Sys Rev Pharm 2021; 12(5): 236-238 Review Article A multifaceted review journal in the field of pharmacy E-ISSN 0976-2779 P-ISSN 0975-8453 Over-: A Modern Problem Divisible from Medicalization Iqra Aslam1*, Tehreem Khalid2, Ghufran Zafar3 1Department of Medical Sciences, Nawaz Sharif Medical College, Gujrat, Pakistan 2Department of Medical Sciences, Mohi-ud-Din Islamic University, Azad Jammu and Kashmir, Pakistan 3Department of Medical Sciences, Hainan Medical University, China Article History: Submitted: 05.05.2021 Accepted: 19.05.2021 Published: 26.05.2021

ABSTRACT be established which can help in setting the boundar- ies for medicine use; (iii) guiding questions have been The question has been mongering around that is the discussed to help in differentiating between medical- use of medicine dangerous? What are the set limits of ization and over-medicalization. This article reflects the medicine usage? The purpose of this review paper is bioethical boundaries of medicine and promotes evalu- to highlight the pragmatic criteria and set boundaries ative analysis of the medicalization phenomenon. that aid in differentiating between medicalization and over-medicalization. When a problem in a human body Key words: Medicalization, Over-medicalization, is considered a medical problem, then this consider- Guidelines, Approach, Strategy, Boundaries, Limits of ation comes with various consequences. It also raises medicine questions about the accuracy of this statement which called the issue a medical problem. However, certain boundaries can neither b crossed nor questioned which *Correspondence: encapsulates various areas of human existence. This Iqra Aslam, Department of Medical Sciences, Nawaz review paper will discuss the following points; (i) con- Sharif Medical College, Gujrat, Pakistan, E-mail: tamim- sequences of both medicalization and over-medicaliza- [email protected] tion; (ii) exhibit that optimum model of health cannot

INTRODUCTION tion is not a wrongly identified medical problem, rather it is more In the modern scientific era where the development in the field political or cultural, or it can also be misunderstood as a medical of medicine has revolutionized the treatment procedures of all issue at the first place. Furthermore, when an issue is misinter- the diseases, on the other hand, this development is also caus- preted, it leads to wrong treatment with the wrong prescription ing havoc. Maybe this is due to the influx of a large amount of which in turn adversely affects human health. According to pa- information, or less access to that information which adversely rens; to decrease the patients suffering, medicine focuses on hu- impacts its proper utilization. Moreover, the quality of the in- man bodies to target those specific sites, but on the other hand, formed text is also controversial and health departments have it also diverts the attention from the social and physical environ- observed an inexorable increase in medicalization. Medicaliza- ment which became the reasons of originating those sufferings tion can be defined as when consumers lookout for medical in individuals at the first place. For instance, instead of treating treatment for various problems linked with their body, where the drug addicts, it could also be possibly done to change their morbidity and mortality are the expressions of the failure of a environment which made them an addict. Moreover, by altering system. As per sociological definition, a person is said to be the social expectations it would be easier for individuals to better medicalized when “using medical language, it is explained in adapt their normal changing bodies instead of forcing them to fit medical terms, acknowledged through a medical framework, the dominant paradigms. In the context of over-medicalization, and then treated with a medical intercession” (Broom DH and links with necessary medical treatments have been found which Woodward RV, 1996; Bull M, 1990). Thus, medicalization is always lead to various serious health disorders. Furthermore, it is the elaboration of new and different criteria encompassing also linked with various other spheres of life which are not directly human behavior and then assessing those problems through linked with health but do affect the lives of individuals. the medical frame rather than using social, physical, environ- Models of health and medicalization mental, or existential frames. Ever since this terminology was According to the definition of health provided by the World introduced, it has been under criticism that it is being used as Health Organization, “a state of complete, physical, mental and a tool for social control. But with time, chemists, sociologists, social well-being.” Thus, every aspect of life collectively contrib- and bioethicists have also highlighted its positive aspects as utes to the health of the man. As per this definition, medicine well. Therefore, the question circulates that how should this provides such a domain that does not only ensure healthy but phenomenon be perceived? The purpose of this paper is to also good lives by providing a tool for the human race to gain highlight points that can provide a pragmatic approach for dis- happiness. Here, Daniel Callahan has pointed out this aspect and tinguishing between medicalization and over-medicalization stated that: linking health and basic well-being as positive ideals, (Busfield J, 2017; Parens E, 2013). has given birth to multiple evils. Among these issues, the tenden- MATERIALS AND METHODS cy to define social problems have been lost, from war to street Numerous impacts of medicalization and over-medical- crimes, the lines have been blurred between the responsibility and ization ‘health problems’, professions of medical personals to political elite orders; the failure to gain social well-being is cited as “sickness” According to Erik Parens, when the medical health department which withhold te human freedom and is subjected for medical exceeds its set boundaries while ascribing medicine then it makes treatment. The following table provides an illustration of such is- medicalization a wrong thing (Parens E, 2013). Over-medicaliza- sues (Table 1).

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Table 1: Own elaboration: Medicalization assessment then there are a few biomedical models in this niche that played a neg- ative role, like overriding norms and values strongly linked with health, Over-medicalization Medicalization over classification of disorders-ICD-10 (Sedler MJ, 2016), self-observing Health Impacts within Boundaries- practices like blood pressure monitoring, pulse, sugar level and burned Opportunities calories, use of mobile applications and technical devices, use of Western Health Impacts Undesirable side effects, Use of medicine as a medicine with a thought that they are the way to harmony, and over-med- poisoning, undue tool of evidence for icalization to improve body functioning or achieving their goals (Gimbert results due to overpre- treating mental health C and Lapointe FJ, 2017). On the one hand, health models are criticized for scription, iatrogenic disorders at psychiat- being the reason behind the objectivity of medical practices and neutrality, disease, multiple other ric hospitals. Fighting on the other hand, criticism is concerned with the marketing of artificial- health risks. against taboos like an ly created health disorders and their cures just for the purpose of gaining exorcism. more and more economic perks. Economic Impacts The burden on public Betterment in indi- and private expendi- vidual’s economic Over-medicalization: A practical approach ture by treatment of state due to on-time Medicine is a social application that is used for curing certain health dis- iatrogenic diseases and right identification orders. However, setting certain limits on its implications is not as easy consequences of medi- of disease. Thus, as it seems to be. Therefore, to evaluate its limits, it is quite advantageous cal errors. granting insurance to develop contrasting and comparative frameworks of study. In many re- coverage, entitlement gions of the world, medical therapy is often given a religious status similar to take a sick leave to a priest when crimes were seen as a result of illness, not sin (Turner BS, and compensation for 1995). Moreover, death was also cited as a medical condition back then for medicines. which medicine was overly used. Therefore, to tackle such situations and Psychological Stigmatization of Explanatory power medicalize a problem, it is imperative to first provide a proper explanation Impacts certain behavior. Re- that de-taboo the to that issue along with a solution. For example, treatment of a depression striction of individual’s concept of various patient must not be done through medications like anti-depressants, who freedom, poor behavior diseases: patients is in this situation due to an alcoholic partner, but first, the situation must management due to learn the causes of be treated and opportunities must be provided to survive in that tense en- sickness, and force multiple diseases and vironment. The cause of the health issue here is not of molecular nature, adjustment of one’s own observe conditions of rather it is due to external, interpersonal, and objective factors (Parens E, needs with the desired other patients as well. 2013). medical requirements According to parens, the solution lies at eradicating the root cause by e.g pharmacological addressing the relationship with the alcoholic partner not the patient of adjustment in females depression. Nonetheless, parens did not show any concerns about medi- with low sexual desires. calizing the alcoholic partner. This isn’t owing to the nature of alcoholism Social Impacts Social, political, and in- Public awareness which depicts that it is not a social problem or a medical problem, but terpersonal background campaigns, recog- due to the reason that there are simple steps and various therapeutic forms plays a significant role nition of medical available to easily combat this issue. Pharmaceutical drugs have proved in defining reactions grounds for certain to be a great help in adjusting the metabolism of alcoholic individuals to originating therefrom diseases and particu- help them overcome this addiction, and no more promising alternative has like tackling the victim’s lar behaviors. Leading been found so far. Here, to overcome the concern of over-medicalization, masochistic personal- towards treatment there is a dire need to shift the focus from a question like; “What is a disor- ity the reason behind rather than punish- der/ disease?” and “How it can be defined?”, to questions like “What con- domestic violence. ing the patients, e.g. cerns as a social practice, should a medicine address?” and “How should restricted criminal certain medicine criteria can be specified?”. liability of mentally Following questions have been designed to facilitate the differentiation distorted individuals. between medicalization and over-medicalization. Here, X is a certain phe- In the middle of the 20th century, rising dissatisfaction with biomedicine nomenon that can be a behavior, condition of body or a sensation, and was observed which offered a health model. The pre-existing health disor- whenever X is treated as certain medical problem the given below ques- ders made it less possible to focus on the attainment of a given health mod- tions should be addressed: el. Scientists viewed human bodies in a mechanistic way and tried to justify • Is X rightly observed and recognized as a medical problem? Is this prob- every problem with the help of medical technologies (Doust J, et al., 2017; lem likely to aggravate the existing physical and mental discomfort, pain, Boorse C, 1975). The health definition and it is model presented by the illness, or even death? World Health Organization has obvious problems which incorporate the entire existence of human beings. However, none of the health models pre- • Is the problem of X not a result of the social or physical environment sented by sociology or philosophy in history are entirely free from errors which is being exaggerated and converted up with a medical profile? Is and practical issues, nor do they offer safety against over-medicalization. the recognition of X not based on social norms abiding by the definition Among these models, a few are; the total absence of diseases, basic state of of normality by questioning the diversity of individuals? If it is finalized health, health an indicator of harmony, homeostasis; health providing a that the suffering or state of the individual’s body is correctly identified, e.g. free will to pursue one’s own goals and duties; and at the end health taken illness that can cause death due to medical reasons and not owing to exag- as objective or subjective matter. geration of social expectations. Then in order to treat the issue medically, the following question can be asked: When it comes to factors to be blamed that lead to over-medicalization,

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• Will medicine provide the fine solution for understanding the issue, its The WHO and other health organizations do provide statistical data to causes, and the treatment? At which stage like mental, social, molecular, or calculate YLD and YLL, however, there are certain limitations to those other, the main issues to X appeared? Are there any replaceable solutions, statistical provisions. This is why it is imperative to focus more on sci- non-medical and better ones, present for understanding and curing X? entific results about X’s condition while answering the 1st question. • Is the medicalization of X the only best solution available? Moreover, personal experiences and subjective elaborations of individ- uals suffering and experiencing conditions of X must also be considered • Will medicalization do less harm than any non-medical solution avail- before finalizing the state either as medicalized or non-medicalized. able out there? CONCLUSION DISCUSSION It is clear that the above mentioned four questions are not obvious to Let’s analyze the four questions mentioned above. None of these ques- provide adequate answers in all the situations, however, there is no tions as self-evident and free from problems. In the first question, there doubt that medicalization of certain health issues gives birth to more are unlimited factors discussed that cause mental and physical suffer- severe issues as a comparison to some which actually need medical at- ing. The pragmatic approach used in this paper is not to address all the tention. The four guiding questions received more question marks and factors available, but only those who were already treated with medical negative responses which means more objection was found on con- tools and explained in medical terms (Table 2). sidering the situation a medical problem. Furthermore, in the afore- Table 2: Use of above mentioned questions with guiding examples mentioned cases, the negative risks increase due to overdiagnosis, false prescriptions, negative long-lasting side effects of drugs, iatrogenic dis- Medicalized X Question no. eases, the excessive burden on economic status, stigmatization, restric- 1 2 3 4 tions, and inadequate solution finding a response. Myocardial infarction √ √ √ √ The purpose of this study, however, is not to completely ban the use Cancer √ √ √ √ of medicines or prohibit medical treatment. The main aim here is to Poliomyelitis √ √ √ √ highlight the adverse impacts of over-medicalization, to distinguish √ - ? √ the boundary line, and to focus more on eradicating the root cause of Alcoholism √ - - √ disease development, rather than treating the disease. As prevention is always better than cure. Anorexia √ - - √ Male-Pattern Hair Loss (MPHL) √ - √ - REFERENCES Prolonged Grief Disorder (PGD) √ - - - 1. Broom DH, Woodward RV. Medicalisation reconsidered: toward Asymmetric labia as an indication for ? - - - a collaborative approach to care. Sociol Health Illn. 1996; 18(3): labiaplasty 357-378. Mild Attention Deficit Hyperactivity ? - - - 2. Bull M. Secularization and medicalization. Br J Sociol. 1990; Disorder (ADHD) 41(2): 245-261. Mild Restless Legs Syndrome (RLS) ? - - - 3. Busfield J. The concept of medicalisation reassessed. Sociol Health Hypoactive Sexual Desire Disorder ? - - - Illn. 2017; 39(5): 759-774. (HSDD) 4. Parens E. On good and bad forms of medicalization. Bioethics. Homosexuality - - - - 2013; 27(1): 28-35. In the table given above, some disorders are given. Out of these, some required immediate medical attention, which if not provided can cause 5. Doust J, Jean Walker M, Rogers WA. Current dilemmas in defin- death and some do not need any medicalization. However, besides ing the boundaries of disease. 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Microbiome. 2015; 3(1): 1-4. develop a comparative chart of Disability-Adjusted Life Year (DALY) 9. Turner BS. Medical power and social knowledge. Sage. 1995. and disease’s global burden. One DALY is equivalent to one whole year lost without healthy life, and the disease burden can be defined as the 10. Conrad P. The medicalization of society: On the transformation of comparative evaluation of the gap between an ideal health situation human conditions into treatable disorders. JHU. 2007. free from illnesses where people normally grow old and then die, and the present health status. The sum of the Years of Life Lost (YLL) is the calculation for DALYs, which is owing to premature sudden death, and YLD is the years lost due to disability due to diseases or injury, as per the definitions of WHO, WTO, and WIPO (Conrad P, 2007).

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