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Title: The questions of medicalisation, prioritisation and ageing society in Finnish health care system Kir


1
The questions of medicalisation,
prioritisation and ageing society in Finnish
health care systemKirsi VainionpääDep. Of
Soc. Studies University of Lapland
2
Medicalisation
  • By medicalisation it is referred to the ways in
    which medicine expands to new arenas that were
    previously not defined to be part of the field of
    medicine (Zola 1972)
  • Medicine has, according to Zola, become the major
    institution of social control and has replaced
    the traditional controlling institutions of
    religion and law.

3
Medicalisation
  • Medicalising everyday living is accomplished
    hidiously by making medicine and the labels
    healthy and ill relevant to the human
    existence.
  • By the acceptance of a specific behaviour as an
    illness and the definition of illness an
    undesirable state the issue becomes not whether
    to deal with a particular problem but how and
    when.

4
Medicalisation
  • Some people have claimed that nowadays, instead
    of clergymen, doctors are acting as the mediators
    of the truth, and people accept regulations that
    are supposed to help them guarantee their health.
    (Conrad 1992,Turner 1992)
  • The extension of medicine and the extent of
    health adoring are described as the tyranny of
    health by Michael Fitzpatrick (2001).

5
Medicalisation
  • Medicalisation happens at three levels
  • conceptual
  • institutional and
  • interactional levels.
  • Can you give me examples?

6
Medicalisation
  • On the conceptual level, medical terminology is
    used to define the problem and also, that the
    medical definition becomes general
  • Can you name examples of conceptual
    medicalisation?

7
Medicalisation
  • Conceptual medicalisation
  • Alcoholism
  • ADHD
  • Ageing
  • Erectile disorders
  • FSD

8
Medicalisation
  • On the institutional level, organizations may
    adopt a medical approach to treating a particular
    problem in which the organization specializes.
  • Can you name examples of institutional
    medicalisation?

9
Medicalisation
  • Specialists inside medicine
  • This is what I study male menopause and thus,
    male clinics. Women have had gynaecologists and
    now men have their andrologists

10
Medicalisation
  • On the interactional level, medicalisation occurs
    as part of doctor patient interaction, when a
    physician defines a problem as medical or treats
    a social problem with a medical form of treatment
  • Can you name examples?

11
Medicalisation
  • This should be easy. Lets think about drunk
    husbands and beaten wifes for example.
  • Another example fear for unemployment and cannot
    sleep gt doctor prescribes sleeping pills and
    ignores the social situation

12
Medicalisation why now?
  • the diminution of religion i.e. secularization
  • a abiding faith in science, rationality and
    progress
  • the increasing prestige and power of medical
    profession
  • the penchant of technological solutions for
    problems
  • (Conrad Schneider 1980b, Conrad 1992)

13
Many conditions have become medicalised
  • giving birth
  • dying
  • a continuing medicalisation of madness
  • alcoholism, opiate addiction
  • homosexuality
  • child abuse and family violence (Conrad
    Schneider 1992, 280286)
  • the medicalisation of compulsive buying (Lee
    Mysyk 2004)
  • finding the diagnosis Attention
    Deficit/Hyperactivity Disorder (ADHD)
  • the use of the drug Ritalin among school age
    population to control the ADHD children (Singh
    2004).

14
Medical social control
  • Medical social control means the ways in which
    medicine functions to secure adherence to social
    norms by using medical means to minimise,
    eliminate, or normalise deviant behaviour
  • Largely understood, medical social control is
    the acceptance of a medical perspective as the
    dominant definition of certain phenomenon (Conrad
    Schneider 1980, 242)

15
Medical social control
  • When medical perspectives of certain problems and
    their solutions become dominant, they diminish
    other possible ways of understanding that problem
  • Medical social control is enacted through
    professional medical intervention, via medical
    treatment
  • These interventions aim at returning sick
    individuals to their conventional social roles or
    adjusting them to new roles, or making
    individuals more comfortable with their
    conditions (Conrad Schneider 1980, 242)

16
Medical social control
  • Medical social control is carried about by
    medical profession and assisted by different
    forms of medical technology.
  • Without medicalisation in a definitional sense,
    medical social control loses its legitimacy and
    is more difficult to accomplish

17
Medical social control
  • The development of a technique of medical social
    control (e.g. pharmaceutical interventions) may
    precede the medicalisation of a problem, but for
    implementation some type of medical definition is
    necessary
  • More typically medicalisation precedes medical
    social control. (Conrad 1992)

18
Medical social control
  • There are four forms of medical social control
  • medical technology (including pharmacy),
  • medical collaboration meaning doctors assist as
    information providers, gatekeepers,
  • medical ideology that imposes a medical model
    primarily because of accrued social and
    ideological benefits and
  • medical surveillance

19
Prioritisation of health care
  • Setting priorities (also a term rationing is
    used) means ranking things in order of
    importance.
  • Medicalisation and the prioritisation of health
    care are related to each other being mainly
    juxtapositional, i.e. they mostly draw to
    opposite directions

20
Prioritisation of health care
  • In health care prioritisation is usually a
    question of choices in conflicts between service
    needs and financial resources.
  • The aim should be a balance between individual
    and common good, and the guiding principle
    helping the greatest possible number of people
    within the limits set by the available resources.

21
Prioritisation of health care
  • Finnish health policy discussion is today mostly
    about prioritisation
  • we have to make hard choices in allocating
    scarce resources.
  • There is no doubt about the need of our society
    to prioritise our health care

22
Prioritisation of health care
  • Priority setting in Scandinavia has gone through
    two phases
  • The first phase in discussions and reports was
    characterised by a search for priority setting
    systems, which could tell the decision-maker
    directly how a given service should be
    prioritized in relation to other services.
  • The second phase has followed the realization
    that the idea of devising a simple set of rules
    is flawed (Holm 1998, 1000)

23
Prioritisation of health care
  • The Finnish Medical Society Duodecim published in
    June 2000 its comment on prioritization called
    Priorisointiterveydenhuollon valinnat
    Prioritisationthe choices in health care.
  • In the booklet there were not concrete advice on
    how to prioritize or make choices
  • According to the Committee, the most equitable
    and the most costs-saving basis to prioritization
    is the requirement of the efficiency of the
    treatments (Finnish Medical Society Duodecim
    2000, 31). (Saarni 2001)

24
Prioritisation of health care
  • The aim of prioritisation should be a balance
    between individual and common good, and the
    guiding principle helping the greatest possible
    number of people within the limits set by the
    available resources.
  • Choices should be based on ethical criteria, such
    as the effectiveness of the treatment, justice
    and equality, and respect for human dignity and
    the rights of the patient.

25
Prioritisation of health care
  • Without discussion on values and clear ground
    rules, such choices tend to be based on chance,
    the status of the individual, the ability of the
    service claimant to plead his/her cause or other
    grounds that do not stand up to critical
    assessment. (National Advisory Board on Health
    Care Ethics (ETENE) 2001)

26
Prioritisation of health care
  • As a basis of rationing can be many different
    normative principles which can be and often are
    juxtapositional when making individual
    prioritisation choices
  • these principles can be divided into two goals
  • i) the efficacy of health care as what comes to
    public health and
  • ii) justice/equality

27
  • FINNISH POPULATION IS AGEING FASTEST OUT OF
  • ALL THE EU POPULATIONS

28
Finnish population by age groups between
19002050,millions (Räty et. al. 2003)
29
Prioritisation of health care
  • In the next fifty years, the fastest growing
    population group in Finland is people over 80
    years
  • It is much cheaper for the society to keep ageing
    people living at their own homes than to situate
    them in nursing homes
  • Governments may even welcome some of societys
    problems being redefined as medical with the
    possibility of new solutions (Moynihan Smith
    2002)

30
Prioritisation of health care
  • In a British Medical Journal recent vote on
    bmj.com for When is a disease a non-disease,
    ageing was voted for number one
  • The growing population of affluent older people
    has great expectations of medical care, fuelled
    by greater consumerism
  • Medications are promoted for personal and social
    problems

31
Prioritisation of health care
  • New technologies in the care of the elderly are
    recommended because they support self-care
  • It is much cheaper for the society to keep
    eldering people living at their own homes than to
    situate them in nursing homes
  • Pharmaceutical companies sponsor diseases and
    promote them to prescribers and consumers in
    order to extend the boundaries of treatable
    disease to expand markets for new products

32
  • Would it be too wild to say that people are
    socially controlled by medicines and
    pharmaceutical industry?

33
Ageing Social or personal problem?
  • Could we end up with blaming the victim ie. do we
    rather see the causes of the problem in
    individuals rather than endemic to the society
    (William Ryan 1971)?
  • C. Wright Mills explored the connections between
    private problems and public issues and pointed
    out that the troubles a person experiences arise
    in the context of broader social problems (Mills
    1959)

34
  • MALE MENOPAUSE AND MALE HORMONE THERAPY IN
    THECONTEXT OF MEDICALISATION AND PRIORITISATION
    OF HEALTH CARE

35
  • Kiinnitä huomiota vointiisi Tunnetko usein
    itsesi väsyneeksi? Onko seksuaalinen halusi
    vähentynyt viime vuosina? Onko lihasvoimasi
    heikentynyt? Kärsitkö väsymyksestä?Tämä voi
    johtua testosteronin puutteesta.
  • www.testosteroni.fi testi )))

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39
A PhD Thesis
  • There are four parts in this PhD Thesis study
  • Male menopause and male hormone therapy in
    Finnish lay journals
  • A disease and a drug as a solution for aging
    society? The development of male menopause and
    its treatments in Finnish physicians information
  • Male menopause on the Internet
  • The diffusion of male hormone therapy in Finland
    compared to the female hormone therapy

40
SOME FINDINGS OF THE FIRST PART Male menopause
and male hormone therapy in Finnish lay journals
  • The amount of Finnish lay magazine articles
    concerning male menopause and its treatment grew
    significantly from the early 1980s to the early
    2000s
  • Male menopause was initially presented as a
    social problem related to mens working careers
  • During the study period writers increasingly
    presented it as an illness managed by medical
    experts and treated with hormones
  • Often a woman was rereffed to as a lay expert,
    guiding her partner to see the doctor
  • The most quoted professional experts in the
    material researched were associated with the
    pharmaceutical industry

41
SOME FINDINGS OF THE SECOND PARTMale menopause
in Finnish physicians information
  • The aim of this study was to investigate
    conceptions of the male menopause (also known as
    andropause) in the educational and professional
    literature of Finnish physicians from 1982 to
    2002
  • The main point of interest was how the
    presentation of the male menopause and its
    treatments have changed

42
SOME FINDINGS OF THE SECOND PARTMale menopause
in Finnish physicians information
  • Material for analysis was retrieved from the two
    main Finnish medical journals and from
    introductory gynaecology and urology textbooks
    using keywords for male ageing and hormones

43
SOME FINDINGS OF THE SECOND PARTMale menopause
in Finnish physicians information
  • The ambivalence surrounding the phenomenon of
    male menopause was noticeable
  • some authors described it as a consequence of the
    decline in gonad functioning that comes with
    increased age
  • some argued that we are making a disease out of
    normal ageing

44
SOME FINDINGS OF THE THIRD PARTCommercial
web-based information on male menopause and male
hormone therapy
  • Objective was to study male menopause by asking
    what kind of themes the Internet provided about
    male menopause and its treatments to evaluate
    the quality of the commercially available
    web-based information by comparing it to the best
    available scientific information
  • The data were selected on the basis of its
    accessibility in web sites available to Finnish
    men.

45
SOME FINDINGS OF THE THIRD PARTCommercial
web-based information on male menopause and male
hormone therapy
  • The content was qualitatively analysed by
    searching for the themes that were used to
    construct the meaning of male menopause.
  • The WWW pages information was also compared to
    the best available medical scientific information

46
SOME FINDINGS OF THE THIRD PARTCommercial
web-based information on male menopause and male
hormone therapy
  • Six different thematic formations were found in
    the material healthism, a take-care-of-yourself
    theme, a quasi-professional theme, an uncertainty
    theme, a risk theme, a good sex theme and a
    similar-to-women theme.
  • The web-based information did not correspond to
    the best available medical scientific
    information.

47
SOME FINDINGS OF THE THIRD PARTCommercial
web-based information on male menopause and male
hormone therapy
  • These themes produce societal phenomena that can
    be briefly detailed according to the themes and
    can be seen to constitute a new form of treatable
    illness, male menopause and male hormone
    therapy.

48
SOME FINDINGS OF THE FOURTH PARTThe first steps
of testosterone therapy dissemination in Finland
  • The objective was to investigate the use of male
    hormone therapy (HT), i.e. testosterone in
    Finland from 19932004
  • Three statistical sources were used
  • i) drug sales statistics taken from Finnish
    Pharmaceutical Data Ltd.,
  • ii) statistics from the Social Insurance
    Institution and
  • iii) statistics from the Health 2000 Survey
    undertaken by the National Public Health
    Institute

49
SOME FINDINGS OF THE FOURTH PARTThe first steps
of testosterone therapy dissemination in Finland
  • Results The wholesale turnover for testosterone
    in 1993 was 472 900. In 2004, the final year of
    the study, it was 913 400. The value of retail
    sales of testosterone in 2004 was 1 461 440.
  • The value per testosterone package sold rose from
    12.67 to 14.74 between 1993 and 2004.

50
SOME FINDINGS OF THE FOURTH PARTThe first steps
of testosterone therapy dissemination in Finland
  • The proportion of men using testosterone was
    largest in the Helsinki Region where 440 was
    spent per 1000 men on testosterone drugs in 2004
  • The growth of the use of male HT was most
    vigorous in the capital area, as would be
    expected considering theories about the diffusion
    of medical innovations.

51
SOME FINDINGS OF THE FOURTH PARTThe first steps
of testosterone therapy dissemination in Finland
  • The Health 2000 data reveals the pioneers of male
    hormone use were highly educated men living in
    the metropolitan area.
  • The results indicate that mens midlife and
    ageing are becoming medicalised.

52
References
  • Conrad, Peter Schneider, Joseph, W. 1980a
    Deviance and medicalization. From badness to
    sickness. C.V. Mosby Company. St.Louis.
  • Conrad, Peter Schneider, Joseph, W. 1980b
    Looking at levels of medicalization a comment on
    Strongs critique of the thesis of medical
    imperialism. Social Science and Medicine 14A,
    7579.
  • Conrad, Peter 1992 Medicalization and Social
    Control. Annual Review of Sociology 18 209232.
  • Conrad, P. Schneider, J.W. 1992 Deviance and
    medicalization. From badness to sickness.
    Expanded edition. Temple University Press.
    Philadelphia.
  • Fitzpatrick, Michael 2001 The Tyranny of Health.
    Doctors and the regulation of lifestyle.
    Routledge. London and New York.
  • Holm, Soren 1998 Goodbye to the simple
    solutions the second phase of priority setting
    in health care, British Medical Journal 317,
    10002.
  • Lee, S. Mysyk, A. 2004 The medicalisation of
    compulsive buying, Social Science Medicine 58,
    1709 718.
  • Singh, I. 2004 Doing their jobs mothering with
    Ritalin in a culture of mother-blame, Social
    Science Medicine 59, 11931205
  • Turner, Bryan S. 1992 Regulating bodies Essays
    in medical sociology. Routledge. London and New
    York.
  • Zola, Irving Kenneth 1972 Medicine as an
    institution of social control. Sociological
    Review 20, 487504.

53
References
  • Finnish Medical Society Duodecim 2000
    Priorisointi terveydenhuollon valinnat.
    Prioritisation the choices in health care.
    Helsinki.
  • Saarni, S. 2001 Priorisointi mahdoton yhtälö?
    Prioritisation an impossible equation?
    Suomen Lääkärilehti Finnish Medical Journal
    56(12), 14171420.
  • National Advisory Board on Health Care Ethics
    (ETENE) 2001 Shared values in health care,
    common goals and principles. ETENE publications
    3. Available online at
  • lt http//www.etene.org/dokumentit/EteneENG.pdf gt
  • Accessed 5th August 2005
  • Moynihan, Ray Smith, Richard 2002 Too much
    medicine? Almost certainly. British Medical
    Journal 324, 859860.
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