler formula and food and brand promotion. CONCLUSIONS Companies have adopted strategies to minimise the effects of the Code on sales and profit in Australia, including increasing toddler formula and food advertisements, increasing brand promotion to the public, and complying with more limited voluntary regulatory arrangements. IMPLICATIONS Comprehensive regulation is urgently required to address changed marketing practices if it is to protect breastfeeding in Australia.
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Affiliation(s)
- Julie Smith
- Australian Centre for Economic Research on Health, College of Medicine, Biology and Environment, The Australian National University, ACT, Australia.
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45
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46
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Leon-Sanromà M, Mínguez J, Cerecedo MJ, Téllez J. [Have we moved on to the DSM-5? A debate with clinical, social and financial implications]. Aten Primaria 2013; 46:4-5. [PMID: 24355582 PMCID: PMC6983573 DOI: 10.1016/j.aprim.2013.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 10/11/2013] [Indexed: 12/03/2022] Open
Affiliation(s)
- Maria Leon-Sanromà
- Especialista en Medicina Familiar y Comunitaria, Miembro del grupo de trabajo en Salud Mental semFYC.
| | - José Mínguez
- Especialista en Medicina Familiar y Comunitaria, Miembro del grupo de trabajo en Salud Mental semFYC
| | - Maria Jesús Cerecedo
- Especialista en Medicina Familiar y Comunitaria, Miembro del grupo de trabajo en Salud Mental semFYC
| | - Juan Téllez
- Especialista en Medicina Familiar y Comunitaria, Miembro del grupo de trabajo en Salud Mental semFYC
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47
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Lindberg LG, Svendsen M, Dømgaard M, Brodersen J. Better safe than sorry: a long-term perspective on experiences with a false-positive screening mammography in Denmark. HEALTH RISK & SOCIETY 2013. [DOI: 10.1080/13698575.2013.848845] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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48
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Jordens CFC, Lipworth WL, Kerridge IH. The quality of Australian health journalism is important for public health. Med J Aust 2013; 199:448-9. [DOI: 10.5694/mja12.11426] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 07/30/2013] [Indexed: 11/17/2022]
Affiliation(s)
| | - Wendy L Lipworth
- Australian Institute of Health Innovation, University of New South Wales, Sydney, NSW
| | - Ian H Kerridge
- Centre for Values, Ethics and the Law in Medicine, University of Sydney, Sydney, NSW
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49
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[Medicalization I. 'Disease labeling: All business.']. Aten Primaria 2013; 45:434-8. [PMID: 24055130 PMCID: PMC6985480 DOI: 10.1016/j.aprim.2013.04.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 04/16/2013] [Accepted: 04/21/2013] [Indexed: 11/23/2022] Open
Abstract
En los países desarrollados, la sociedad ha desplazado al campo médico problemas de la realidad subjetiva y social de las personas, y la obsesión por una salud perfecta se ha convertido en un factor patógeno predominante. De manera paradójica, a la vez que mejora el nivel de salud de la población, existe un aumento del número de enfermedades y enfermos. En la práctica clínica diaria, y por diferentes motivos, ponemos «etiquetas de enfermedad» a comportamientos o acontecimientos que no son más que elementos que integran el carácter o forma de ser de las personas, o bien se trata de reacciones saludables ante situaciones vitales acontecidas como conflictos laborales, familiares, escolares o duelos. En este artículo se analizan los agentes responsables del proceso de medicalizar y las consecuencias que ello conlleva, deteniéndonos en el efecto iatrogénico de las intervenciones innecesarias.
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Abstract
Spirituality has long been associated with recovery from the socially constructed "addictive disease." Alcoholics Anonymous (AA) and its analogs have enjoyed widespread acceptance as a spiritual approach for achieving recovery. AA or its derivatives are the predominant approaches in treatment programs even though a wide array of evidence-based approaches are now promoted by governmental sources in the United States. This philosophical analysis contrasts the state of science about addictive disorders with the reliance on a spiritual approach that is heavily grounded in Christian theology. We present four problems that need consideration before accepting the applicability of 12-step spiritual practices as the backbone of addiction treatment or recovery.
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Affiliation(s)
- Robert Walker
- 1University of Kentucky Center on Drug and Alcohol Research and Department of Behavioral Science , Lexington, Kentucky , USA
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