Opting out of forced longevity: the De-medicalization of American Society?

In her book, Ordinary Medicine, Sharon Kaufman contends that the increasingly complicated means by which modern medicine achieves its goals to alleviate symptoms, prevent diseases, and increase life expectance have fundamentally transformed how end-of-life experiences are anticipated and handled. Advanced medical technologies not only made more diseases into chronic conditions, which, in turn, prompts the demand to create more high-tech treatments, but they also start to redefine the ways patients and their family members envision healthcare options. The denial of medical treatment in preference for improved life quality is perceived more and more as a problematic, if not an unethical choice.

On the other hand, The New York Times published an article this summer stating that the rates of major age-related chronic illnesses, such as cancer, dementia, and heart disease are, in fact, on the decline, especially in developed nations such as the U.S. and European countries.

http://www.nytimes.com/2016/07/10/upshot/a-medical-mystery-of-the-best-kind-major-diseases-are-in-decline.html?_r=0

For instance, although still a leading killer, deaths caused by heart diseases (HD) such as stroke, or sudden cardiac arrest, have decreased for more than 30 percent from 2000 to 2012. Whereas physicians and medical scientists speculated that factors such as better prevention programs, healthier lifestyles, and higher quality medical treatment might contribute to the declining rates of major chronic diseases, these reasons, even all taken together, could not fully account for what is currently happening. Interestingly, this New York Times article also points out that, even though HD-related mortality rates have been on the decline for nearly more than half a century, lately, medical researchers have noticed that the rate of this decline appears to be decelerating.

How do we reconcile this apparent disparity between Kaufman’s ethnographic observations, through which she claims that the development and expansion of biotechnology has rendered more old-age related diseases chronic, and the New York Times column that depicts a conflicting social reality? One could argue that the medical report cited by the New York Times, which was originally published in a medical journal JAMA Cardiology, examines only the mortality rate due to heart diseases, while paying scant attention to the living conditions of those who choose to prolong or sustain their lives by accepting intrusive medical interventions, such as the implantation of cardiac defibrillator.

http://cardiology.jamanetwork.com/article.aspx?articleid=2530559

Even so, Kaufman’s thesis on the medicalization of old age still seems somewhat inadequate in elucidating, for example, why there has been a slow down in the decline of HD mortality rate since 2010.

As we have already touched on during our last class discussion, maybe an incipient sociological/anthropological phenomenon is taking place in American society today, where informed patients and their family members have become exceedingly disenchanted with biomedical procedures and pharmaceutical products. If this is the case, instead of studying the medicalization of American society, perhaps we should begin to study the de-medicalization of American society? Further, is the distinction between medicalization and de-medicalization a new manifestation of global inequalities, where individuals from less developed countries have just begun to fetishize biotechnologies, compared to the privileged, who have already decided to opt out of forced longevity for the pleasure of living.

*For an example, see the story why Lenard Cohen decided to pick up smoking on his 80th birthday

http://www.nytimes.com/2014/09/21/opinion/sunday/too-young-to-die-too-old-to-worry.html

 

 

 

 

5 thoughts on “Opting out of forced longevity: the De-medicalization of American Society?”

  1. Thanks for bringing up these questions Yuezhu! I don’t think the fact that rates of some chronic illnesses are declining negates the argument that biotechnology has made more diseases into chronic conditions. The way I read it, Kaufman isn’t arguing that biotechnology has created more chronic conditions in the way that we could statistically measure, but that technology has transformed preexisting diseases into chronic conditions. Years ago, when it was not a chronic, manageable condition, heart disease was still called heart disease. Heart disease has always been heart disease whether it has been a chronic, technologically-mediated condition or not. So, the rates of disease do not matter so much as how they are categorized

  2. Hello Yuezhu,

    Thank you for the articles, I found them very interested and wanted to touch upon a few points.

    I am interested in understanding what has been going on since 2011 that has resulted in the deceleration of cardiovascular disease, heart disease, and stroke mortality rates. According to later discussion in this article, the trends were significant between 2000 and 2011, nevertheless, this trend continues to endure. Some questions that I have – how is the category of mortality statistically defined, are there problems of reporting that would create some inconsistencies across the data?

    Particular trends like the decline of stomach cancer suggest that there are significant changes, either brought on by a combination of healthier lifestyle habits or public health initiatives that have influenced the deceleration of these diseases. The authors argue that heavier bodies have healthier outcomes, they are less likely to be affected by osteoporosis. This had me think about the food that we eat now – how has it changed to create these outcomes. Similarly, I found myself echoing Dr. Cummings ‘questions. “How has the aging process of our cells changed”? Our perception is that we are living longer, and aging slower. Without a doubt, this is going to have many repercussions for the infrastructure of societies that are not equipped to handle an expanding elderly population. It remains peculiar to me that social behaviors (as expressed by Leonard Cohen) will be adopted to degenerate because it seems counterintuitive to this fascination people have with the preservation of life. This had me thinking about the following questions: are people living too long that they have become disenchanted with life or had death become some sort of therapeutic release to escape from the hardships people are facing because of this forced longevity?

    Will this become a class issue? Will marginalized people who typically experience more acutely these pressures over their life course be inclined to develop these bad habits in order to escape classism, racism, and other -isms that will plague them for a really long time as they continue living?

  3. Thanks for your post Sun! When discussing the medicalization of American society I think it is interesting to also consider the demedicalization processes. One I particularly think about is the anti-vaccination movement. The idea that vaccinations have become harmful and the requirements of the government that we inject our bodies with chemicals have been taken up in a notable movement in western societies, in an interestingly different way than say sub-Saharan Africa, where people who fear vaccines in line with government conspiracies are considered to be propagating global health crises. I think this speaks to global inequalities in health care decision-making, where in the U.S. we can individualize decisions to not inject our children as personal choice against a biomedical model. Alternatively, in places like Nigeria, boycotts of vaccination campaigns are explicated not as a rejection of biomedicine, but as a reliance on tradition or ignorance. This rejection of mass vaccine campaigns in Nigeria is of course implicated in broader social issues, and exists simultaneously with a use of other biomedical technologies for health. I think a further study of the American rejection of biomedicine along these lines would prove a highly informative and useful topic for understanding its relationship with global inequalities and social movements.

    http://www.bbc.com/news/health-33774181

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1831725/

  4. Thanks for this post. It is always difficult to reconcile quantitative data with ethnographic accounts, since they are trying to get at different things. At the same time though, your provocation regarding de-medicalization is I think getting at something really important. There are a whole variety of areas in which there has been considerable pushback against the technologization of both birth and death, some of which we touched on in class yesterday. And yet there is a tension that Kaufman points to in her work, whereby people insist that they don’t want technological intervention – that they want to demedicalize their process of dying – and yet, at the moment where a decision needs to be made, they very often insist upon using that technology. The anti-vaccination movement and natural childbirth movements are notable exceptions, and I think it’s worth thinking about why demedicalization has been so much more successful in the realm of birth and children, then in the realm of old age and death.

  5. Hi! I’m sorry that this post is late — I didn’t see there was a second post from last week until I went to post my own blog today! Anyways, I felt that you raised a very interesting point about de-medicalization, and I wanted to add my two cents.

    As Whitney touched on, de-medicalization has really taken on an almost aggressively anti-biomedical approach. In addition to the anti-vaccine movement, there are some ideologies that are becoming more prominent, like food as medicine, as well as a resurgence of more traditional healing practices, like Chinese Medicine and Ayurveda. From my own research, I have heard many physicians say that they are treating patients now who are very much a mixed bag — they are going to their family medicine doctor for a high blood pressure medication, and they are also taking a variety of herbal supplements and seeing an acupuncturist to treat the underlying cause.

    Along the same lines that you were suggesting, this is very much a de-medicalization, and a departure from the previous inherent faith in biomedicine. I think your questions about the simultaneous medicalization in other parts of the world, with the United States’ de-medicalization, prompts questions about global health, technologies, and the equitable integration of bio-resources.

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