Impact of Globalization
- increased spread of disease
- reduce public health funding
- reduce gov. ability to enforce public health measures.
How does the industry control information about drugs?
- funding medical research
- funding conferences and CME
- educational materials
- advertising
Factors that contribute to the moralization of health
- Rise of secular morality
- Rise of Protestantism
- individualism
- self control
- responsibility - fear of harm to children
- association with marginalized groups
- favorable short-term cost/benefit ratio
- people don’t want to pay a lot for a virtue - confusion about cause
- if there is no scientific evidence for a cause, it must be from a higher power
Four Historical Health Regimes
- Quarantine Regime
- Sanitary Science Regime
- Social Medicine Regime
- New Public Health Regime
Quarantine Regime
14th - mid-19th century
Threat = sick places
Response = quarantine
Responsible = state
Sanitary Science Regime
mid-19th - early 20th century
threat = contamination
response = sanitation
responsibility = state
Chadwick’s sanitary idea - epidemiology and public health were born.
Class ideology - concern for the the poor and their troubling state
Social Medicine Regime
late 20th century
threat = germs
response = hygiene
responsibility = individual
New Public Health Regime
1970 - now
threat = human action
response = personal lifestyle or political change
responsibility = individual or state (depending on the response)
Goffman’s view of framing
unintentional
Media Studies view of framing
intentional
Ghost writing - Not a problem
- similar to co-authoring in universities which is not a problem.
- the skill of writing is not considered valuable intellectual talent. doesn’t require this much attention.
Ghostwriting - the problem
- plagiarism
- physicians get credit and get the move up the hierarchy more quickly without doing any work
Elliot - The ghost, white coat black hat - take home message
- ghost writers and pharmaceutical company funding (through advertisements and funding for printing) largely indicate what will be present in medical journals.
Lextin - Profit First - take home message
- companies hide the negative side of drugs for publication
- mainly for financial reasons, the pharmaceutical industry is gaining more and more control over the quality of drugs released.
Carpenter - Health for Some
The have been real gains in health but poverty and health inequalities have increased in an era of globalization. Health gains are not secure due to negative activities of multinationals as well as ineffective governance
Dependency theory -
economic growth necessarily means improvement in health. NOT TRUE.
Why has mortality decreased?
- exportation of hazardous jobs
Work place injury has also declined. Why?
- not being reported
- job security
- do not expect compensation
Knowles - The Responsibility of the Individual
- Most improvements in health are do to improve sanitation, hygiene and cleanliness, Not medical/surgical therapies.
- To improve health with individual responsibility, we need to even economic levels and improve access to health care
Simple paradigm of medicine
one germ = one disease = one cure
Reasons we wouldn’t change out lifestyle to be more health
- demand for instant gratification
- death and disease will be cured by science
- die quickly so we don’t have to be old and the disease and stigma that comes with that.
- physicians do not want to change the system
Leichter - Lifestyle correctness
- secular morality has made health a state of grace.
- way to set social boundaries on what is (un)acceptable.
- means of social control through guilt/morality.
Solomon & Green - The History of Non-Medical Opiate Use
- The “drug problem” had/has little to do with the physiological effects of the drug and more to do with political, moral, and social factors.
- Laws got increasingly stricter over time until white kids starts smoking pot in the 60s, now criticized for being too harsh
Why was there an opium concern?
hostility against chinese immigrants, not physical harm
