DOCSLIB.ORG

Depression and Antidepressants in Australia and Beyond - a Critical Public Health Analysis Melissa Raven University of Wollongong

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Depression and Antidepressants in Australia and Beyond - a Critical Public Health Analysis Melissa Raven University of Wollongong University of Wollongong Research Online University of Wollongong Thesis Collection University of Wollongong Thesis Collections 2012 Depression and antidepressants in Australia and beyond - a critical public health analysis Melissa Raven University of Wollongong Recommended Citation Raven, Melissa, Depression and antidepressants in Australia and beyond - a critical public health analysis, Doctor of Philosophy thesis, Faculty of Arts, University of Wollongong, 2012. http://ro.uow.edu.au/theses/3686 Research Online is the open access institutional repository for the University of Wollongong. For further information contact the UOW Library: [email protected] Depression and antidepressants in Australia and beyond A critical public health analysis A thesis submitted in fulfilment of the requirements for the award of the degree Doctor of Philosophy from UNIVERSITY OF WOLLONGONG by Melissa Raven BA(Hons), MPsych(Clin), MMedSci(ClinEpid) Faculty of Arts 2012 ii Certification I, Melissa Raven, declare that this thesis, submitted in fulfilment of the requirements for the award of Doctor of Philosophy, in the Faculty of Arts, University of Wollongong, is wholly my own work unless otherwise referenced or acknowledged. The document has not been submitted for qualifications at any other academic institution. Melissa Raven 5 July 2012 iii iv Concise table of contents List of acronyms .................................................................................... xiii Abstract ................................................................................................... xv Publications in support of thesis ........................................................... xvii Acknowledgments ................................................................................. xix 1. Introduction ......................................................................................… 1 2. Background: Depression and antidepressants ................................... 39 3. Players in the depression/antidepressant arena .................................. 73 4. Current debates about depression .................................................... 109 5. Current debates about suicide .......................................................... 139 6. Current debates about antidepressants ............................................. 159 7. Pharmaceutical industry practices and issues .................................. 245 8. Depression awareness campaigns: Selling depression and antidepressants ................................................................................ 339 9. The Mental Health Foundation of Australia's National Depression Awareness Campaign: Selling depression and antidepressants ..... 379 10. Conclusion ..................................................................................... 425 Appendices ........................................................................................... 435 References ............................................................................................ 442 v Detailed table of chapter contents 1. INTRODUCTION 1.1 INTRODUCTION ............................................................................................. 1 1.2 DISCIPLINES AND PERSPECTIVES ........................................................… 4 1.3 DEPRESSION ...............................................................................................… 9 1.4 ANTIDEPRESSANTS .................................................................................... 11 1.5 SIGNIFICANCE OF THE ISSUE .................................................................. 13 1.5.1 Large numbers of people receiving depression diagnoses/treatment ... 14 1.5.2 Problems with diagnosis of depression ................................................. 15 1.5.3 Problematic epidemiology of depression .............................................. 16 1.5.4 Inappropriate generalisation of evidence about depression .................. 16 1.5.5 Under-researched outcomes for untreated depression .......................... 17 1.5.6 Questionable theories of depression and antidepressant action ............ 17 1.5.7 Medicalisation of personal and social problems ................................... 18 1.5.8 Under-researched social causes of depression ...................................... 18 1.5.9 Overstated effectiveness of antidepressants .......................................... 18 1.5.10 Overstated safety of antidepressants ................................................... 20 1.5.11 Public beliefs that antidepressants are problematic ............................ 21 1.5.12 Antidepressant prescription outside diagnostic criteria ...................... 21 1.5.13 Substantial and increasing costs of antidepressants ............................ 22 1.5.14 Aggressive enlargement of the market for antidepressants ................ 22 1.5.15 Under-research and under-funding of alternative treatments ............. 23 1.6 METHODOLOGY .......................................................................................... 24 1.6.1 Critical analysis of claims ..................................................................... 24 1.6.2 Analysis of strategies of advocates ....................................................... 31 1.7 CONCLUSION ............................................................................................... 37 2. BACKGROUND: DEPRESSION AND ANTIDEPRESSANTS 2.1 INTRODUCTION ........................................................................................... 39 2.2 DEPRESSION ................................................................................................. 40 2.2.1 History of depression ............................................................................ 40 2.2.2 Experiences of depression ..................................................................... 42 2.2.3 Happiness .............................................................................................. 45 2.2.4 Depression diagnosis ............................................................................ 45 2.2.5 Epidemiology of depression ................................................................. 48 2.2.6 Causal factors ........................................................................................ 50 2.2.7 Treatment .............................................................................................. 51 2.3 ANTIDEPRESSANTS .................................................................................... 52 2.3.1 Pharmacology of antidepressants .......................................................... 55 2.3.2 Antidepressant epidemiology ................................................................ 59 2.3.3 Reasons for antidepressant prescribing ................................................. 63 vi 2.3.4 Likelihood of antidepressant prescription after depression diagnosis .. 65 2.3.5 Duration of antidepressant use .............................................................. 66 2.3.6 Who uses antidepressants? .................................................................... 66 2.3.7 Antidepressant risks .............................................................................. 68 2.3.8 Effectiveness of antidepressants ........................................................... 70 2.3.9 Economics of antidepressants ............................................................... 71 2.4 CONCLUSION ............................................................................................... 71 3. PLAYERS IN THE DEPRESSION/ANTIDEPRESSANT ARENA 3.1 INTRODUCTION ........................................................................................... 73 3.2 CONSUMERS ................................................................................................ 75 3.3 HEALTH PROFESSIONALS AND PROFESSIONAL ORGANISATIONS ..........................................................................................................................77 3,3.1 Doctors .................................................................................................. 77 3.3.2 Medical professional organisations ....................................................... 81 3.3.3 Psychologists and other therapists/counsellors ..................................... 83 3.3.4 Pharmacists ........................................................................................... 83 3.3.5 Nurses ................................................................................................... 84 3.3.6 Researchers and academics ................................................................... 84 3.4 THE PHARMACEUTICAL INDUSTRY ...................................................... 85 3.5 GOVERNMENTS ........................................................................................... 86 3.5.1 US governments .................................................................................... 87 3.5.2 Australian governments ........................................................................ 89 3.6 WORLD HEALTH ORGANIZATION .......................................................... 97 3.7. MEDICAL JOURNALS ................................................................................ 98 3.8. LAWYERS ..................................................................................................... 99 3.9 CONSUMER GROUPS AND COMMUNITY ORGANISATIONS ........... 100 3.10 OTHER ORGANISATIONS ...................................................................... 101 3.10.3 Cochrane Centre
Load more

Recommended publications
  • Overdiagnosis and Overtreatment Over Time
    University of Massachusetts Medical School eScholarship@UMMS Family Medicine and Community Health Publications and Presentations Family Medicine and Community Health 2015-6 Overdiagnosis and overtreatment over time Stephen A. Martin University of Massachusetts Medical School Et al. Let us know how access to this document benefits ou.y Follow this and additional works at: https://escholarship.umassmed.edu/fmch_articles Part of the Community Health and Preventive Medicine Commons, Diagnosis Commons, Family Medicine Commons, Preventive Medicine Commons, and the Primary Care Commons Repository Citation Martin SA, Podolsky SH, Greene JA. (2015). Overdiagnosis and overtreatment over time. Family Medicine and Community Health Publications and Presentations. https://doi.org/10.1515/dx-2014-0072. Retrieved from https://escholarship.umassmed.edu/fmch_articles/318 Creative Commons License This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License. This material is brought to you by eScholarship@UMMS. It has been accepted for inclusion in Family Medicine and Community Health Publications and Presentations by an authorized administrator of eScholarship@UMMS. For more information, please contact [email protected]. Diagnosis 2015; 2(2): 105–109 Opinion Paper Open Access Stephen A. Martin*, Scott H. Podolsky and Jeremy A. Greene Overdiagnosis and overtreatment over time Abstract: Overdiagnosis and overtreatment are often Introduction thought of as relatively recent phenomena, influenced by a contemporary combination of technology, speciali- In recent years, an increasing number of clinicians, jour- zation, payment models, marketing, and supply-related nalists, health service researchers, and policy-makers demand. Yet a quick glance at the historical record reveals have drawn attention to the problems of overdiagnosis that physicians and medical manufacturers have been and the overtreatment that it so often engenders [1, 2].
    [Show full text]
  • BOOKTIVISM: the Power of Words
    BOOKTIVISM: The Power of Words Book•ti•vi•sm(noun). 1. The mobilization of groups of concerned citizens produced by reading books offering powerful analyses of social or political issues. 2. A call to action based on the sharing of knowledge through books. 3. Books + activism = “booktivism.” 4. A term first used at the SellingSickness, 2013: People Before Profits conference in Washington, DC, see www.sellingsickness.com. Read. Discuss. Be thoughtful. Be committed. Here are some more suggestions to get you started: 1) Set up a reading group on disease-mongering among interested friends and colleagues. If you do The books included in BOOKTIVISM celebrate recent contributions to the broad topic of disease- not already have a group of interested readers, post a notice in your workplace, library, community mongering, especially as they examine the growing prevalence and consequences of overtreatment, center, apartment building, etc. Once you have a group, decide where to meet. Book clubs can overscreening, overmarketing, and overdiagnosis (see Lynn Payer’s 1992 classic, Disease-Mongers: How meet anywhere – at homes, in dorms, in pubs, in coffeehouses, at libraries, even online! Decide on Doctors, Drug Companies, and Insurers Are Making You Feel Sick, for an introduction to timing and format. Will you meet monthly/bimonthly? You’ll need time to prepare for the sessions, disease-mongering). but not so much time that you lose touch. Circulate the reading guide. It is usually best if one person leads each discussion, to have some questions at the ready and get things rolling. Although the challenge to disease-mongering is not unprecedented (the women’s health movement of the 1970s was another key historical moment), these books represent an impressive groundswell OR, maybe you’d like to of amazing, powerful, brilliant, and often deeply unsettling investigations by physicians, health scientists, 2) Set up a lecture/discussion group.
    [Show full text]
  • Greenshield.Ca MORE HEALTH CARE DOESN’T NECESSARILY MEAN BETTER HEALTH …But It Can Mean More Harm
    AUGUST/SEPTEMBER 2019 Don’t miss episode 19 of our podcast as we discuss better approaches to health care with Dr. Danielle Martin, family physician, author, chief medical executive at Women’s College Hospital, and YouTube star. CLICK HERE TO LISTEN WHAT’S INSIDE MORE HEALTH CARE DOESN’T NECESSARILY MEAN BETTER HEALTH Page 2 WHAT’S UP... Drug pricing in the news Message of health care survey: evolve with the times Page 12 greenshield.ca MORE HEALTH CARE DOESN’T NECESSARILY MEAN BETTER HEALTH …But it can mean more harm Turns out that 60 really is the new 40—and even 80 is the new 60—as people worldwide are living longer. In fact, we can expect to live more than twice as long as our ancestors.1 So why then, if we are healthier and more active than ever, are more people becoming patients? It’s because health care is no longer considered just for the sick, it has expanded into also focusing on the well. At first blush, this may sound like a good thing; it may sound like prevention. But if your plan members are healthy—in that they don’t have health problems that need solving— health services may actually create problems. Problems like overdiagnosis and in turn, overtreatment—including all the anxiety, energy, time commitment, potential costs, and even physical harm that can come along with it. The controversy surrounding the medicalization of healthy people raises awareness of the difference between what is truly prevention versus what is just early diagnosis that may—or may not—be a good thing.
    [Show full text]
  • Adopting the UNESCO Ethics Model to Critique Disease Mongering Barbara Postol
    Duquesne University Duquesne Scholarship Collection Electronic Theses and Dissertations Spring 1-1-2016 Adopting the UNESCO Ethics Model to Critique Disease Mongering Barbara Postol Follow this and additional works at: https://dsc.duq.edu/etd Recommended Citation Postol, B. (2016). Adopting the UNESCO Ethics Model to Critique Disease Mongering (Doctoral dissertation, Duquesne University). Retrieved from https://dsc.duq.edu/etd/1496 This One-year Embargo is brought to you for free and open access by Duquesne Scholarship Collection. It has been accepted for inclusion in Electronic Theses and Dissertations by an authorized administrator of Duquesne Scholarship Collection. ADOPTING THE UNESCO ETHICS MODEL TO CRITIQUE DISEASE MONGERING A Dissertation Submitted to the McAnulty College and Graduate School of Liberal Arts Duquesne University In partial fulfillment of the requirements for the degree of Doctor of Philosophy By Barbara A. Postol May 2016 Copyright by Barbara A. Postol 2016 ADOPTING THE UNESCO ETHICS MODEL TO CRITIQUE DISEASE MONGERING By Barbara A. Postol Approved April 5, 2016 ________________________________ ________________________________ Henk ten Have, MD, PhD Gerard Magill, PhD Director, Center for Healthcare Ethics Vernon F. Gallagher Chair for Professor of Healthcare Ethics Integration of Science, Theology, (Dissertation/Project Chair) Philosophy and Law Professor of Healthcare Ethics (Committee Member) ________________________________ ________________________________ Joris Gielen, PhD Henk ten Have, MD, PhD Assistant Professor of Healthcare Ethics Professor of Healthcare Ethics (Committee Member) (Center Director) ________________________________ James Swindal, PhD Dean, McAnulty College and Graduate School of Liberal Arts Professor and Dean of McAnulty College (Dean) iii ABSTRACT ADOPTING THE UNESCO ETHICS MODEL TO CRITIQUE DISEASE MONGERING By Barbara A.
    [Show full text]
  • Older Adults' Experiences of Polypharmacy And
    OLDER ADULTS’ EXPERIENCES OF POLYPHARMACY AND PERCEPTIONS OF DEPRESCRIBING NETWORKS, EXPERTS, AND PARADOXES: OLDER ADULTS’ EXPERIENCES OF POLYPHARMACY AND PERCEPTIONS OF DEPRESCRIBING By: ALISON ROSS, BA(H), MA A Thesis Submitted to the School of Graduate Studies in Partial Fulfillment of the Requirements for the Degree Doctor of Philosophy McMaster University © Copyright by Alison Ross, September 2019 McMaster University DOCTOR OF PHILOSOPHY (2019) Hamilton, Ontario (Health Studies) TITLE: NetWorks, Experts, and Paradoxes: Older Adults’ Experiences of Polypharmacy and Perceptions of Deprescribing AUTHOR: Alison Ross, BA(H) (Queen’s University), MA (McMaster University) SUPERVISOR: Dr. James Gillett NUMBER OF PAGES: x, 166 ii Abstract As medical researchers test the feasibility of deprescribing programs to reduce medication burden associated with polypharmacy, limited scholarly consideration has been given to the perspectives of the older adults largely targeted by these programs. This dissertation makes central the voices of older adults experiencing polypharmacy and/or deprescribing. Presented as a collection of three articles, this work explores the perspectives of older adults on their use of medication in the context of both polypharmacy and deprescribing. Data were collected using in- depth semi-structured qualitative intervieWs With older adults concurrently using 5+ prescription medications. The first article draWs on Habermas’ writing on the contribution of communicative action in negotiating trust within complex social relationships. This analysis highlights the social nature of medication work and challenges to communicative action within personal and professional health systems. The second article applies embodiment theory to understand the Way older adults’ construct unique forms of expertise regarding their health, resulting from a lifetime of experiences living as and in their bodies.
    [Show full text]
  • A Pill for the Ill? Depression, Medicalization and Public Health Vilhelmsson, Andreas
    A Pill for the Ill? Depression, Medicalization and Public Health Vilhelmsson, Andreas 2014 Link to publication Citation for published version (APA): Vilhelmsson, A. (2014). A Pill for the Ill? Depression, Medicalization and Public Health. Department of Clinical Sciences, Lund University. http://www.lu.se/lup/publication/4ac22a39-b865-497d-9b68-5d48190682bf Total number of authors: 1 General rights Unless other specific re-use rights are stated the following general rights apply: Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. • Users may download and print one copy of any publication from the public portal for the purpose of private study or research. • You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal Read more about Creative commons licenses: https://creativecommons.org/licenses/ Take down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. LUND UNIVERSITY PO Box 117 221 00 Lund +46 46-222 00 00 A Pill for the Ill? Depression, Medicalization and Public Health Andreas Vilhelmsson DOCTORAL DISSERTATION by due permission of the Faculty of Medicine, Lund
    [Show full text]
  • Disease Mongering (Pseudo-Disease Promotion)
    DIRECTORATE GENERAL FOR INTERNAL POLICIES POLICY DEPARTMENT A: ECONOMIC AND SCIENTIFIC POLICY Disease Mongering (Pseudo-Disease Promotion) NOTE Abstract Disease mongering is the promotion of pseudo-diseases by the pharmaceutical industry aiming at economic benefit. Medical equipment manufacturers, insurance companies, doctors or patient groups may also use it for monetary gain or influence. It has increased in parallel with society's 'medicalisation' and the growth of the pharmaceutical complex. Due to massive investments in marketing and lobbying, ample use of internet and media, and the emergence of new markets, it is becoming a matter of concern, and policy makers should be aware of its perils and consequences. IP/A/ENVI/NT/2012-20 November 2012 PE 492.462 EN This document was requested by the European Parliament's Committee on Environment, Public Health and Food Safety and produced internally in the Policy Department for Economic and Scientific Policy. AUTHORS Dr. Marcelo SOSA-IUDICISSA Dr. Purificación TEJEDOR DEL REAL RESPONSIBLE ADMINISTRATOR Dr. Marcelo SOSA-IUDICISSA Policy Department A: Economic and Scientific Policy European Parliament B-1047 Brussels E-mail: [email protected] LINGUISTIC VERSION Original: EN ABOUT THE EDITOR To contact the Policy Department or to subscribe to its newsletter please write to: [email protected] Manuscript completed in November 2012. Brussels, © European Union, 2012. This document is available on the Internet at: http://www.europarl.europa.eu/studies DISCLAIMER The opinions expressed in this document are the sole responsibility of the authors and do not necessarily represent the official position of the European Parliament.
    [Show full text]
  • Big Pharma and Health Care: Unsolvable Conflict of Interests Between Private Enterprise and Public Health
    Isr J Psychiatry Relat Sci Vol 45 No. 2 (2008) 83–94 Big Pharma and Health Care: Unsolvable Conflict of Interests between Private Enterprise and Public Health Mayer Brezis, MD, MPH Center for Clinical Quality & Safety, Hadassah Medical Center & School of Public Health, The Hebrew University of Jerusalem, Israel . Abstract: A landmark paper on Game Theory showed that individual maximization of profit necessarily endangers the public good, and since the problem has no technical solution, “it requires a fundamental extension in morality” (1). We propose here that public health, as a public good, now emerges as a grave example of this problem. Recent events and reports increasingly suggest misalignment between the interests of the pharmaceutical industry and those of public health. Johnson & Johnson illegally and effectively promoted Propulsid off-label for children despite internal company documents raising safety concerns. Death in drug trial has been described as a “trade secret.” On Vioxx, Topol wrote: “Sadly, it is clear that Merck’s commercial interest exceeded its concern about the drug’s toxicity” (2). More and more concerns are raised by scholars and major journal editors about the type and the quality of published evidence, often biased towards efficacy of new products. The industry, funding over 80% of trials, sets up a research agenda guided more by marketing than by clinical considerations. Smart statistical and epidemiological tactics help obtain the de- sired results. Budget for marketing is by far greater than for research. Massive advertising to physicians and to the pub- lic gets increasingly sophisticated: ghost writing, professional guidelines, targeting of consumer groups and manipulating media for disease mongering.
    [Show full text]
  • GP's View on Medical Overuse. a Questionnaire Study
    RESEARCH ARTICLE Is it really always only the others who are to blame? GP's view on medical overuse. A questionnaire study Maximilian Pausch1, Angela Schedlbauer2, Maren Weiss3, Thomas Kuehlein2, 2 Susann HueberID * 1 Faculty of Medicine, Friedrich-Alexander-University Erlangen-NuÈrnberg (FAU), Erlangen, Germany, 2 Institute of General Practice, UniversitaÈtsklinikum Erlangen, Erlangen, Germany, 3 Institute of Psychology, Friedrich-Alexander-University Erlangen-NuÈrnberg (FAU), Erlangen, Germany a1111111111 * [email protected] a1111111111 a1111111111 a1111111111 a1111111111 Abstract Background OPEN ACCESS Medical overuse is a common problem in health care. Preventing unnecessary medicine is Citation: Pausch M, Schedlbauer A, Weiss M, one of the main tasks of General Practice, so called quaternary prevention. We aimed to Kuehlein T, Hueber S (2020) Is it really always only capture the current opinion of German General Practitioners (GPs) to medical overuse. the others who are to blame? GP's view on medical overuse. A questionnaire study. PLoS ONE 15(1): e0227457. https://doi.org/10.1371/journal. Methods pone.0227457 A quantitative online study was conducted. The questionnaire was developed based on a Editor: Monika R. Asnani, University of the West qualitative study and literature search. GPs were asked to estimate prevalence of medical Indies Faculty of Medical Sciences Mona, JAMAICA overuse as well as to evaluate drivers and solutions of medical overuse. GPs in Bavaria Received: August 15, 2019 were recruited via email (750 addresses). A descriptive data analysis was performed. Addi- Accepted: December 18, 2019 tionally the association between doctors' attitudes and (1) demographic variables and (2) Published: January 15, 2020 interest in campaigns against medical overuse was assessed.
    [Show full text]
  • Introduction to Addictive Behaviors, Fourth Edition
    ebook THE GUILFORD PRESS INTRODUCTION TO ADDICTIVE BEHAVIORS Introduction to Addictive Behaviors FOURTH EDITION Dennis L. Thombs Cynthia J. Osborn THE GUILFORD PRESS New York London © 2013 The Guilford Press A Division of Guilford Publications, Inc. 72 Spring Street, New York, NY 10012 www.guilford.com All rights reserved No part of this book may be reproduced, translated, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the publisher. Printed in the United States of America This book is printed on acid-free paper. Last digit is print number: 9 8 7 6 5 4 3 2 1 The authors have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards of practice that are accepted at the time of publication. However, in view of the possibility of human error or changes in behavioral, mental health, or medical sciences, neither the authors, nor the editor and publisher, nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they are not responsible for any errors or omissions or the results obtained from the use of such information. Readers are encouraged to confirm the information contained in this book with other sources. Library of Congress Cataloging-in-Publication Data Thombs, Dennis L. Introduction to addictive behaviors / Dennis L. Thombs and Cynthia J. Osborn.
    [Show full text]
  • Illicit Psychoactive Medication Use: Experiences of Medicalization and Normalization
    City University of New York (CUNY) CUNY Academic Works All Dissertations, Theses, and Capstone Projects Dissertations, Theses, and Capstone Projects 9-2019 Illicit Psychoactive Medication Use: Experiences of Medicalization and Normalization Mark Pawson The Graduate Center, City University of New York How does access to this work benefit ou?y Let us know! More information about this work at: https://academicworks.cuny.edu/gc_etds/3320 Discover additional works at: https://academicworks.cuny.edu This work is made publicly available by the City University of New York (CUNY). Contact: [email protected] ILLICIT PSYCHOACTIVE MEDICATION USE: EXPERIENCES OF MEDICALIZATION AND NORMALIZATION By MARK PAWSON A dissertation submitted to the Graduate Faculty in Sociology in partial fulfillment of the requirements for the degree of Doctor of Philosophy, The City University of New York 2019 i © 2019 MARK PAWSON All Rights Reserved ii Illicit Psychoactive Medication Use: Experiences of Medicalization and Normalization by Mark Pawson This manuscript has been read and accepted for the Graduate Faculty in Sociology in satisfaction of the dissertation requirement for the degree of Doctor of Philosophy. Date Barbara Katz Rothman Chair of Examining Committee Date Lynn Chancer Executive Officer Supervisory Committee: Lynn Chancer Thomas DeGloma Brian Kelly THE CITY UNIVERSITY OF NEW YORK iii Abstract Illicit Psychoactive Medication Use: Experiences of Medicalization and Normalization By Mark Pawson Advisor: Barbara Katz Rothman This dissertation explores illicit psychoactive medication use among young adults. Overwhelmingly, the literature on this drug trend, particularly among this population, is grounded in a study of pathology. However, my research demonstrates that this obscures a significant portion of how youth practice and make meaning of their consumption of these controversial medications.
    [Show full text]
  • Position Statement: Too Much Medicine
    Position statement: Too Much Medicine July 2018 Position The RACGP supports optimal medicine,1 in which the benefits of tests and treatments are carefully weighed against their harms to prevent injury and wastage. The RACGP is committed to: • Advocating for clinical governance around disease definition and judicious use of clinical resources and therapeutic options • Supporting GPs to practice evidence-based medicine through education, training, and the dissemination of clinical guidelines • Recommending the need for regulatory controls to prevent commercial interests misusing disease definitions, promoting over-testing or over-treatment. Background More is not always better when it comes to medicine. Concern is rising within the medical community about the excessive and unnecessary use of tests, medicines, and procedures. There is potential for this problem – dubbed ‘too much medicine’ – to cause real harm to patients and to the healthcare system as a whole. ‘Too much medicine’ is a broad term, encompassing the concepts of over-diagnosis, over detection, over-treatment, over-utilisation, disease mongering, medicalisation, false positives, misdiagnosis, and diagnosis creep.2 As such, the problem has many facets and no simple solutions. A coordinated response on the part of health practitioners, industry and government is required. Problems caused by ‘too much medicine’ Harms to the individual Unnecessary tests and treatments can be painful and dangerous, carrying a risk of complication that can affect quality of life, or in extreme cases, trigger a life-threatening problem. Some issues can arise immediately, such as adverse drug reactions and unplanned hospitalisation. Others are more insidious, such as the increased cancer risk that occurs through exposure to radiation as a result of unnecessary medical imaging.
    [Show full text]