Medicalization, Markets and Consumers
Author(s): Peter Conrad and Valerie Leiter
Source: Journal of Health and Social Behavior, Vol. 45, Extra Issue: Health and Health Care
in the United States: Origins and Dynamics (2004), pp. 158-176
Published by: American Sociological Association
Stable URL: http://www.jstor.org/stable/3653830
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Medicalization, Markets and Consumers*
PETER CONRAD
Brandeis University
VALERIE LEITER
Simmons College
Journal of Health and Social Behavior 2004, Vol 45 (Extra Issue): 158-176
This paper examines the impact of changes in the medical marketplace on med-
icalization in U S. society. Using four cases (Viagra, Paxil, human growth hor-
mone and in vitro fertilization), we focus on two aspects of the changing med-
ical marketplace: the role of direct-to-consumer advertising of prescription
drugs and the emergence ofprivate medical markets. We demonstrate how con-
sumers and pharmaceutical corporations contribute to medicalization, with
physicians, insurance coverage, and changes in regulatory practices playing
facilitating roles. In some cases, insurers attempt to counteract medicalization
by restricting access. We distinguish mediated and private medical markets,
each characterized by differing relationships with corporations, insurers, con-
sumers, and physicians. In the changing medical environment, with medical
markets as intervening factors, corporations and insurers are becoming more
significant determinants in the medicalization process.
Over the past three decades there has been a
marked increase in the medicalization of soci-
ety (Zola 1972; Conrad and Schneider 1992;
Barsky and Boros 1995; Riska 2003).
Medicalization occurs when previously non-
medical problems are defined and treated as
medical problems, usually in terms of illnesses
or disorders. While medicalization can be bi-
directional, there is strong evidence for
increases in medicalization. This growth of
medical jurisdiction is "one of the most potent
transformations of the last half of the twentieth
century in the West" (Clarke et al. 2003:161).
In this same period, the institution of medicine
has undergone major changes in its social
orga ...
MYTH OF MANAGED CARE2The myth of Managed CareMario.docxgemaherd
MYTH OF MANAGED CARE 2
The myth of Managed Care
Marion Allen
Rasmussen College
Foundations of Managed Care
May 31, 2020
Part 1: Outline
The main myth that drew my attention is that managed care is that HMOs threaten the quality of care. HMOs equal (bad) for-profit medicine. This research shall report on the validity or invalidity of this myth. From my point of view, the myth is invalid as it will be supported by the points highlighted below:
1) The goal of HMOs is to ensure that there is enough health care is available to society at the most affordable means.
2) HMOs exist as insurance set up for the cultural aspects of the people. This is due to the presence of the domineering medicinal culture in this land.
The topics in this writing shall include:
1) Fact elaboration-this will describe the fact about the myth presented here. It is factual to say that 0.89 of members of HMOs in Massachusetts are non-profit mind oriented. Most of the members here are among the excellent members of the country (Luft, 1980).
2) The impact of the myth to the public. It takes the bold citizens to refute this myth, and probably, the teenagers are in the light of successfully rebutting it. Under this topic, I shall include two subtopics which include:
2a) The impact of the myth on the teenagers
2b) The effect of the myth on the seniors. Society is made to believe in the worse managed health care.
3) The impact of the myth on the objective of HMOs (Relman & Reinhardt,1986). The main aim of HMOs is to enhance excellent health care that many citizens can afford.
4) Impact of the myth on the economy.
The following are the sub-topics under this topic:
4a) Impact on the local economy.
4b) Impact on the global economy.
Part 2: Annotated Bibliography
Christianson, J. B., Sanchez, S. M., Wholey, D. R., & Shadle, M. (1991). The HMO industry:
Evolution in population demographics and market structures. Medical Care Review, 48(1), 3-46.
The authors, Christianson et al., reviewed the topic under the HMO industry and came up with a conclusion that HMOs were in existence in the 1980s and helped in improving the lives of the citizens in the United States. They wrote that the prolonged stay of the patients in the hospitals made people include political oppositions. The contribution of these authors is useful in this research as it helps in analyzing the impact of the myth on the various individuals in society, specifically the seniors who spread political stories. It helps in determining the validity of the myth.
Luft, H. S. (1980). Assessing the evidence on HMO performance. The Milbank Memorial Fund
Quarterly. Health and Society, 501-536.
Luft is an author who contributed to the literature concerning the profit issue related to the HMOs. It is evidenced that prepaid services have been in place for a long time in the USA, and thus this constitutes the culture of health providers. In writing, this author explains how traditional medici.
Running head UNIVERSAL DISEASE AND MEDICAL CONDITIONS1UNIVE.docxtoltonkendal
Running head: UNIVERSAL DISEASE AND MEDICAL CONDITIONS
1
UNIVERSAL DISEASE AND MEDICAL CONDITIONS
4
Universal Disease and Medical Conditions
Name
Institution
Course
Date
Introduction
In the recent past, concern and attention has been directed towards climate change, politics and the war on terrorism. The federal and state governments have shifted their focus and attention in trying to eradicate these national issues that have been affecting the world at large. The issue of climate change has brought about a lot of unwarranted effects on the climatic conditions experienced in the US and other countries (Brownson et al., 2018). Issues such as heat waves and floods arising from Hurricanes have been reported rapidly in the country. Thus, its justified for the authorities to concern themselves in trying to balance the climate from the effects brought about by human activities and practices.
This justification can also be extended to other emotive issues such as the war on terrorism and politics, which also affect the welfare of the people as well as the performance of their economy. Without a healthy population, the government will not be able to combat the war on terrorism successfully and neither will it be able to mitigate the environment against the ill effects of climate change. All in all, there is greater need for the federal and local governments to shift their focus on matters to do with public health and come up with scientific evidences necessary to reduce the already discovered medical conditions in the US (Brownson et al., 2018).
Thesis Statement
In this paper, I am going to highlight some study cases that have been conducted by researchers in different fields of medicine and show how the Federal and state governments have ignored the issue of public health. The paper will be discussing the medical conditions in the US that have been researched and documented, but the government is not giving them the attention it deserves. My point in the paper is that the US government has focused its attention and resources on national issues such as climate change and the war on terrorism and forgot to fund research on public health medical conditions that also area a national concern. I will be using scholarly articles to discuss the discovered medical conditions.
My argument is that public health is strategically centered in the achievement of developmental and sustainable goals by the national government. There are several studies that have been conducted to document some public health concerns that are affecting the human populations, animals and the environment. I sought to discuss some of the medical conditions through an overview of articles published to highlight the effects of these conditions on humans and the environment and what the authorities need to do in order to reduce or eliminate such public health concerns
The Health Effects of a World Without Darkness
This article was composed by Rebecca Boyle. According the artic ...
MYTH OF MANAGED CARE2The myth of Managed CareMario.docxgemaherd
MYTH OF MANAGED CARE 2
The myth of Managed Care
Marion Allen
Rasmussen College
Foundations of Managed Care
May 31, 2020
Part 1: Outline
The main myth that drew my attention is that managed care is that HMOs threaten the quality of care. HMOs equal (bad) for-profit medicine. This research shall report on the validity or invalidity of this myth. From my point of view, the myth is invalid as it will be supported by the points highlighted below:
1) The goal of HMOs is to ensure that there is enough health care is available to society at the most affordable means.
2) HMOs exist as insurance set up for the cultural aspects of the people. This is due to the presence of the domineering medicinal culture in this land.
The topics in this writing shall include:
1) Fact elaboration-this will describe the fact about the myth presented here. It is factual to say that 0.89 of members of HMOs in Massachusetts are non-profit mind oriented. Most of the members here are among the excellent members of the country (Luft, 1980).
2) The impact of the myth to the public. It takes the bold citizens to refute this myth, and probably, the teenagers are in the light of successfully rebutting it. Under this topic, I shall include two subtopics which include:
2a) The impact of the myth on the teenagers
2b) The effect of the myth on the seniors. Society is made to believe in the worse managed health care.
3) The impact of the myth on the objective of HMOs (Relman & Reinhardt,1986). The main aim of HMOs is to enhance excellent health care that many citizens can afford.
4) Impact of the myth on the economy.
The following are the sub-topics under this topic:
4a) Impact on the local economy.
4b) Impact on the global economy.
Part 2: Annotated Bibliography
Christianson, J. B., Sanchez, S. M., Wholey, D. R., & Shadle, M. (1991). The HMO industry:
Evolution in population demographics and market structures. Medical Care Review, 48(1), 3-46.
The authors, Christianson et al., reviewed the topic under the HMO industry and came up with a conclusion that HMOs were in existence in the 1980s and helped in improving the lives of the citizens in the United States. They wrote that the prolonged stay of the patients in the hospitals made people include political oppositions. The contribution of these authors is useful in this research as it helps in analyzing the impact of the myth on the various individuals in society, specifically the seniors who spread political stories. It helps in determining the validity of the myth.
Luft, H. S. (1980). Assessing the evidence on HMO performance. The Milbank Memorial Fund
Quarterly. Health and Society, 501-536.
Luft is an author who contributed to the literature concerning the profit issue related to the HMOs. It is evidenced that prepaid services have been in place for a long time in the USA, and thus this constitutes the culture of health providers. In writing, this author explains how traditional medici.
Running head UNIVERSAL DISEASE AND MEDICAL CONDITIONS1UNIVE.docxtoltonkendal
Running head: UNIVERSAL DISEASE AND MEDICAL CONDITIONS
1
UNIVERSAL DISEASE AND MEDICAL CONDITIONS
4
Universal Disease and Medical Conditions
Name
Institution
Course
Date
Introduction
In the recent past, concern and attention has been directed towards climate change, politics and the war on terrorism. The federal and state governments have shifted their focus and attention in trying to eradicate these national issues that have been affecting the world at large. The issue of climate change has brought about a lot of unwarranted effects on the climatic conditions experienced in the US and other countries (Brownson et al., 2018). Issues such as heat waves and floods arising from Hurricanes have been reported rapidly in the country. Thus, its justified for the authorities to concern themselves in trying to balance the climate from the effects brought about by human activities and practices.
This justification can also be extended to other emotive issues such as the war on terrorism and politics, which also affect the welfare of the people as well as the performance of their economy. Without a healthy population, the government will not be able to combat the war on terrorism successfully and neither will it be able to mitigate the environment against the ill effects of climate change. All in all, there is greater need for the federal and local governments to shift their focus on matters to do with public health and come up with scientific evidences necessary to reduce the already discovered medical conditions in the US (Brownson et al., 2018).
Thesis Statement
In this paper, I am going to highlight some study cases that have been conducted by researchers in different fields of medicine and show how the Federal and state governments have ignored the issue of public health. The paper will be discussing the medical conditions in the US that have been researched and documented, but the government is not giving them the attention it deserves. My point in the paper is that the US government has focused its attention and resources on national issues such as climate change and the war on terrorism and forgot to fund research on public health medical conditions that also area a national concern. I will be using scholarly articles to discuss the discovered medical conditions.
My argument is that public health is strategically centered in the achievement of developmental and sustainable goals by the national government. There are several studies that have been conducted to document some public health concerns that are affecting the human populations, animals and the environment. I sought to discuss some of the medical conditions through an overview of articles published to highlight the effects of these conditions on humans and the environment and what the authorities need to do in order to reduce or eliminate such public health concerns
The Health Effects of a World Without Darkness
This article was composed by Rebecca Boyle. According the artic ...
Five Questions” You will write responses to five (5.docxRAJU852744
“
Five Questions
”
:
You will write responses to five (5) questions provided by the instructor, each response
approximately 350-500 words long.
These questions will help you identify and evaluate:
theroleofthegoverningbodythatyouaretargetingwithyourproposal;
thetwoopposingpolicypositionsandtheirclaimsmakers(i.e.thosewhoaresupporting
each position and their investment in that stance); and,
your integration of conceptual material from weekly readings and class discussions
through midterm, including:
types of moral perspectives;
political alliances and relative political power of policy proposals;
impact of social factors/social conditions on issue and proposed solutions;
current and projected disparities in healthcare use and outcomes.
It is expected that you will be building on these writings as you proceed through the term.
list of the topic
Sources must include course readings as well as research from peer-reviewed academic
journals.
Final write-up of the paper is due at 7 p.m. on Wednesday of Finals Week and emailed to the instructor
.
Choose one of the following for your policy analysis paper.
Public Health and Rights to Privacy:
Should medical providers be bound by Public Health policies? Recently, a nurse who was exposed to the Ebola virus refused quarantine rules imposed by the legislature and health department of New Jersey. What were the arguments on both sides? What roles did science, cultural values and norms, and political posturing play in policymaking? What other factors were involved? What are implications for other issues in which private and public health sectors must collaborate?
Is unregulated economic growth good for our health?
Scientists argue that diminishing biodiversity in our ecosystems world-wide, much of it due to unrestricted development and other human activity, will affect our health in the future. Are there ways we can grow an economy and maintain diversity in the environment?
Health care digitization and other new technologies in your docto
r’s
office:
Physicians and their staffs are facing increased pressures to digitize medical records, and recruit and maintain a remote client base through telemedicine practices, i.e., incorporate new technologies into their practices. Are these new practices changing the doctor-patient relationship? What do both doctors and patients think about the changes? And, what roles are medical industries, healthcare corporations, and governments playing in effecting certain changes?
Making the rules regarding wom
en’s
contraceptive choices:
One of most controversial (and litigated) provision of the PPACA is the obligation of employer plans to cover contraceptive services under prevention. Businesses that oppose coverage have challenged the law and won concessions. What are the origins of this debate, both in the construction of the law and in the history of women
’s
contraceptive choices in America? What implications doe ...
1. From which country does your brand originate2. What makes th.docxambersalomon88660
1. From which country does your brand originate?
2. What makes this important? How does this contribute to the brand’s value?
3. What is the brand’s value proposition?
a. Brand Value Proposition is a business or marketing statement that summarizes why a consumer should buy a product or use a service. This statement should convince a potential consumer that one particular product or service will add more value or better solve a problem than other similar offerings.
4. What is your brand’s strategy?
5. In what specific category will your brand compete?
a. how defined
6. Who is the target audience?
a. Demographics, psychographics. Primary audience,
7. secondary audience(s).
a. Create a persona of your ideal target customer.
8. What is your brand’s name?
a. Naming rationale
9. How much will it cost?
a. Pricing strategy.
10. What is its brand positioning?
a. What are the reasons to believe its brand positioning?
11. With which other brands does your brand directly compete?
a. The competitive set.
12. What is your brand’s key competitive differentiation?
13. What makes it unique? Special features or attributes.
14. What emotional benefits are associated with your brand?
15. What is your brand’s personality?
a. What’s is your brand’s identifiable DNA? The characteristics that are core to your brand, without which your brand would not be itself.
16. What is your brand’s story? The narrative that describes the creation, inspiration, and sustaining value of your brand.
17. What are your brand’s style guidelines?
a. Color palate
b. Graphic style
c. Mood board
18. If your brand were to hire one person to represent the brand in advertising who would that be?
a. Rationale/fit with target customers
19. What experiential mode does your brand express?
a. Sense, feel, think, act, relate.
20. Does your brand relate to the “heart” or to the “head”? Why?
21. What plan do you have to sustain your brand long term?
22. What is your brand’s advertising campaign main idea?
23. What is the campaign tagline?
24. What are any special features of your brand?
a. E.g. social impact, key sponsorships, celebrity endorsements, high profile founder...
Stagnating Life Expectancies and Future
Prospects in an Age of Uncertainty∗
Justin T. Denney, Rice University
Robert McNown, University of Colorado at Boulder
Richard G. Rogers, University of Colorado at Boulder
Steven Doubilet, University of Colorado at Boulder
Objective. This article provides a timely assessment of U.S. life expectancy given
recent stalls in the growth of length of life, the continuing drop in international
rankings of life expectancy for the United States, and a period of growing social and
economic insecurity. Methods. Time-series analysis is used on over 70 years of data
from the Human Mortality Database to forecast future life expectancy to the year
2055. Results. The results show limited improvements in U.S. life expectancy at
birth, less than three years on average, for both men and women..
Medicalization of SocietyThe social construction of .docxbuffydtesurina
Medicalization of Society
The social construction of medical knowledge
*
Medicalization of SocietyDescribes a process whereby previously non-medical problems become defined and treated as medical problems, usually in terms of illness, disorders, and conditions. Some suggest that the growth of medical jurisdiction is one of the most significant transformations of the last half of the 20th century.
*
DefinitionThe term refers to the process by which certain events or characteristics of everyday life become medical issues, and thus come within the purview of doctors and other health professionals to engage with, study, and treat. The process of medicalization typically involves changes in social attitudes and terminology, and usually accompanies (or is driven by) the availability of treatments.
*
The prevalence of medicalization
Indicators:
percentage of gross national income increased from 4.5% in 1950 to 16% in 2006
# of physicians per population has doubled in that time frame, extending medical capacity
Jurisdiction of medicine has grown to encompass new problems not previously deemed ‘medical’
Examples: ADHD, eating disorders, CFS,PTSD, panic disorder, fetal alcohol syndrome, PMS, SIDS, obesity, alcoholism
*
Medicalization concerns itself with deviance and ‘normal life events’.Behaviors once defined as immoral, sinful, or criminal have been given medical meaning moving them from badness to sickness.Common life processes have been medicalized: including aging, anxiety and mood, menstruation, birth control, fertility, childbirth, menopause, and death.
*
Increasing MedicalizationNew categories of disease and drug therapies.Expanding/contracting medical categories.Elastic categories: Alzheimer Disease (AD) and the removal of age criteria led to AD encompassing senile dementia sufferers, sharply increasing the number of AD cases (now a top 5 cause of death in the US).Demedicalization whereby a problem is no longer defined as medical problem worthy of medical intervention (e.g. masturbation, homosexuality). Unsuccessful attempts include childbirth. Partial success includes disability.
*
Beyond Sociology…Numerous articles on medicalization in Medline search.British Medical Journal (2002) special issue on medicalization.PLoS Medicine (2006) devoted to ‘disease mongering’.President’s council on Bioethics dedicated session (2003).Seattle Times (2005) Suddenly Sick series.
*
Medicalization has gained attention beyond the social sciences.
Increased medicalizationNew epidemic of medical problems? Or,Is medicine better able to understand and identify and treat existing problems? Or, Are life’s problems increasingly defined as medical problems despite dubious evidence of their medical nature?
*
We’re not interested ncessarily in whether conditions are really medical or not, rather, we’re going to think of medical knowledge and the conditions which come to be understood as medical - as .
The Following is another student post to wish i have to reply APA st.docxadelaider1
The Following is another student post to wish i have to reply APA style. references and less than 10 % similarity. The due date is September 6.
Dianelis Pons
Community Nursing
Professor. Lisys Camacho
Florida National University
September 2020
The development of Public Hygiene stopped during feudalism and began to resurface with the Industrial Revolution (xviii) with Raus, Ramazini and, above all, Johan Peter Frank. The latter is considered the "Father of Public Health" and established the medical police. At that time is when the State, in order to conserve the productive forces, takes greater part in controlling water and cleaning, also adding some aspects of the way of life, such as control of food and occupational diseases (Bush, 2018).
The 19th century was one of great advances in medicine due to the appearance of medical equipment and the discoveries of bacteriology made by Pasteur in 1870 and Koch in 1882 (Bush, 2018). Together with the above and the appearance of social medicine, in the second half of this century, the development of public health is encouraged, expanding health measures by the States and beginning the development of health services, as happened in Russia in 1865 and in Germany in 1883 (Coovadia et al., 2009). In the first half of the 20th century, due to an awakening of interest in health, advances were made in this field and the ministries of public health emerged. In relation to the latter there is a historical fact of great importance when the first in the world was created in Cuba, as the Ministry of Health and Welfare, and later they emerged in Germany, England, France and others (Bush, 2018).
At this time authors such as Sigerist, Rosen, Lee and Jones stand out and one of the first definitions of public health emerges, at least one of the best known, made by the North American Winslow in 1920, which due to its importance is reproduced below:
"Public Health is the art of preventing diseases, prolonging life, promoting health and efficiency through the organized effort of the community for: environmental sanitation; Control of Communicable Diseases; education in personal Hygiene; organization of medical services and nursing for the early diagnosis and preventive treatment of diseases and the development of the social mechanism that ensures each one an adequate standard of living for the preservation of health; organizing these benefits so that each citizen is in conditions of their right natural to health and longevity” (Coovadia et al., 2009).
Prevention marks the beginning of a new stage after the first epidemiological revolution, which increases with the second epidemiological revolution. Thus, public health continues to expand its field and its functions and integrates preventive care for people and that of the natural environment, the social environment, and also aspects of curative care (Coovadia et al., 2009).
There is currently a broad consensus that public health has become an integrative .
The importance of public policy as a determinant of health is routinely acknowledged, but there remains a continuing absence of mainstream debate about the ways in which the politics, power and ideology, which underpin public policy influence people's health. This paper explores the possible reasons behind the absence of a politics of health and demonstrates how explicit acknowledgement of the political nature of health will lead to more effective health promotion strategy and policy, and to more realistic and evidence-based public health and health promotion practice
According to the NASW Code of Ethics section 6.04 (NASW, 2008), .docxaryan532920
According to the NASW Code of Ethics section 6.04 (NASW, 2008), social workers are ethically bound to work for policies that support the healthy development of individuals, guarantee equal access to services, and promote social and economic justice.
For this Discussion
, review this week’s resources, including
Working with Survivors of Sexual Abuse and Trauma: The Case of Rita
and “The Johnson Family”. Consider what change you might make to the policies that affect the client in the case you chose. Finally, think about how you might evaluate the success of the policy changes.
By Day 3
Post
an explanation of one change you might make to the policies that affect the client in the case. Be sure to reference the case you selected in your post. Finally, explain how you might evaluate the success of the policy changes.
Working With Survivors of Sexual Abuse and Trauma: The Case of Rita
Rita is a 22-year-old, heterosexual, Latina female working in the hospitality industry at a resort. She is the youngest of five children and lives at home with her parents. Rita has dated in the past but never developed a serious relationship. She is close to her immediate and extended family as well as to her female friends in the Latino community. Although her parents and three of her siblings were born in the Dominican Republic, Rita was born in the United States.
A year ago, Rita was sexually assaulted by an acquaintance of a male coworker. Rita and a female coworker met Juan and Bob after work at a local bar for a light meal and a few drinks. Because Rita had to get up early to work her shift the next day, Bob offered to drive her home. Instead of taking Rita directly home, however, he drove to a desolate spot nearby and assaulted her. Afterward, Bob threatened to harm her family if she did not remain silent and proceeded to drive her home. Although Rita did not tell her family what happened, she did call our agency hotline the next day to discuss her options. Because Rita’s assault occurred within the 5-day window for forensic evidence collection of this kind, Rita consented to activation of the county’s sexual assault response team (SART). Although she agreed to have an advocate and the sexual assault nurse examiner (SANE) meet her at the hospital, Rita tearfully stated that she did not want to file a police report at that time because she did not want to upset her family. The nurse examiner interviewed Rita, collected evidence, recorded any injuries, administered antibiotics for possible sexually transmitted infections, and gave Rita emergency contraception in case of pregnancy. The advocate stayed with Rita during the procedure, supporting her and validating her experience, and gave her a referral for individual crisis counseling at our agency.
My treatment goals for Rita included alleviation of rape trauma syndrome symptoms that included shame and self-blame, validation of self-worth and empowerment, and processing how it would feel to discl.
According to the text, crime has been part of the human condition si.docxaryan532920
According to the text, crime has been part of the human condition since people began to live in groups. Ancient documents indicate that conduct we now call murder, theft, or robbery was identified as criminal by civilizations that existed thousands of years ago. Criminal laws regulate human conduct and tell people what they can and cannot do and, in some instances, what they must do under certain circumstances. In this assignment, you will explore different types of criminal conduct and the goals of criminal law.
Write a four to six (4-6) page paper in which you:
Determine whether or not the Ex Post Facto Clause can be used as a defense to prohibit the increase in federal minimum/mandatory sentencing guidelines after a federal defendant has committed the crime. Provide a rationale to support your position.
Explain the distinction between criminal, tort, and moral wrongs. Next, support or criticize the premise that the standards set by moral laws are higher than those set by criminal law.
Identify and discuss the differences between solicitation of another to commit a crime and a conspiracy to commit a crime. Next, support or criticize the use of the unilateral approach to conspiracy convictions.
Identify the four (4) goals of criminal law, and discuss the manner in which these four goals effectuate the purpose of protecting the public and preventing the conviction of innocent persons.
Use at least three (3) quality academic resources in this assignment.
Note:
Wikipedia and similar types of websites do not qualify as academic resources.
Your assignment must follow these formatting requirements:
This course requires use of new
Strayer Writing Standards (SWS
). The format is different than other Strayer University courses. Please take a moment to review the SWS documentation for details.
Be typed, double spaced, using Times New Roman font (size 12), with one-inch margins on all sides; citations and references must follow SWS or school-specific format. Check with your professor for any additional instructions.
Include a cover page containing the title of the assignment, the student's name, the professor's name, the course title, and the date. The cover page and the reference page are not included in the required assignment page length.
The specific course learning outcomes associated with this assignment are:
Describe the nature and history of American criminal law.
Explain the role of individuals and federal, state, and local government agencies in crime fighting and prosecution of criminal offenses.
Analyze the essential legal elements of criminal conduct.
Use technology and information resources to research issues in criminal law.
Write clearly and concisely about criminal law using proper writing mechanics.
.
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You will write responses to five (5) questions provided by the instructor, each response
approximately 350-500 words long.
These questions will help you identify and evaluate:
theroleofthegoverningbodythatyouaretargetingwithyourproposal;
thetwoopposingpolicypositionsandtheirclaimsmakers(i.e.thosewhoaresupporting
each position and their investment in that stance); and,
your integration of conceptual material from weekly readings and class discussions
through midterm, including:
types of moral perspectives;
political alliances and relative political power of policy proposals;
impact of social factors/social conditions on issue and proposed solutions;
current and projected disparities in healthcare use and outcomes.
It is expected that you will be building on these writings as you proceed through the term.
list of the topic
Sources must include course readings as well as research from peer-reviewed academic
journals.
Final write-up of the paper is due at 7 p.m. on Wednesday of Finals Week and emailed to the instructor
.
Choose one of the following for your policy analysis paper.
Public Health and Rights to Privacy:
Should medical providers be bound by Public Health policies? Recently, a nurse who was exposed to the Ebola virus refused quarantine rules imposed by the legislature and health department of New Jersey. What were the arguments on both sides? What roles did science, cultural values and norms, and political posturing play in policymaking? What other factors were involved? What are implications for other issues in which private and public health sectors must collaborate?
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Scientists argue that diminishing biodiversity in our ecosystems world-wide, much of it due to unrestricted development and other human activity, will affect our health in the future. Are there ways we can grow an economy and maintain diversity in the environment?
Health care digitization and other new technologies in your docto
r’s
office:
Physicians and their staffs are facing increased pressures to digitize medical records, and recruit and maintain a remote client base through telemedicine practices, i.e., incorporate new technologies into their practices. Are these new practices changing the doctor-patient relationship? What do both doctors and patients think about the changes? And, what roles are medical industries, healthcare corporations, and governments playing in effecting certain changes?
Making the rules regarding wom
en’s
contraceptive choices:
One of most controversial (and litigated) provision of the PPACA is the obligation of employer plans to cover contraceptive services under prevention. Businesses that oppose coverage have challenged the law and won concessions. What are the origins of this debate, both in the construction of the law and in the history of women
’s
contraceptive choices in America? What implications doe ...
1. From which country does your brand originate2. What makes th.docxambersalomon88660
1. From which country does your brand originate?
2. What makes this important? How does this contribute to the brand’s value?
3. What is the brand’s value proposition?
a. Brand Value Proposition is a business or marketing statement that summarizes why a consumer should buy a product or use a service. This statement should convince a potential consumer that one particular product or service will add more value or better solve a problem than other similar offerings.
4. What is your brand’s strategy?
5. In what specific category will your brand compete?
a. how defined
6. Who is the target audience?
a. Demographics, psychographics. Primary audience,
7. secondary audience(s).
a. Create a persona of your ideal target customer.
8. What is your brand’s name?
a. Naming rationale
9. How much will it cost?
a. Pricing strategy.
10. What is its brand positioning?
a. What are the reasons to believe its brand positioning?
11. With which other brands does your brand directly compete?
a. The competitive set.
12. What is your brand’s key competitive differentiation?
13. What makes it unique? Special features or attributes.
14. What emotional benefits are associated with your brand?
15. What is your brand’s personality?
a. What’s is your brand’s identifiable DNA? The characteristics that are core to your brand, without which your brand would not be itself.
16. What is your brand’s story? The narrative that describes the creation, inspiration, and sustaining value of your brand.
17. What are your brand’s style guidelines?
a. Color palate
b. Graphic style
c. Mood board
18. If your brand were to hire one person to represent the brand in advertising who would that be?
a. Rationale/fit with target customers
19. What experiential mode does your brand express?
a. Sense, feel, think, act, relate.
20. Does your brand relate to the “heart” or to the “head”? Why?
21. What plan do you have to sustain your brand long term?
22. What is your brand’s advertising campaign main idea?
23. What is the campaign tagline?
24. What are any special features of your brand?
a. E.g. social impact, key sponsorships, celebrity endorsements, high profile founder...
Stagnating Life Expectancies and Future
Prospects in an Age of Uncertainty∗
Justin T. Denney, Rice University
Robert McNown, University of Colorado at Boulder
Richard G. Rogers, University of Colorado at Boulder
Steven Doubilet, University of Colorado at Boulder
Objective. This article provides a timely assessment of U.S. life expectancy given
recent stalls in the growth of length of life, the continuing drop in international
rankings of life expectancy for the United States, and a period of growing social and
economic insecurity. Methods. Time-series analysis is used on over 70 years of data
from the Human Mortality Database to forecast future life expectancy to the year
2055. Results. The results show limited improvements in U.S. life expectancy at
birth, less than three years on average, for both men and women..
Medicalization of SocietyThe social construction of .docxbuffydtesurina
Medicalization of Society
The social construction of medical knowledge
*
Medicalization of SocietyDescribes a process whereby previously non-medical problems become defined and treated as medical problems, usually in terms of illness, disorders, and conditions. Some suggest that the growth of medical jurisdiction is one of the most significant transformations of the last half of the 20th century.
*
DefinitionThe term refers to the process by which certain events or characteristics of everyday life become medical issues, and thus come within the purview of doctors and other health professionals to engage with, study, and treat. The process of medicalization typically involves changes in social attitudes and terminology, and usually accompanies (or is driven by) the availability of treatments.
*
The prevalence of medicalization
Indicators:
percentage of gross national income increased from 4.5% in 1950 to 16% in 2006
# of physicians per population has doubled in that time frame, extending medical capacity
Jurisdiction of medicine has grown to encompass new problems not previously deemed ‘medical’
Examples: ADHD, eating disorders, CFS,PTSD, panic disorder, fetal alcohol syndrome, PMS, SIDS, obesity, alcoholism
*
Medicalization concerns itself with deviance and ‘normal life events’.Behaviors once defined as immoral, sinful, or criminal have been given medical meaning moving them from badness to sickness.Common life processes have been medicalized: including aging, anxiety and mood, menstruation, birth control, fertility, childbirth, menopause, and death.
*
Increasing MedicalizationNew categories of disease and drug therapies.Expanding/contracting medical categories.Elastic categories: Alzheimer Disease (AD) and the removal of age criteria led to AD encompassing senile dementia sufferers, sharply increasing the number of AD cases (now a top 5 cause of death in the US).Demedicalization whereby a problem is no longer defined as medical problem worthy of medical intervention (e.g. masturbation, homosexuality). Unsuccessful attempts include childbirth. Partial success includes disability.
*
Beyond Sociology…Numerous articles on medicalization in Medline search.British Medical Journal (2002) special issue on medicalization.PLoS Medicine (2006) devoted to ‘disease mongering’.President’s council on Bioethics dedicated session (2003).Seattle Times (2005) Suddenly Sick series.
*
Medicalization has gained attention beyond the social sciences.
Increased medicalizationNew epidemic of medical problems? Or,Is medicine better able to understand and identify and treat existing problems? Or, Are life’s problems increasingly defined as medical problems despite dubious evidence of their medical nature?
*
We’re not interested ncessarily in whether conditions are really medical or not, rather, we’re going to think of medical knowledge and the conditions which come to be understood as medical - as .
The Following is another student post to wish i have to reply APA st.docxadelaider1
The Following is another student post to wish i have to reply APA style. references and less than 10 % similarity. The due date is September 6.
Dianelis Pons
Community Nursing
Professor. Lisys Camacho
Florida National University
September 2020
The development of Public Hygiene stopped during feudalism and began to resurface with the Industrial Revolution (xviii) with Raus, Ramazini and, above all, Johan Peter Frank. The latter is considered the "Father of Public Health" and established the medical police. At that time is when the State, in order to conserve the productive forces, takes greater part in controlling water and cleaning, also adding some aspects of the way of life, such as control of food and occupational diseases (Bush, 2018).
The 19th century was one of great advances in medicine due to the appearance of medical equipment and the discoveries of bacteriology made by Pasteur in 1870 and Koch in 1882 (Bush, 2018). Together with the above and the appearance of social medicine, in the second half of this century, the development of public health is encouraged, expanding health measures by the States and beginning the development of health services, as happened in Russia in 1865 and in Germany in 1883 (Coovadia et al., 2009). In the first half of the 20th century, due to an awakening of interest in health, advances were made in this field and the ministries of public health emerged. In relation to the latter there is a historical fact of great importance when the first in the world was created in Cuba, as the Ministry of Health and Welfare, and later they emerged in Germany, England, France and others (Bush, 2018).
At this time authors such as Sigerist, Rosen, Lee and Jones stand out and one of the first definitions of public health emerges, at least one of the best known, made by the North American Winslow in 1920, which due to its importance is reproduced below:
"Public Health is the art of preventing diseases, prolonging life, promoting health and efficiency through the organized effort of the community for: environmental sanitation; Control of Communicable Diseases; education in personal Hygiene; organization of medical services and nursing for the early diagnosis and preventive treatment of diseases and the development of the social mechanism that ensures each one an adequate standard of living for the preservation of health; organizing these benefits so that each citizen is in conditions of their right natural to health and longevity” (Coovadia et al., 2009).
Prevention marks the beginning of a new stage after the first epidemiological revolution, which increases with the second epidemiological revolution. Thus, public health continues to expand its field and its functions and integrates preventive care for people and that of the natural environment, the social environment, and also aspects of curative care (Coovadia et al., 2009).
There is currently a broad consensus that public health has become an integrative .
The importance of public policy as a determinant of health is routinely acknowledged, but there remains a continuing absence of mainstream debate about the ways in which the politics, power and ideology, which underpin public policy influence people's health. This paper explores the possible reasons behind the absence of a politics of health and demonstrates how explicit acknowledgement of the political nature of health will lead to more effective health promotion strategy and policy, and to more realistic and evidence-based public health and health promotion practice
Similar to Medicalization, Markets and ConsumersAuthor(s) Peter .docx (20)
According to the NASW Code of Ethics section 6.04 (NASW, 2008), .docxaryan532920
According to the NASW Code of Ethics section 6.04 (NASW, 2008), social workers are ethically bound to work for policies that support the healthy development of individuals, guarantee equal access to services, and promote social and economic justice.
For this Discussion
, review this week’s resources, including
Working with Survivors of Sexual Abuse and Trauma: The Case of Rita
and “The Johnson Family”. Consider what change you might make to the policies that affect the client in the case you chose. Finally, think about how you might evaluate the success of the policy changes.
By Day 3
Post
an explanation of one change you might make to the policies that affect the client in the case. Be sure to reference the case you selected in your post. Finally, explain how you might evaluate the success of the policy changes.
Working With Survivors of Sexual Abuse and Trauma: The Case of Rita
Rita is a 22-year-old, heterosexual, Latina female working in the hospitality industry at a resort. She is the youngest of five children and lives at home with her parents. Rita has dated in the past but never developed a serious relationship. She is close to her immediate and extended family as well as to her female friends in the Latino community. Although her parents and three of her siblings were born in the Dominican Republic, Rita was born in the United States.
A year ago, Rita was sexually assaulted by an acquaintance of a male coworker. Rita and a female coworker met Juan and Bob after work at a local bar for a light meal and a few drinks. Because Rita had to get up early to work her shift the next day, Bob offered to drive her home. Instead of taking Rita directly home, however, he drove to a desolate spot nearby and assaulted her. Afterward, Bob threatened to harm her family if she did not remain silent and proceeded to drive her home. Although Rita did not tell her family what happened, she did call our agency hotline the next day to discuss her options. Because Rita’s assault occurred within the 5-day window for forensic evidence collection of this kind, Rita consented to activation of the county’s sexual assault response team (SART). Although she agreed to have an advocate and the sexual assault nurse examiner (SANE) meet her at the hospital, Rita tearfully stated that she did not want to file a police report at that time because she did not want to upset her family. The nurse examiner interviewed Rita, collected evidence, recorded any injuries, administered antibiotics for possible sexually transmitted infections, and gave Rita emergency contraception in case of pregnancy. The advocate stayed with Rita during the procedure, supporting her and validating her experience, and gave her a referral for individual crisis counseling at our agency.
My treatment goals for Rita included alleviation of rape trauma syndrome symptoms that included shame and self-blame, validation of self-worth and empowerment, and processing how it would feel to discl.
According to the text, crime has been part of the human condition si.docxaryan532920
According to the text, crime has been part of the human condition since people began to live in groups. Ancient documents indicate that conduct we now call murder, theft, or robbery was identified as criminal by civilizations that existed thousands of years ago. Criminal laws regulate human conduct and tell people what they can and cannot do and, in some instances, what they must do under certain circumstances. In this assignment, you will explore different types of criminal conduct and the goals of criminal law.
Write a four to six (4-6) page paper in which you:
Determine whether or not the Ex Post Facto Clause can be used as a defense to prohibit the increase in federal minimum/mandatory sentencing guidelines after a federal defendant has committed the crime. Provide a rationale to support your position.
Explain the distinction between criminal, tort, and moral wrongs. Next, support or criticize the premise that the standards set by moral laws are higher than those set by criminal law.
Identify and discuss the differences between solicitation of another to commit a crime and a conspiracy to commit a crime. Next, support or criticize the use of the unilateral approach to conspiracy convictions.
Identify the four (4) goals of criminal law, and discuss the manner in which these four goals effectuate the purpose of protecting the public and preventing the conviction of innocent persons.
Use at least three (3) quality academic resources in this assignment.
Note:
Wikipedia and similar types of websites do not qualify as academic resources.
Your assignment must follow these formatting requirements:
This course requires use of new
Strayer Writing Standards (SWS
). The format is different than other Strayer University courses. Please take a moment to review the SWS documentation for details.
Be typed, double spaced, using Times New Roman font (size 12), with one-inch margins on all sides; citations and references must follow SWS or school-specific format. Check with your professor for any additional instructions.
Include a cover page containing the title of the assignment, the student's name, the professor's name, the course title, and the date. The cover page and the reference page are not included in the required assignment page length.
The specific course learning outcomes associated with this assignment are:
Describe the nature and history of American criminal law.
Explain the role of individuals and federal, state, and local government agencies in crime fighting and prosecution of criminal offenses.
Analyze the essential legal elements of criminal conduct.
Use technology and information resources to research issues in criminal law.
Write clearly and concisely about criminal law using proper writing mechanics.
.
According to Ronald Story and Bruce Laurie, The dozen years between.docxaryan532920
According to Ronald Story and Bruce Laurie, “The dozen years between 1968 and 1980 marked more than the beginning of Republican ascendency; they also saw the breakup of the New Deal coalition and the advent of conservative domination of American politics.” (CP 139).
In this essay, you should explain,
first
, how it is that conservatives came to dominate American politics by the 1980s and,
second
,
how the ideas and policies they embraced shaped American society into the twenty first century.
Rules:
1. 3-4 pages
2. Double spaced, 12-point font
3. Standard margins—Approximately 1.25 on left and right margins and 1 on top and bottom
4. In crafting your essay, you will want to construct a clear thesis and draw on evidence from the sources described below.
5.
Only
use these sources below.
Sources:
Context: The Close of the 1960s
1. The black cat tavern and the LGBT Movement
Link:
https://www.npr.org/2017/02/13/514935126/stonewall-riots-grab-the-spotlight-from-black-cat-protests
2. ESPN Sport center on Katherine Switzwer
Link:
https://www.youtube.com/watch?v=U6CoScOIK_I
3. Crisis in the Cities and 1968.pdf (attachment)
4. Excerpt from MLK’s final Speech in 1968
Link:
https://www.youtube.com/watch?v=Oehry1JC9Rk
5. Vietnam-The path to war.pdf (attachment)
The Rediscovery of the Market: Conservative Politics and Policies
6. Alfred Kahn’s Legacy: Cheap Flights
Link:
https://www.npr.org/2010/12/29/132422495/alfred-kahns-legacy-cheap-flights
7. A Second Gilded Age?.pdf (attachment)
.
According to Kirk (2016), most of your time will be spent work with .docxaryan532920
According to Kirk (2016), most of your time will be spent work with your data. The four following group actions were mentioned by Kirk (2016):
Data acquisition: Gathering the raw material
Data examination: Identifying physical properties and meaning
Data transformation: Enhancing your data through modification and consolidation
Data exploration: Using exploratory analysis and research techniques to learn
Select 1 data action and elaborate on the actions performed in that action group.
Reference: Kirk, A. (2016). Data Visualisation: A Handbook for Data Driven Design (p. 50). SAGE Publications.
.
According to the Council on Social Work Education, Competency 5 Eng.docxaryan532920
According to the Council on Social Work Education, Competency 5: Engage in Policy Practice:
Social workers understand that human rights and social justice, as well as social welfare and services, are mediated by policy and its implementation at the federal, state, and local levels. Social workers understand the history and current structures of social policies and services, the role of policy in service delivery, and the role of practice in policy development. Social workers understand their role in policy development and implementation within their practice settings at the micro, mezzo, and macro levels and they actively engage in policy practice to effect change within those settings. Social workers recognize and understand the historical, social, cultural, economic, organizational, environmental, and global influences that affect social policy. They are also knowledgeable about policy formulation, analysis, implementation, and evaluation.
Walden’s MSW program expects students in their specialization year to be able to:
Evaluate the implication of policies and policy change in the lives of clients/constituents.
Demonstrate critical thinking skills that can be used to inform policymakers and influence policies that impact clients/constituents and services.
This assignment is intended to help students demonstrate the behavioral components of this competency in their field education.
To prepare
: Working with your field instructor, identify a social problem that is common among the organization (or its clients) and research current policies at that state and federal levels that impact the social problem. Then, from a position of advocacy, identify methods to address the social problem (i.e., how you, as a social worker, and the agency advocate to change the problem). You are expected to specifically address how both you and the agency can effectively engage policy makers to make them aware of the social problem and the impact that the policies have on the agency and clients.
The Assignment (2-3 pages): Social Problems is Ex-cons finding Jobs Opportunities in State of California. The Agency is Called "Manifest" the website is Manifest.org
Identify the social problem
Explain rational for selecting social problem
Describe state and federal policies that impact the social problem
Identify specific methods to address the social problems
Explain how the agency and student can advocate to change the social problem
You are expected to present and discuss this assignment with your agency Field Instructor. Your field instructor will be evaluating your ability to demonstrate this competency in their field evaluation. In addition, you will submit this assignment for classroom credit. The Field Liaison will grade the assignment “PASS/FAIL,” see rubric for passing criteria.
.
According to Kirk (2016), most of our time will be spent working.docxaryan532920
According to Kirk (2016), most of our time will be spent working with our data. The four following group actions were mentioned by Kirk (2016):
Book: Kirk, A. (2016). Data visualisation a handbook for data driven design. Los Angeles, CA: Sage.
Data acquisition: Gathering the raw material
Data examination: Identifying physical properties and meaning
Data transformation: Enhancing your data through modification and consolidation
Data exploration: Using exploratory analysis and research techniques to learn
Select 1 data action and elaborate on the actions preformed in that action group.
.
According to Kirk (2016), most of your time will be spent working wi.docxaryan532920
According to Kirk (2016), most of your time will be spent working with your data. The four following group actions were mentioned by Kirk (2016):
Data acquisition: Gathering the raw material
Data examination: Identifying physical properties and meaning
Data transformation: Enhancing your data through modification and consolidation
Data exploration: Using exploratory analysis and research techniques to learn
Select 1 data action and elaborate on the actions preformed in that action group.
.
According to Davenport (2014) the organizational value of healthcare.docxaryan532920
According to Davenport (2014) the organizational value of healthcare analytics, both determination and importance, provide a potential increase in annual revenue and ROI based on the value and use of analytics. To complete this assignment, research and evaluate the challenges faced in the implementation of healthcare analytics in the Health Care Organization (HCO) or health care industry using the following tools:
The paper must also address the following:
Application of PICO (problem, intervention, comparison group, and outcomes) to the challenge identified in your research.
The paper:
Must be two to four double-spaced pages in length (not including title and references pages) and formatted according to APA style as outlined in the
Ashford Writing Center. (Links to an external site.)
Must include a separate title page with the following:
Title of paper
Student’s name
Course name and number
Instructor’s name
Date submitted
Must use at least three scholarly sources in addition to the course text.
Must document all sources in APA style as outlined in the Ashford Writing Center.
Must include a separate references page that is formatted according to APA style as outlined in the Ashford Writing Center.
.
According to the authors, privacy and security go hand in hand; .docxaryan532920
According to the authors, privacy and security go hand in hand; and hence, privacy cannot be protected without implementing proper security controls and technologies. Today, organizations must make not only reasonable efforts to offer protection of privacy of data, but also must go much further as privacy breaches are damaging to its customers, reputation, and potentially could put the company out of business. As we continue learning from our various professional areas of practice, its no doubt that breaches have become an increasing concern to many businesses and their future operations. Taking Cyberattacks proliferation of 2011 into context, security experts at Intel/McAfee discovered huge series of cyberattacks on the networks of 72 organizations globally, including the United Nations, governments and corporations.
Q: From this research revelation in our chapter 11, briefly state and name the countries and organizations identified as the targeted victims?
.
According to Gilbert and Troitzsch (2005), Foundations of Simula.docxaryan532920
According to Gilbert and Troitzsch (2005), Foundations of Simulation Modeling, a simulation model is a computer program that captures the behavior of a real-world system and its input and possible output processes.
Briefly explain what the simulation modeling relies upon?
-500 words at least.
-No Plagiarism.
-APA Format.
.
According to Klein (2016), using ethical absolutism and ethical .docxaryan532920
According to Klein (2016), using ethical absolutism and ethical relativism in ethical decision making can lead to different outcomes. How can moral reasoning about a specific situation differ based on relativism or absolutism? Can you provide an illustration or example of an accounting procedure/situation whose outcome may differ based on absolutism or relativism? Is ethical relativism a more suitable standard within a global IFRS Environment? Why or why not?
at least 250 words
.
According to Franks and Smallwood (2013), information has become.docxaryan532920
According to Franks and Smallwood (2013), information has become the lifeblood of every business organization, and that an increasing volume of information today has increased and exchanged through the use of social networks and Web2.0 tools like blogs, microblogs, and wikis. When looking at social media in the enterprise, there is a notable difference in functionality between e-mail and social media, and has been documented by research – “…that social media differ greatly from e-mail use due to its maturity and stability.” (Franks & Smallwood, 2013).
Provide a page response identifying and clearly stating what the difference are? APA Standard, 2 page response, not including front page and references.
.
According to the Council on Social Work Education, Competency 5.docxaryan532920
According to the Council on Social Work Education, Competency 5: Engage in Policy Practice:
Social workers understand that human rights and social justice, as well as social welfare and services, are mediated by policy and its implementation at the federal, state, and local levels. Social workers understand the history and current structures of social policies and services, the role of policy in service delivery, and the role of practice in policy development. Social workers understand their role in policy development and implementation within their practice settings at the micro, mezzo, and macro levels and they actively engage in policy practice to effect change within those settings. Social workers recognize and understand the historical, social, cultural, economic, organizational, environmental, and global influences that affect social policy. They are also knowledgeable about policy formulation, analysis, implementation, and evaluation. Social workers:
Identify social policy at the local, state, and federal level that impacts well-being, service delivery, and access to social services;
Assess how social welfare and economic policies impact the delivery of and access to social services;
Apply critical thinking to analyze, formulate, and advocate for policies that advance human rights and social, economic, and environmental justice.
This assignment is intended to help students demonstrate the behavioral components of this competency in their field education.
To prepare: Working with your field instructor, identify, evaluate, and discuss policies established by the local, state, and federal government (within the last five years) that affect the day to day operations of the field placement agency.
The Assignment (1-2 pages): (In The States California. The Good Seed is a Drop-In center for 18-25 years!
Describe the policies and their impact on the field agency.
Propose specific recommendations regarding how you, as a social work intern, and the agency can advocate for policies pertaining to advancing social justice for the agency and the clients it serves.
.
According to the authors, privacy and security go hand in hand; and .docxaryan532920
According to the authors, privacy and security go hand in hand; and hence, privacy cannot be protected without implementing proper security controls and technologies. Today, organizations must make not only reasonable efforts to offer protection of privacy of data, but also must go much further as privacy breaches are damaging to its customers, reputation, and potentially could put the company out of business. As we continue learning from our various professional areas of practice, its no doubt that breaches have become an increasing concern to many businesses and their future operations. Taking Cyberattacks proliferation of 2011 into context, security experts at Intel/McAfee discovered huge series of cyberattacks on the networks of 72 organizations globally, including the United Nations, governments and corporations.
From this research revelation in our chapter 11, briefly state and name the countries and organizations identified as the targeted victims?
Use the APA format to include your references. Each paragraph should have different references and each para should have at least 4 sentences.
.
According to recent surveys, China, India, and the Philippines are t.docxaryan532920
According to recent surveys, China, India, and the Philippines are the three most popular countries for IT outsourcing. Write a short paper (4 paragraphs) explaining what the appeal would be for US companies to outsource IT functions to these countries. You may discuss cost, labor pool, language, or possibly government support as your reasons. There are many other reasons you may choose to highlight in your paper. Be sure to use your own words.
Must be in APA format with references and citations.
.
According to the authors, countries that lag behind the rest of the .docxaryan532920
According to the authors, countries that lag behind the rest of the world’s ICT capabilities encounter difficulties at various levels. Discuss specific areas, both within and outside, eGovernance, in which citizens living in a country that lags behind the rest of the world in ICT capacity are lacking. Include in your discussion quality of life, sustainability, safety, affluence, and any other areas that you find of interest. Use at least 8-10 sentences to discuss this topic.
.
According to Peskin et al. (2013) in our course reader, Studies on .docxaryan532920
According to Peskin et al. (2013) in our course reader, "Studies on early health risk factors, including prenatal nicotine/alcohol exposure, birth complications, and minor physical anomalies have found that these risk factors significantly increase the likelihood of anti-social and criminal behavior throughout life." What policy changes might you suggest to help curtail the occurrence or effects of these risk factors? Remember to think about public health policy, not just criminal policy.
.
According to Franks and Smallwood (2013), information has become the.docxaryan532920
According to Franks and Smallwood (2013), information has become the lifeblood of every business organization, and that an increasing volume of information today has increased and exchanged through the use of social networks and Web2.0 tools like blogs, microblogs, and wikis. When looking at social media in the enterprise, there is a notable difference in functionality between e-mail and social media, and has been documented by research – “…that social media differ greatly from e-mail use due to its maturity and stability.” (Franks & Smallwood, 2013).
Q: Please identify and clearly state what the difference is?
Use the APA format to include your references. Each paragraph should have different references and each para should have at least 4 sentences.
.
According to Ang (2011), how is Social Media management differen.docxaryan532920
According to Ang (2011), how is Social Media management different than traditional Customer Relationship Management (CRM)? Define the four pillars of social media (connectivity, conversations, content creation and collaboration) and analyze how each pillar can be used to aid Social Media management. Identify the benefits Social Media management. Provide examples to illustrate each point.
The paper must be 1-2 pages in length (excluding title and reference page) and in APA (6th edition) format. The paper must include the Ang (2011) article in correct APA format.
.
According to (Alsaidi & Kausar (2018), It is expected that by 2020,.docxaryan532920
According to (Alsaidi & Kausar (2018), "It is expected that by 2020, around 25 billion objects will become the part of global IoT network, which will pose new challenges in securing IoT systems. It will become an easy target for hackers as these systems are often deployed in an uncontrolled and hostile environment. The main security challenges in IoT environment are authorization, privacy, authentication, admission control, system conformation, storage, and administration" (p. 213).
Discuss and describe the difference between a black hole attack and a wormhole attack.
.
Introduction to AI for Nonprofits with Tapp NetworkTechSoup
Dive into the world of AI! Experts Jon Hill and Tareq Monaur will guide you through AI's role in enhancing nonprofit websites and basic marketing strategies, making it easy to understand and apply.
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
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• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
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Medicalization, Markets and ConsumersAuthor(s) Peter .docx
1. Medicalization, Markets and Consumers
Author(s): Peter Conrad and Valerie Leiter
Source: Journal of Health and Social Behavior, Vol. 45, Extra
Issue: Health and Health Care
in the United States: Origins and Dynamics (2004), pp. 158-176
Published by: American Sociological Association
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Medicalization, Markets and Consumers*
PETER CONRAD
Brandeis University
VALERIE LEITER
Simmons College
Journal of Health and Social Behavior 2004, Vol 45 (Extra
Issue): 158-176
This paper examines the impact of changes in the medical
marketplace on med-
icalization in U S. society. Using four cases (Viagra, Paxil,
human growth hor-
mone and in vitro fertilization), we focus on two aspects of the
changing med-
ical marketplace: the role of direct-to-consumer advertising of
prescription
drugs and the emergence ofprivate medical markets. We
demonstrate how con-
sumers and pharmaceutical corporations contribute to
medicalization, with
physicians, insurance coverage, and changes in regulatory
practices playing
facilitating roles. In some cases, insurers attempt to counteract
medicalization
by restricting access. We distinguish mediated and private
medical markets,
3. each characterized by differing relationships with corporations,
insurers, con-
sumers, and physicians. In the changing medical environment,
with medical
markets as intervening factors, corporations and insurers are
becoming more
significant determinants in the medicalization process.
Over the past three decades there has been a
marked increase in the medicalization of soci-
ety (Zola 1972; Conrad and Schneider 1992;
Barsky and Boros 1995; Riska 2003).
Medicalization occurs when previously non-
medical problems are defined and treated as
medical problems, usually in terms of illnesses
or disorders. While medicalization can be bi-
directional, there is strong evidence for
increases in medicalization. This growth of
medical jurisdiction is "one of the most potent
transformations of the last half of the twentieth
century in the West" (Clarke et al. 2003:161).
In this same period, the institution of medicine
has undergone major changes in its social
organization, with the advent of managed care,
the declining power of the medical profession,
and a rise in consumer advocacy and account-
ability (Starr 1982; McKinlay and Marceau
2001). As medicine has changed, has the
process of medicalization been transformed as
well? In an ambitious paper, Clarke and her
colleagues (2003) argue that the technoscien-
tific changes in medicine have expanded med-
4. icine's boundaries even further into biomed-
icalization, a wide ranging process that
includes complex and multi-sited transforma-
tions in medical knowledge, technology, sur-
veillance, and bodies. Our task here is narrow-
er and more focused. We ask, how have
changes in the institution of medicine affected
the process of medicalization? Have the shift-
ing power dynamics in medicine altered med-
icalization? What are current engines driving
increased medicalization? What factors con-
strain its growth?
Most previous analyses of medicalization
focused on the influence of physicians, lay
reformers, or medical and scientific discover-
ies. This paper departs from that tack, focusing
instead on the creation of markets and the
impact of these markets on medicalization.
Although the players are similar, the emphasis
is different. Given the changing medical scene,
important arenas of medicalization are moving
from professional to market domains.
In this paper we examine the impact of
* Our thanks to Phil Brown, Emily Kolker, Stefan
Timmermans, anonymous reviewers, and the editors
for comments on a earlier version of this paper. Send
correspondence to: Peter Conrad, Department of
Sociology, MS-71, Brandeis University, Waltham,
MA 02454-9110. Email: [email protected]ndeis.edu.
5. 158
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MEDICALIZATION, MARKETS AND CONSUMERS 159
changes in the medical marketplace on the
increasing medicalization of society. We first
review the extant general explanations for the
increased medicalization, setting these in the
context of recent changes in the medical sys-
tem and expanding medical knowledge. The
core of the paper focuses on two aspects of the
changing medical market place: Direct-to-con-
sumer advertising of prescription drugs in
insurance mediated medical markets and the
emergence of new private medical markets.
The final section links these two aspects of the
changing medical marketplace to medicaliza-
tion and to consumers' access to health care.
AGENTS OF MEDICALIZATION
There are numerous broad social factors that
have encouraged or abetted medicalization,
including the diminution of religion; an abid-
ing faith in science, rationality, and progress;
an increased reliance on experts; and a general
humanitarian trend in Western societies
6. (Conrad 1992:213). These factors, rather than
being explanatory, set the context in which
medicalization occurs.
Sociologists and other analysts have identi-
fied direct factors that facilitate medicaliza-
tion. Foremost among these, on the "supply"
side is the prestige and power of the medical
profession. It is well known that the medical
profession gained great influence and authori-
ty in the first three quarters of the twentieth
century, attaining both a professional domi-
nance (Freidson 1970) and cultural authority
(Starr 1982). Professional dominance and
medical monopolization gave medicine juris-
diction over virtually anything to which the
label "health" or "illness" could be attached
(Freidson 1970). Studies of problems ranging
from childbirth (Wertz and Wertz 1989) to
child abuse (Pfohl 1977) to the rise of behav-
ioral pediatrics (Halpern 1990) all purport
some kind of intra-professional explanation for
an increase in medicalization. It should be
noted, however, that sometimes problems have
been thrust onto the medical profession, which
may be resisted (e.g., Kurz 1987).
On the "demand" side of medicalization,
there has been growth in consumer demand for
medical solutions. Barsky and Borus (1995)
suggest that the public's tolerance for mild
symptoms and benign problems has decreased,
spurring a "progressive medicalization of
7. physical distress in which uncomfortable body
states and isolated symptoms are reclassified
as diseases . . ." (p. 1931). Conrad and Potter
(2000) note that the expansion of attention
deficit hyperactivity disorder (ADHD) from a
childhood to an adult disorder typically
involves patients asking doctors for a diagnosis
and medication. Patients have become more
knowledgeable, demanding, and critical of
medical care (Williams and Calnan 1996). The
Internet has facilitated consumer involvement
by offering easily accessible health-related
information and providing a method for com-
munication among like-minded individuals
(Hardey 2001). Organized lay interests and
advocates frequently play a significant role in
medicalization, such as in the creation and
institutionalization (in DSM-III) of the diagno-
sis post-traumatic stress disorder (Scott 1990).
However, advocates for sexual addiction
(Levine and Troiden 1988) and multiple chem-
ical sensitivity disorder (Kroll-Smith and
Floyd 1997) have not had such success.
New medical knowledge can also contribute
to medicalization, especially in terms of etiol-
ogy and treatment. The Human Genome
Project and the attendant rise of genetics is one
major potential source of increased medical-
ization. If a problem can be shown to have a
genetic component it becomes a good candi-
date for (new or renewed) medical definitions
(Conrad 2000). Similarly, the development of
8. new medical treatments with pharmaceutical
drugs can be an important factor in the med-
icalization of particular problems, such as the
impact of Ritalin on ADHD or estrogen
replacement therapy on menopause. However,
it is important to emphasize that new biomed-
ical knowledge or interventions alone cannot
engender medicalization. Etiology or treat-
ment may be a central component of a claim to
medicalization, but those claims must be
championed by supporters or promoters of a
diagnosis, be they physicians, patients, lay
advocates, or commercial entities such as drug
companies.
Many of the key medicalization studies were
completed over a decade ago. Important
changes have occurred in health care since
then, especially the increased corporatization
of health care (Light 2000). Light (1993) has
proposed the concept "countervailing powers"
to describe the changing balance of power
among the medical profession and related
social institutions. In American society, profes-
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160 JOURNAL OF HEALTH AND SOCIAL BEHAVIOR
sional medicine historically dominated health
care, but we now see "buyers" (e.g., corpora-
tions that pay for employees' health insurance);
9. "providers" (e.g., physicians, hospitals,
HMOs); "payers" (e.g., insurance companies,
governments); and "consumers" (e.g., patients,
advocacy groups) all vying for power and
influence over medical care. The growing
influence of the biotechnology industry (espe-
cially the pharmaceutical and genomics indus-
tries), has increased the complexity of the "the
medical-industrial complex" (Relman 1980;
Clarke et al. 2003).
In this paper we explore how the develop-
ment and promotion of new technologies, con-
sumer demand, and the emergence of new
medical markets have facilitated new areas of
medicalization. Using the cases of Viagra,
Paxil, human growth hormone, and in vitro
fertilization (IVF) as illustrations, we contend
that, in the climate of increased corporatization
of health care and decreased public regulation,
the creation or expansion of new medical mar-
kets are a significant force toward medicaliza-
tion.
ON MEDICAL MARKETS
Until the last decade or so, sociologists
rarely examined medicine as any kind of mar-
ketplace. But it is becoming clear that, with the
development of managed care, corporatized
medicine, and the rise of the biotechnology
industry, medical markets are increasingly
important in the analysis of health care.
When medical products, services, or treat-
10. ments are promoted to consumers to improve
their health, appearance, or well-being, we see
the development of medical markets. The idea
of medical markets has been described as a
"theoretical anomaly" (Light 2000:395), as
medical markets often do not meet many of the
elements in classical definitions of a competi-
tive marketplace. In a free market, consumers
are supposed to be informed, appreciate differ-
ences in quality, and have bargaining power
and free choice about buying, but these
assumptions are often violated in health care
markets (Lown 2000). Asymmetry of informa-
tion and "uncertainty in the definition, recog-
nition, and diagnosis of disease states"
(Montagne 1992:401) in particular distinguish
medical markets from other "consumer" mar-
kets.
There are, however, some medical markets
that do resemble classic consumer markets, in
which goods and services are exchanged as
commodities. Over the last few decades, the
"medical-industrial complex" has grown,
"mainly as a response to the entrepreneurial
opportunities afforded by the expansion of
health insurance coverage offering indemnifi-
cation through Medicare and employment-
based plans" (Relman 1991:856). In short, the
existence of third party funding has encour-
aged certain types of medical markets because
of available insurance, although this has been
partly restrained by managed care.
The use of advertising, the development of
11. specific medical markets, and the standardiza-
tion of medical services into product lines have
contributed to an increased commodification
of medical goods and services. Advertising of
health care has become more commonplace
(Dyer 1997), and new medical markets have
emerged, particularly for specialty services.
Imershein and Estes (1996) argue that medical
services are increasingly organized into prod-
uct lines (with attached payment schemes),
consistent with a market-based approach to
exchange. Cosmetic surgery is the most com-
modified of medical specialties, offering treat-
ments that are often not covered by insurance,
such as liposuction and breast augmentation
(Sullivan 2001). Cosmetic surgeons advertise
to stimulate demand for their services, for
which patients pay cash (or borrow from
finance companies that partner with cosmetic
surgeons, much like purchasing a car).
In the last five years, a loosened regulatory
environment has given pharmaceutical and
biotechnology companies more freedom in
advertising their wares, both to physicians and
consumers. The Federal Drug Administration
Modernization Act of 1997 made several
changes that have facilitated medicalization.
Most relevant to our analysis, the act loosened
the restrictions placed on the kind of informa-
tion that pharmaceutical companies could
share with physicians regarding "off-label"
uses of their drugs, and subsequently, the
information that must be included in direct-to-
12. consumer advertisements.
The constant development of new technolo-
gies, treatments, and drugs sparks consumer
interest in obtaining access to these new med-
ical goods and services, and advertising can
further increase consumer demand. Consumers
may gain access to these goods and services
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MEDICALIZATION, MARKETS AND CONSUMERS 161
through one of two kinds of markets: mediated
markets and private markets.
In mediated markets, there is an indirect
relationship between consumers, on the
demand side, and medical producers or
providers, on the supply side, with third party
payers occupying an intervening role. Third
party payers (typically private or public insur-
ers) intervene in the exchange relationship
between consumers and providers or producers
in two ways: by defining what is "medically
necessary" and then paying for only those
goods and services that they have deemed
medically necessary. The degree of control
exercised by third party payers varies, depend-
ing upon the level of "management" of care
being exercised. Managed care regulations
13. dampen consumer demand for medical goods
and services, particularly regarding access to
new technologies (Mechanic 2002), reducing
consumers' ability to purchase medical solu-
tions to perceived health problems.
Consumers who want medical goods or ser-
vices but cannot obtain them through mediated
markets may turn instead to private markets,
depending upon the cost of the goods or ser-
vices and consumers' financial resources. In
private markets, there is a more direct econom-
ic relationship between consumers and med-
ical producers or providers: If consumers can
afford a treatment, they can most likely find a
medical provider who will provide it for
"cash." Again, cosmetic surgery is one exam-
ple of private medical markets. In private med-
ical markets, care is provided to consumers
who can afford to pay for it, and other potential
consumers are excluded.
In our analysis, we examine how four rela-
tively recent medical developments are distrib-
uted through mediated and private markets,
and how distribution through these two types
of markets is related to medicalization.
Specifically, we look at (1) the creation of
demand for new medical products in mediated
medical markets; and (2) the development of
private medical markets.
CREATING AND CAPITALIZING ON
MEDICAL MARKETS
14. In 1999, the pharmaceutical industry was
the most profitable industry in the United
States, with an 18.6 percent return on revenues
(Angell 2000). It is among the fastest growing
components of health care, rising at 15 percent
a year, now constituting 8 percent of health
care spending (Angell 2000). In the same year,
Americans purchased 2.5 billion prescriptions,
averaging nine per American, for a total of
$125 billion (Cohen et al. 2001). The pharma-
ceutical industry has a long history of market-
ing prescription medication directly to doctors
through "detailing," direct mail, ads in medical
journals, gifts, travel subsidies, and sponsoring
events (Wanzana 2000).
While some direct-to-consumer advertising
existed in the United States for over two
decades (Pines 1999), recently the pharmaceu-
tical industry has substantially increased its
investment in targeting consumers directly.
Annual spending on direct-to-consumer adver-
tising for prescription drugs tripled between
1996 and 2000; it is only 15 percent of all mar-
keting, but by far the fastest rising segment.
Much of this increase has been in television
advertising after the Federal Drug
Administration Modernization Act of 1997
made it easier to advertise drugs to the general
public (Lyles 2002). This change allowed
broadcast ads to name both the disorder and
15. the drug so long as they also contain limited
risk and benefit information, making televi-
sion drug advertising more feasible and more
attractive to the pharmaceutical industry.
Spending specifically on television advertising
increased six-fold between 1996 and 2000, to
$1.5 billion dollars (Rosenthal et al. 2002).
The pharmaceutical companies claim that
direct-to-consumer advertising has an educa-
tional function that creates better informed
consumers, encouraging consumers to consult
their physicians about underdiagnosed symp-
toms and treatment options, and enabling
patients to make better choices (Bonaccorso
and Sturchio 2002; Lyles 2002). Critics are
concerned that such advertising leads to physi-
cians wasting time during medical visits
explaining why a treatment is not appropriate,
can lead to unnecessary use of medical
resources and excessive profits for drug com-
panies, and medicalize normal conditions
(Mintzes 2002; Rosenthal et al. 2002). The
vast majority of direct-to-consumer advertis-
ing focuses on a limited number of drugs; in
2000, 20 drugs accounted for 60 percent of
direct-to-consumer advertising. These include
a wide range of drugs, including antidepres-
sants, antihistamines, antihyperliplidemics,
and anti-inflammatory agents.
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16. 162 JOURNAL OF HEALTH AND SOCIAL BEHAVIOR
One aspect of direct-to-consumer advertis-
ing that has not been discussed is its impact on
expanding the medicalization of human prob-
lems. So-called "consumer education cam-
paigns" are used to introduce products, bring-
ing new people into a market by creating a pre-
viously unrecognized demand for the product
(Applbaum 2000). The direct-to-consumer
advertising may well shape the way the public
conceptualizes problems and it may increase
consumer demand for medical solutions. At
least two of the top 20 drugs promoted with
direct-to-consumer advertising (see Rosenthal
et al. 2002) have significant implications for
medicalization: Viagra (ranked 6) and Paxil
(ranked 4).
Viagra and Erectile Dysfunction
Male impotence has been a medical problem
for many years. There is some evidence of
medicalization in the Victorian era (Mumford
1992), although its dominant framing through-
out much of the 20th century appears to have
been as a psychogenic problem. In the 1990s,
the problem became redefined as sexual dys-
function and its treatment was promoted by
urologists, the medical technology industry,
mass media, and entrepreneurs (Teifer 1994).
17. A consensus conference in 1992 officially
renamed the problem "erectile dysfunction"
(National Institutes on Health Consensus
Development Panel on Impotence 1993), high-
lighting its nature as a biogenic rather than
psychogenic problem. Available treatments
such a penile surgery, implants, and injections
were medical, although their results were
mixed (Teifer 1994).
In March 1998, the Federal Drug
Administration (FDA) approved Viagra (silde-
nafil citrate) as a treatment for erectile dys-
function. Intended primarily for the use of
older men with erectile problems and for erec-
tile dysfunction associated with prostate can-
cer, diabetes, or other medical problems (Loe
2001), Viagra was the first non-invasive med-
ical treatment for male sexual dysfunction. The
medication operates by increasing the blood
flow to the penis, allowing a man to achieve
and sustain an erection when sexually aroused.
Ingested orally, it takes effect in 30 to 60 min-
utes and can last from 4 to 6 hours.
A demand for a drug for erectile problems
surely existed before Pfizer began advertising
Viagra. Estimates of the prevalence of erectile
dysfunction range from 10 to 20 million men
(Fabbri et al. 1997) to suggestions that up to
half all American men are "sexually dysfunc-
tional" (Laumann et al. 1999). Erectile diffi-
culties affected not only men but their partners
as well, and they were linked to powerful
issues surrounding masculinity and sexual per-
18. formance, making "erectile dysfunction cen-
tral to masculine self esteem" (Teifer
1994:370). Pfizer Pharmaceuticals, the manu-
facturer of Viagra, tapped into this vast poten-
tial market and shaped it by promoting sexual
difficulties as a medical problem and Viagra as
the solution.
With an aging population, a high prevalence
of sexual dysfunction, and an even larger con-
cern with sexual performance insecurity, the
potential American market was huge, with an
even more extensive worldwide market. The
initial advertising for Viagra was minimal
(Carpiano 2001), but Pfizer soon marketed
Viagra aggressively both to physicians and the
general public. The direct-to-consumer ads
included spokesmen as mainstream as former
Senator and Presidential candidate Bob Dole,
well recognized athletes, and ordinary people,
all testifying to the wonders of Viagra and how
it has changed an important part of their lives.
One typical ad showed baseball star Rafael
Palmiero with the words "I take batting prac-
tice," indicating both that vigorous athletes can
take Viagra and that even stars might need
some help in performance. Viagra became an
official sponsor of major league baseball, as
well as sponsoring both the Viagra car in the
NASCAR circuit and Spanish language soccer
broadcasts. Thus advertising expanded the
market to include virtually any man who might
consider himself as having some type of erec-
tile or sexual problems.
19. Viagra sales were phenomenal. Physicians
wrote 2.9 million prescriptions in the first
three months of its availability; in the first year
alone, over three million men were treated with
Viagra, translating into $1.5 billion in sales
(Carpiano 2001). Perhaps 200,000 prescrip-
tions for Viagra are written weekly (Tuller
2002), with untold more Viagra sold through
the Internet and other outlets. In 2000, Viagra
was ranked 6th in terms of both direct-to-con-
sumer spending and sales, with a total of $89.5
million spent and $809 million in sales, and a
17 percent increase in utilization from 1999 to
2000 (NIHCM 2001).
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MEDICALIZATION, MARKETS AND CONSUMERS 163
Viagra was a factor in the diagnostic expan-
sion of sexual dysfunction and the increased
medicalization of sexual performance (cf.
Conrad and Potter 2000). Prior to Viagra, med-
ical treatment was largely limited to major dys-
functions (e.g., as from prostate surgery). Now
it included mild dysfunctions (e.g., occasional
erectile problems) and could be used as an
enhancement (Conrad and Potter 2004), offer-
ing a "jump start" or extra strength for sexual
encounters (Loe 2001).
Viagra is not an inexpensive medication: It
20. costs about $10 per pill. Within months of the
FDA's approval of the drug, many large insur-
ers (e.g., Kaiser Permanente and Aetna U.S.
Healthcare) decided that they would not cover
the drug, except at an extra cost to employers
or individuals, while others did cover the drug
(e.g., Blue Cross/Blue Shield plans in Indiana
and California, Harvard Pilgrim Health Care,
and the Defense Department's health plan).
However, many insurers who currently cover
the drug limit the number of pills per month.
For example, Tufts Health Plan (2002) covers
four tablets every 30 days, and Blue Cross and
Blue Shield of Texas (2003) covers eight
tablets every 30 days. In Britain, however, the
National Health Service covers Viagra only for
sexual dysfunction related to conditions such
as diabetes, prostate cancer, and renal failure
(Michael Bury, University of London-Royal
Holloway, personal communication).
The health insurance industry was involved
in the debate over whether "sexual dysfunc-
tion" was a medical necessity and whether
Viagra should be covered by health insurance,
resulting in mixed insurance coverage for
Viagra. In this case, the insurance industry
attempted to counteract increased medicaliza-
tion of male sexual dysfunction by restricting
access to Viagra. However, individuals with a
physician's prescription could of course pur-
chase the drug on their own or through a range
of Internet sites.
One important social benefit from the popu-
21. larity and widespread use of Viagra is a reduc-
tion of the stigma of sexual dysfunction.
Seeing ads for Viagra in so many mainstream
locations and making Viagra part of everyday
discussions has made sexual dysfunction and
its treatment appear conventional and com-
monplace. This has most likely also increased
the market for Viagra, since it would be less
stigmatizing to inquire about and use it.
The success of Viagra and the subsequent
expansion of the concept of male sexual dys-
function has prompted other companies to
enter and expand this market, including phar-
maceutical companies either developing new
drugs to compete with Viagra (Tuller 2002) or
seeking a "female Viagra" (Moynihan 2003;
Hartley 2003). Given the aging baby boomers
and the entrepreneurial pharmaceutical indus-
try's increased promotion of "lifestyle" drugs
marketed directly to consumers (Mamo and
Fishman 2001), the medicalization of sexual
dysfunction is likely to continue to expand, at
least for the foreseeable future.
Paxil and Social Anxiety Disorders
When the FDA approved Paxil (paroxetine
hydrochloride) for the treatment of depression
in 1996, Paxil followed Prozac and several
other selective serotonin reuptake inhibitors
(SSRIs) into an already saturated market for
the treatment of depression. The manufacturer
of Paxil (now called GlaxoSmithKline)
responded to the saturated "depression mar-
ket" by requesting FDA approval for addition-
22. al applications of Paxil, specializing instead in
the "anxiety market," including panic disorder
and obsessive compulsive disorder at first, and
then social anxiety disorder (SAD) and gener-
alized anxiety disorder (GAD). Paxil's applica-
tion to SAD and GAD has contributed to the
medicalization of emotions, expanding med-
ical jurisdiction over emotions such as worry
and shyness.
SAD and GAD were fairly obscure diag-
noses when they were added to the American
Psychiatric Association's Diagnostic and
Statistical Manual (DSM) in 1980. According
to the DSM-IV, SAD (or "social phobia") is a
persistent and extreme "fear of social and per-
formance situations in which embarrassment
may occur" (American Psychiatric Association
1994:411) and GAD involves chronic, exces-
sive anxiety and worry (lasting at least six
months), involving multiple symptoms
(American Psychiatric Association 1994:
435-36). Both conditions are defined as being
associated with significant distress and impair-
ment in functioning. Horwitz (2002) notes how
small changes in wording of criteria for SAD
resulted in a tremendous growth in its estimat-
ed prevalence (and potential market).
Marketing diseases and then selling drugs to
treat those diseases is now common in the
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164 JOURNAL OF HEALTH AND SOCIAL BEHAVIOR
"post-Prozac" era. Since the FDA approved the
use of Paxil for SAD in 1999 and for GAD in
2001, GlaxoSmithKline has spent millions of
dollars to raise the public visibility of SAD and
GAD, by sponsoring well-choreographed dis-
ease awareness campaigns. The pharmaceuti-
cal company's savvy approach to marketing
SAD and GAD, which relied upon a mixture of
"expert" and patient voices, simultaneously
gave the conditions diagnostic validity and cre-
ated the perception that it could happen to any-
one (Koerner 2002). Soon after the FDA
approved the use of Paxil for SAD, Cohn and
Wolfe (a public relations firm that was work-
ing for what was then SmithKline) began
putting up posters at bus stops with the slogan,
"Imagine Being Allergic to People." Later in
1999, a series of ads featured "Paxil's efficacy
in helping SAD sufferers brave dinner parties
and public speaking" (Koerner 2002:61).
Barry Brand, Paxil's product director, said,
"Every marketer's dream is to find an uniden-
tified or unknown market and develop it.
That's what we were able to do with social anx-
iety disorder" (Vedantam 2001).
Through media campaigns, GlaxoSmithKline
redefined SAD and GAD, paradoxically, as
24. both common (reducing the stigma associated
with having a "mental illness") and abnormal
(subject to medical intervention, in the form of
Paxil). Prevalence estimates of both SAD and
GAD range widely. For example, estimates of
the prevalence of SAD range from 3 percent to
13 percent (American Psychiatric Association
1994:414), with the National Institute of
Mental Health estimating that 3.7 percent of
the U.S. population has SAD (Vedantam
2001). Higher prevalence rates are associated
with less stringent application of the DSM-
specified criteria for these conditions.'
Horwitz (2002) argues that, "Because commu-
nity studies consider all symptoms, whether
internal or not, expectable or not, deviant or
not, as signs of disorder, they inevitably over-
estimate the prevalence of mental disorder in
the community" (p.105). Likewise, the disease
awareness campaign focused on individuals'
feelings in social situations likely to evoke fear
in many people, especially public speaking,
and offered consumers symptom-based "self
tests" to assess the likelihood that they had
SAD and GAD (www.paxil.com). This kind of
clinical ambiguity is fertile ground for creating
an expansive medical market.
Some question the validity of SAD, due to
its loosely defined boundaries and the aggres-
sive marketing of it as a disease: "[T]he
impression often conveyed by commercials for
the drugs is clear: almost anyone could benefit
from them" (Goode 2002). Murray Stein, a
psychiatry professor at the University of
25. California at San Diego, has called the use of
prescription medicines such as Paxil, which
are costly and may have significant side
effects, "cosmetic psychopharmacology"
(Vedantam 2001:1). Paxil's web page
(www.paxil.com) stresses the elimination of
symptoms (e.g., improved sleep) and improved
performance (e.g., "improved ability to con-
centrate and make decisions") as benefits.
Efforts to define SAD and GAD as condi-
tions, and market Paxil as treatment for them,
have been extremely successful. Paxil is one of
the three most widely recognized prescription
drugs, after Viagra and Claritin (Marino 2002),
and it is currently ranked sixth in terms of pre-
scriptions (Nittan 2001), with U.S. sales of
approximately $2.1 billion and global sales of
$2.7 billion. It is of course not possible to dis-
tinguish how much of this was for SAD or
GAD and how much of it was prescribed for
other problems including depression, obses-
sive compulsive disorder, or post traumatic
stress disorder.
But there has been some recent backlash
against the drug. In 2002, a federal judge
ordered a temporary halt to Paxil ads over the
claim that Paxil is not habit forming (White
2002). Apparently, patients and health care
providers have submitted thousands of reports
to the FDA describing withdrawal symptoms
(Peterson 2002). Multiple lawsuits have been
filed, asserting that physicians and consumers
26. were misled by advertisements regarding the
severity of withdrawal (Barry 2002). Like sim-
ilarly marketed consumer goods, such as music
and clothing, it is possible that Paxil's popular-
ity may be waning. However, along the way,
the GalaxoSmithKline campaign for Paxil has
increased the medicalization of anxiety, infer-
ring directly and indirectly that shyness and
worrying may be medical problems and that
Paxil is the way to treat them.
DEVELOPMENT OF PRIVATE MEDICAL
MARKETS
When treatments or services are not covered
by health insurance, but the demand for the
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MEDICALIZATION, MARKETS AND CONSUMERS 165
medical service or treatment remains, a private
medical market may evolve. Private medical
markets emerge when an available medical
intervention-frequently medical technology
or an "off-label" use of an approved drug-
meets consumers willing to pay out of their
pockets to receive treatment. Such markets are
sustained by consumer demand, and they can
be expanded by increasing the availability of
the intervention, reducing the cost of the treat-
27. ment, or expanding the range of uses or target
populations. Some of these interventions can
be seen as medical enhancements rather than
treatments for a disease, but this is a slippery
slope. This commercialization of medicine has
been well-developed in cosmetic surgery
(Sullivan 2001), but it exists in other areas as
well. The relation of increasing medicalization
and private markets for biomedical enhance-
ments and technology are illustrated through
two cases: the use of human growth hormone
for idiopathic shortness and in vitro fertiliza-
tion for infertility.
Human Growth Hormone and Idiopathic
Short Stature
Medications are frequently prescribed for
"off-label" uses, as treatments of conditions
beyond those approved by the Federal Drug
Administration. While physicians, in practice,2
have autonomy and authority to prescribe for
off-label uses of a drug, manufacturers cannot
legally market for off-label uses.
Prior to 1985, human growth hormone
extracted from cadavers was used to treat indi-
viduals who had a growth hormone deficiency.
The growth hormone was in low supply and
thus very expensive and carried severe risks of
Creutzfeldt-Jacobs disease, a potentially fatal
brain disease. In 1985 the FDA removed it
from the market. With fortuitous timing,
28. Genentech introduced an FDA approved syn-
thetic human growth hormone within six
months of the removal of cadaver-extracted
growth hormone. The recombinant hormone,
marketed as Protropin, could be produced in
"potentially unlimited quantities" (Lantos et
al. 1989:1020) to such an extent that physi-
cians credited the new technology with ending
the market shortage of the hormone
(Glasbrenner 1986). Genentech soon claimed
75 percent of the existing $200 million U.S.
market (Werth 1991). The hormone had been
approved by the FDA only for treating hypopi-
tuitary dwarfism (or growth hormone defi-
ciency) and chronic renal failure. While indi-
vidual cases might be disputed, the medical
profession established strict guidelines (Bercu
1996) to distinguish between growth hormone
deficiency disorder and what has been called
idiopathic short stature or ISS (children with
normal growth hormone who are short).3
As time went on, physicians, patients, and
drug companies all sought other medical uses
for human growth hormone. By 1990,
researchers and leading drug companies were
investigating the possibility of administering
human growth hormone to children with "idio-
pathic short stature," that is "normal" children
who were of short stature but had no deficien-
cy of the hormone. Short stature is defined as
the lower 3 percentiles for age and sex, which
is roughly two standard deviations below the
29. sex-age means. For adult males it is 64.5 inch-
es or less; for adult females it is 59.5 inches
(NHANES 2000). It is estimated that 1.8 mil-
lion children in the United States and a similar
number in Europe can be characterized with
significant short stature. Only 20 percent of
these are referred to pediatric endocrinologists
and only 5 percent of these are growth hor-
mone deficient (Hintz 1996). The vast majori-
ty of short children therefore can be considered
idiopathic short stature, defined as "a hetero-
geneous state that encompasses individuals
with short stature, including those with FSS
(familial short stature), for which there is no
recognized cause" (Kelnar et al. 1999:151).
The causes of short stature may well be famil-
ial (short parents), genetic, or nutritional, but it
can be seen as "normal shortness" as opposed
to more specific "deficiency shortness."
A national survey of 534 pediatric endocri-
nologists documented that 94 percent of them
had prescribed human growth hormone within
the previous 5 years for children who were not
hormone deficient (Cutler et al. 1996:532).
Genentech and, to some extent, Eli Lilly (who
marketed a similar hormone) worked closely
with the Human Growth Foundation, a non-
profit advocacy group that supported "short
children" (Werth 1991), a more general term
including both hypopituitary dwarfism and
idiopathic short stature. Genentech also sup-
ported research by pediatric endocrinologists
and began its own longitudinal research on
"healthy" children who were not hormone
30. deficient. These activities further blurred the
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166 JOURNAL OF HEALTH AND SOCIAL BEHAVIOR
boundaries demarcating "legitimate" and "off-
label" use of human growth hormone.4 In
2003, the FDA approved Eli Lilly's Humatrope
to treat idiopathic short stature children in the
shortest 1.2 percent of the population, which
will likely accelerate its use in potentially short
children (Kaufman 2003).
There is some evidence that shortness (and
especially extreme shortness) often is a deval-
ued status and can have social consequences,
especially for males. Some researchers have
found social disadvantages of shortness,
including discrimination in hiring and salaries,
assumptions regarding maturity and compe-
tence, issues around self-esteem and perceived
attractiveness, and practical problems such as
buying well-fitting clothes (see Conrad and
Potter 2004). Whatever the real or imagined
disadvantages of shortness, some parents have
anxieties about their children's height. With the
availability of synthetic human growth hor-
mone, parents could consider interventions
that would influence the height of their chil-
dren.
31. At least 13,000 children in the United States
with idiopathic short stature were treated with
human growth hormone in 1994.5 Research on
growth hormone treatment with idiopathic
short children has been equivocal. It is debat-
able how much treatment can increase growth
from predicted height (cf. Hintz 1996). One
major multi-center study, sponsored by
Genentech, reported that of the 80 individuals
in the study who reached final height, the
mean gain from predicted height was 5.9 cen-
timeters in girls and 5.0 centimeters in boys
(Hintz et al. 2000). The height gains are mod-
est; human growth hormone will not transform
a short person into a tall one, but only into a
less short one. Human growth hormone treat-
ment costs about $20,000 a year and must be
continued for three to six years. Parents of
idiopathic short stature children must pay this
out of their own funds, since health insurance
will only cover treatment for hormone defi-
ciency. If the average height gain is two inch-
es, and the average cost is $100,000, the cost of
height enhancement is roughly $50,000 an
inch.
The relative ease with which manufacturers
may promote and physicians may prescribe
human growth hormone for off-label treatment
has increased the range of possible uses
(Conrad and Potter 2004). The Federal Drug
Administration Modernization Act of 1997
eased limitations upon manufacturers, broad-
ening the information that they may provide to
32. physicians about off-label use of their products
(Stapleton 1999). In terms of shortness, the
potential market is considerable, with nearly
four million children in the United States and
Europe who could be defined as having idio-
pathic short stature. This could further increase
the medicalization of short stature.
In Vitro Fertilization and the Medical
Treatment for Infertility
The development of reproductive technolo-
gies has resulted in the medicalization of infer-
tility. In vitro fertilization (or IVF), in which
eggs are abstracted and fertilized and then
implanted inside a woman's uterus, is one such
case. When it was first practiced successfully,
resulting in the conception of the first "test
tube baby" in 1978, in vitro fertilization held
out hope of a technological "fix" to an esti-
mated 7 percent of couples who experience
infertility (Centers for Disease Control 2001).
"Persons now perceive that not only can the
source of infertility be diagnosed, but it can be
treated" (Scritchfield 1995:139), and assisted
reproductive technology "has transformed
infertility into a clinical need" (Bates and
Bates 1996:301).
Yet the medical market for in vitro fertiliza-
tion has remained fairly constrained because
many consumers do not have insurance cover-
age for in vitro fertilization (Neumann 1997).
33. One study found that a minority of plans (14 to
17 percent, depending upon the type of plan)
cover in vitro fertilization (Alan Guttmacher
Institute 1993), and another study found that
30 to 40 percent of in vitro fertilization ser-
vices are covered partially and that insurance
reimburses for about half of the costs when in
vitro fertilization is covered (Collins et al.
1995). At first, health insurers justified their
exclusion of IVF from coverage on two
grounds: efficacy and cost. Initially, success
rates were estimated to be 15-20 percent per
attempt (Kolata 1983), and recent estimates of
success rates range from 32.2 percent for
women under 35 years to 9.7 percent for
women ages 40-41 (Centers for Disease
Control 2001). Insurance companies have
often labeled in vitro fertilization as "experi-
mental," as a result of these relatively low suc-
cess rates. In vitro fertilization is also a fairly
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MEDICALIZATION, MARKETS AND CONSUMERS 167
expensive treatment, costing about $10,000 on
average for one cycle (Wilcox and Rossi
2002), and it often requires multiple cycles to
produce a successful pregnancy, if a successful
outcome is attained at all. Some insurance car-
34. riers provided coverage for assisted reproduc-
tive technology when it first became available
but dropped that benefit (Lang 1998) or decid-
ed to charge extra for in vitro fertilization cov-
erage (The New York Times 1998).
In response to insurers' overall refusal to
cover in vitro fertilization, many middle and
upper-middle class couples pay the cost out-of-
pocket, using their savings and going into sub-
stantial debt. Pamela Madsen, the executive
director of the New York chapter of Resolve,
an infertility support and advocacy group, had
two babies using in vitro fertilization. She
described her difficulty to a reporter:
I'm tapped out, mortgaged out, credit-card-
ed out. And we were lucky. We got our
babies. We still live in a one-bedroom
apartment. We had a nest egg when we got
married; we had health insurance, and the
system wasn't there for us (Lang 1998:12).
Facing looming personal debt from infertili-
ty treatment and substantial resistance from
health insurers, middle and upper-middle class
consumers have turned to litigation and legis-
lation as means of gaining rights to reimburse-
ment for in vitro fertilization. These couples
have made "a claim upon society to guarantee,
through whatever means possible, the capacity
to reproduce" (Blank 1997:281). Thus far, nine
states have passed legislation regulating health
insurance coverage of in vitro fertilization in
response to advocacy efforts by groups such as
35. Resolve (the largest fertility support group in
the United States). Recently, there have also
been some calls for federal legislation to "pro-
tect the insurance rights of infertile couples"
(McKee 2001).
Consumers have also sought health insur-
ance coverage for in vitro fertilization through
the courts, claiming that infertility is an illness
or a disability, but such attempts have had only
limited success. In this arena, consumers and
insurers have wrestled over the medicalization
of infertility and over in vitro fertilization as a
treatment for infertility. The position that infer-
tility is a disease is supported by the American
Society for Reproductive Medicine, which
states that, "infertility is a disease of the repro-
ductive system that impairs one of the body's
most basic functions: the conception of chil-
dren" (American Society for Reproductive
Medicine 2002). Earlier cases in which con-
sumers claimed that infertility is an illness
were sometimes successful (e.g., Witcraft v.
Sundstrand Health and Disability Group
Benefit Plan and Egert v. Connecticut General
Life Insurance Co.). More recent consumer
claims that infertility is a disability, and that
insurers' lack of coverage of in vitro fertiliza-
tion constitutes discrimination under the
Americans with Disabilities Act of 1990 have
had less success in the courts (e.g. Zantanian v.
WDSU-Television Inc. and Krauel v. Iowa
36. Methodist Medical Center).
Insurers have fought hard against claims of
infertility as an illness or a disability, making
three main defenses: "(1) infertility is not an
illness; (2) artificial reproductive technology
(ART) is not medically necessary; and (3)
ARTs are experimental" (Gilbert 1996:44).
Regarding infertility as an illness, "some argue
that infertility is sought by some couples and
suffered by others. Therefore, it is a socially
constructed need-not a medical need" (Bates
and Bates 1996:301). Nonpregnancy is not an
illness. Some insurers have argued that infer-
tility treatment is elective and does not cure
any sickness or disease (Tischler 1994). The
medical necessity argument has been used to
exclude in vitro fertilization from coverage by
drawing attention to the social aspects of infer-
tility and uses of IVF. Some contend that this
argument is used to control in vitro fertiliza-
tion's fiscal impact on insurers (Hughes and
Giacomini 2001), restricting the use of in vitro
fertilization to a small number of cases in
which the source of infertility problems can be
specifically pinpointed and addressed. For
example, the use of in vitro fertilization to
bypass blocked or damaged fallopian tubes is a
very specific, medical use of the technology.
The use of in vitro fertilization to address
infertility associated with age or to help single
or lesbian women have biological children is
more social. This medical necessity argument
has had some success in the courts (e.g.,
37. Kinzie v. Physicians Liability Insurance
Company 1987).
Even with a few successful court cases,
insurers in general have not accepted con-
sumers' claims that infertility is a disease or
disability and have not increased coverage. As
a result, many consumers must still pay out-of-
pocket for in vitro fertilization services, and
some fertility clinics have turned to creative
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168 JOURNAL OF HEALTH AND SOCIAL BEHAVIOR
financial arrangements to increase the private
market for their services. These arrangements
offer money-back guarantees or substantial
refunds if patients do not get pregnant or if
they miscarry early in the pregnancy
(Hamilton 1996; Wilcox and Rossi 2002;
Wozencraft 1996).
The private market for in vitro fertilization
appears to be here to stay. Physicians are drawn
to reproductive medicine because of the "cut-
ting edge" nature of the work, as well as the
potential for commercial profit (Brody 1987).
In vitro fertilization clinics advertise using
Internet websites with links to finance compa-
nies to help pay for the procedure. Consumers
who wish to have biological children are drawn
38. to technological solutions to infertility. Yet the
consumer demand for in vitro fertilization and
other reproductive technologies is constrained
by insurers' refusals to pay for such services,
except under specific "medical" circum-
stances. This has resulted in the creation of a
private medical market for consumers who can
afford to pay for in vitro fertilization or who
are willing to take on significant debt to do so.
DISCUSSION
We have described four cases where the
development of medical markets facilitated
medicalization, and we have identified two
forms of medical markets: mediated and pri-
vate markets. We outline the main attributes of
these markets in Table 1. In mediated markets,
corporate medical producers attempt to
increase demand for their products by promot-
ing directly to consumers and providers, with
the market mediated by health insurers and
managed care organizations. Consumers
become the target for market expansion, with
physicians largely remaining as gatekeepers
prescribing treatment.6 In private medical mar-
kets, due to limits in types of promotion per-
mitted (e.g., for off-label uses), corporations
promote indirectly to providers or consumers
(e.g., on the Internet). Consumers are the
prime driver for demand, generally without
39. insurance support, and must pay directly for
medical products or services. Physicians are
necessary facilitators for treatment but are
sometimes promoters (i.e., entrepreneurs) for
the product as well (e.g., cosmetic surgery).
There may be a tension between restricted
access to health care and the expansion of
mediated and private markets. Private markets
tend to emerge when insurers define a problem
or treatment as not medically necessary and
therefore not subject to third party reimburse-
ment. Thus insurers here attempt to constrain
access to medicalized solutions by refusing to
cover particular treatments or services. These
markets are not fixed; given changes in pro-
motion, insurance coverage, or consumer role,
private markets could become mediated mar-
kets and vice versa. In operation, such markets
are more on a continuum than mutually exclu-
sive in their attributes.
A key to all markets is the existence of a
medical product and consumer demand. In
some cases, the pharmaceutical companies
develop strategies to expand their markets
(e.g., Viagra and Paxil), while in others the
markets are more consumer-driven. Table 2
outlines the different modes of promotion and
their relation to medicalization.
In two cases the development of medical
markets is primarily corporate driven. Viagra
and Paxil are promoted by pharmaceutical
companies through direct-to-consumer adver-
40. tising, but the goals and means differ. With
Viagra, the goal is to increase the appeal of the
product to a wider population. When first
introduced, Viagra was aimed at older men or
others with established erectile dysfunction.
However, in recent years much of the advertis-
ing has been aimed at a younger and broader
population, with the implicit message that
TABLE 1. Comparison of Mediated and Private Markets
Relation to Mediated Markets Private Markets
Corporate Direct promotion to providers and consumers
Indirect promotion to providers via off-label
(direct-to-consumer advertising) use or consumers on the
Internet
Insurers Problem is generally covered by insurance with
Problem is not covered
relatively flexible criteria by insurance or only covered under
strict
medical criteria
Consumers Targeted for market expansion Promoter of market
expansion
Physicians Gatekeeper, with authority to define problem
Facilitator, with authority to define problem
and prescribe treatment and prescribe treatment
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41. MEDICALIZATION, MARKETS AND CONSUMERS 169
TABLE 2. Promotion of Medical Markets and Medicalization
Product Promoter Goal Means Medicalization
Viagra Corporate Driven Create new populations Direct-to-
consumer Expands diagnosis of
for product advertising to younger erectile dysfunction
and "virile" types
Paxil Corporate Driven Create new problems for Direct-to-
consumer "dis- Promotes disorders of
approved product ease awareness cam- SAD and GAD
paign"
Human Consumer and Expand product to non- Secure "off-
label" use of Makes short stature into
Growth Corporate Driven FDA approved uses product a
medical problem
Hormone
In Vitro Redefine infertility into Seek right to treatment
Further medicalizes
Fertili- Consumer Driven a health problem so through
legislation infertility
zation technology is covered and litigation
by health insurance
Viagra can help them too with whatever sexual/
performance problems they may have. This
market expansion means offering a medical
42. solution to a wider range of mild or transitory
erectile problems. The promoters of Paxil, on
the other hand, want to differentiate their drug
from others on the market. After getting FDA
approval for new uses, GlaxoSmithKline
developed a direct-to-consumer "disease
awareness campaign" to "alert" consumers
that they might have a diagnosable problem
(e.g., SAD) and that Paxil could be the right
choice for them. This encourages people to
redefine their life difficulties in medical terms
and creates a further demand for the product.
In both cases the advertising aims to increase
the consumer demand for the medical treat-
ment product. Increased medicalization is a
by-product.
Human growth hormone can be seen as
jointly corporate and consumer driven. While
there was no direct corporate product advertis-
ing to consumers, Genentech had to pay a $50
million settlement for "overpromoting" human
growth hormone to medical practitioners for
treating unapproved conditions (including
idiopathic short stature) (Nordenberg 1999). It
is unclear how much the promotion to doctors
and hospitals stimulated the development of
the medical market for growth hormone, but is
safe to assume it had some effect. Genentech
and other pharmaceutical companies support
consumer groups that promote hormone inter-
ventions for idiopathic short stature, but con-
sumer groups are the primary advocates for
43. human growth hormone treatment (Conrad and
Potter 2004). For in vitro fertilization, con-
sumers are the main proponents pressuring for
insurance coverage. Through organizations, lit-
igation, and legislation, consumers are striving
to achieve medical legitimacy for all kinds of
infertility so that third parties will pay for
treatment. When human growth hormone for
idiopathic short stature and in vitro fertiliza-
tion for infertility are not covered by health
insurers, consumers must pay for these ser-
vices out-of-pocket, creating a private medical
market. This type of market has all the charac-
teristics of any private market: Those who can
afford to pay can acquire the services.
Medical markets can change, based upon
whether insurers deem the product to be a
medical necessity and cover a service or drug.
The in vitro fertilization debate clearly turns
on whether infertility treatment is medically
necessary; consumers say it is and should be
covered by insurance while insurers claim hav-
ing children is a social choice, not a medical
one. We see medical necessity reflected in the
human growth hormone and Viagra cases as
well, even if the term is not typically applied.
Consumer advocates claim that human growth
hormone is a medical necessity since medical
treatment could mitigate the suffering, stigma,
and discrimination due to the biological limita-
tion of extreme shortness. Is the treatment of
erectile dysfunction a medical necessity? In
terms of insurers, the answer is, "sort of."
44. When insurers cover the cost of Viagra, they
often limit it to four to eight pills a month.
Does this mean sexual intercourse is a medical
necessity four to eight times a month?
It is also possible to see some uses of human
growth hormone, Viagra, Paxil and in vitro fer-
tilization as biomedical enhancements rather
than treatments. While there are certainly med-
ically legitimated uses for each of these drugs
and procedures, some uses may constitute
enhancement rather than treatment.
Biomedical enhancements are medical inter-
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170 JOURNAL OF HEALTH AND SOCIAL BEHAVIOR
ventions used to improve physical or mental
characteristics or performance in those with no
identifiable pathology. Adding a few inches of
height to one's child, insuring strong erections,
increasing one's social abilities, or having a
biological child might all be improvements
that could be sought by many individuals. One
need not have a disorder to benefit from these
medical interventions. Peter Kramer (1993)
claimed that Prozac can make people "better
than well." There has been some debate in the
45. bioethics literature about a distinction between
therapy and enhancement, but medicalizing
human problems creates a slippery slope
between enhancement and legitimated medical
treatment (Conrad and Potter 2004).
While erectile dysfunction, anxiety, short
stature, and infertility surely can impact peo-
ple's lives to varying degrees, they are not life-
threatening conditions nor even major health
risks. Anti-hypertensive or cholesterol reduc-
ing drugs associated with cardiovascular dis-
ease are also widely promoted, but for a well
established medical problem. While prevention
of disease is a major market for drugs and
interventions, the relatively common problems
of life, on the margins of medicine, hold the
greatest potential for market expansion and
medicalization.
The role of physicians as "providers" is
changing in the current medical marketplace,
with some areas shifting more than others.
With off-label uses of drugs like human
growth hormone for idiopathic short stature,
physicians play a facilitating role in the mar-
ket. It is a physician's prerogative to prescribe
medications for uses beyond those approved by
the FDA. Doctors commonly prescribe drugs
for unapproved uses if, in their judgment, the
drug would be an effective treatment for a
patient's problem. Similarly, technical inter-
ventions such as in vitro fertilization would be
totally unavailable without physician involve-
46. ment. Thus physicians still have an important
central role in facilitating medical markets,
especially in private markets.
But the physician's role is challenged on
other fronts, particularly with direct-to-con-
sumer advertising undermining physicians'
authority regarding which drugs to prescribe.
Physicians have always been the major conduit
between the pharmaceutical industry and
patients (which is why the pharmaceutical
industry spends billions of dollars advertising
and promoting their wares to physicians).
Physicians in the past have provided prescrip-
tions in response to patients' direct requests,
even when the scientific knowledge suggested
that it was not appropriate, because they wor-
ried about economics and their professional
image and because they wanted to respond to
patients' requests for help (Schwartz,
Soumerai and Avorn 1989). But direct-to-con-
sumer advertising has increased consumers'
role in the prescribing equation. While physi-
cians remain the gatekeeper to these drugs,
reflected in most direct-to-consumer ads end-
ing with a statement like, "ask your doctor if
Paxil [or Viagra] is right for you," there is
increased pressure to respond to consumers'
independent requests for medications. In the
context of current debates regarding chal-
lenges to physicians' professional knowledge
(Timmermans and Kolker 2004), it appears
that pharmaceutical manufacturers are circum-
venting physicians' control over knowledge
47. regarding available drugs.
Insurers as "payers" exert a strong influence
on medical markets. In the context of the
examples presented here, insurers including
HMOs set the limits on some medical markets,
thus acting as a constraint on access to med-
icalized solutions to human problems. This is
particularly clear with in vitro fertilization,
where insurers' definition of the treatment as
"experimental" and their refusal to cover it
except in very specific diagnostic situations
has limited in vitro fertilization to those who
could afford to pay for it. Insurers will only pay
for human growth hormone for children with a
diagnosed growth hormone deficiency; idio-
pathic short stature children only receive treat-
ment if their families can pay for it. Few can
afford the tariff. Even with Viagra, some insur-
ance plans don't cover this treatment for erec-
tile dysfunction, while others limit the use. It
has long been an axiom in medicalization stud-
ies that the only way to get human services
paid for is to turn life difficulties into medical
problems. Yet under managed care insurers are
responding to this medicalization by restricting
payment for these services. Insurance con-
straints do not necessarily affect the conceptu-
al level of medicalization but they constrain
access to medicalized solutions at the patient
level (Conrad and Schneider 1980)7. By
restricting access to medical solutions in the
48. name of "medical necessity" insurers attempt
to limit individuals' claims that they are suffer-
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MEDICALIZATION, MARKETS AND CONSUMERS 171
ing from illnesses rather than everyday life
(Sabin and Daniels 1994).
Consumers have a dual role related to med-
ical markets. In some instances the market for
a problem exists long before any medical pro-
motion. Individuals have been seeking nos-
trums to improve sexual performance or votive
objects to insure fertility for centuries, while
short people have often tried to appear taller
(think elevator shoes and high heels). In a
sense, there is a ready-made market demand
for a product. Consumers and medical interests
are already allied, and consumers may become
the dynamic force for market creation. In other
cases, the public constitutes potential con-
sumers who must be shaped into a market. This
involves persuading consumers of the necessi-
ty or utility of a product offered or creating
consumer demand. Direct-to-consumer adver-
tising for Paxil exemplifies this, although it is
partly true for Viagra as well. Such promotion
can induce people to self-label their problems
49. as medical entities and seek more medical ser-
vices. This medical commodification shifts
both definition and solution into the medical
sphere.
Recent changes in FDA regulations allow
for a different kind of drug marketing by loos-
ening off-label provisions and enabling televi-
sion advertising of prescription drugs, facili-
tating the emergence of new medical markets.
Broadcast ads can now name the disorder and
the drug, so long as they include limited risk
and benefit information (Lyles 2002). As
noted, corporate pharmaceutical spending on
television advertising increased six-fold from
1996 to 2000, and ads for products such as
Paxil and Viagra have become common.
Off-label uses of FDA approved drugs is one
of the easiest routes to the expansion of med-
ical markets. Once a drug has been approved
for one use or population, it can be prescribed
for broader purposes. Ritalin is approved for
childhood ADHD, but for the past decade it has
been used widely with adults (Conrad and
Potter 2000). Provigil (modafinil) is approved
for sleep disorders, such as narcolepsy and
hypersomia, but in its direct-to-consumer
advertising, Cepahlon, the manufacturer, has
touted that the drug can drastically reduce the
amount of sleep required without affecting
performance (Wolpe 2002). While drug com-
panies have been limited in their advertising
for off-label uses, FDA regulations allow for
50. considerably more latitude in promotion.
Manufacturers will likely promote off-label
applications to the extent legally permitted,
perhaps expanding diagnoses (Conrad and
Potter 2000) and further medicalization.8
Medicalization narrows the definition of
health and widens the definition of sickness.
The direct-to-consumer advertising focuses on
"help seeking" advertisements (Lyles 2002),
which try to create an "awareness" of symp-
toms or conditions among consumers.
"Consumer education campaigns" are used to
introduce new products or extended applica-
tions, essentially bringing new people into a
market by creating a previously unrecognized
demand for a product (Applbaum 2000). The
marketing of Viagra expands the bounds of
erectile dysfunction, implying that it is not
"healthy" or "normal" to have variation in
penile erections. Paxil ads emphasize that it
may be pathological to be anxious or shy in
social situations and that this can be changed
by using the drug. Employing human growth
hormone to treat short stature indicates a nar-
rowing of the range of normal height as well as
reinforcing the notion that shortness is deviant
and undesirable, and that it should be altered.
The marketing of Paxil, Viagra and, to a lesser
degree, human growth hormone targets rela-
tively healthy people. Drug companies' search
for markets creates broader disease definitions
51. for their products, indirectly reducing what is
"normal."
CONCLUSION
We highlight the increasing importance of
pharmaceutical companies, insurers, and con-
sumers for medicalization as they are involved
in the creation of medical markets. The med-
ical profession has a diminished but still key
role in medicalization. Given the changes in
medicine and its organization, important are-
nas of medicalization are moving from profes-
sional to market domains.
It is not new knowledge or technology that
engenders medicalization but how they are
used. Corporate and medical promotion of
products, treatments, and drugs underlies the
emergence of new medical markets. With our
corporatized medical-industrial complex, the
creation or expansion of medical markets
becomes an important conduit to medicaliza-
tion. Consumer demand is not simply unfet-
tered desire for medical solutions, but it is
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172 JOURNAL OF HEALTH AND SOCIAL BEHAVIOR
shaped by the availability and accessibility of
52. medical interventions. This creates a new set of
relationships among corporate entities, insur-
ers, physicians, and consumers.
In the context of the changing balance of
power among the medical profession and relat-
ed institutions, the engines of medicalization
are found in the marketplace nexus of the
biotechnology industry and rising con-
sumerism. The brakes take the form of insur-
ers, including private and government spon-
sored managed care. As corporate entities and
consumers pursue the goals of promotion or
reception of new medical interventions, we are
likely to see the development of new medical
markets along with a growing pressure to med-
icalize the troubles and problems of everyday
life.
NOTES
1. According to the DSM, the diagnostic crite-
ria for SAD include: a marked and persis-
tent fear of social or performance situations
in which embarrassment may occur, an
immediate anxiety response, a recognition
that the fear is excessive or unreasonable,
avoidance of the situation or endurance
with dread, interference with daily routine
or marked distress about the phobia, and the
fear not being due to substance effects or
other conditions (American Psychiatric
Association, 1994:411).
53. 2. Professional medicine has long approved of
off-label uses of drugs. In 1999, the
American Medical Association approved a
position statement (Resolution #528), intro-
duced by the Society of Cardiovascular and
Interventional Radiology, on off-label use
of devices and medications. In summary,
the AMA permits physicians to decide what
to prescribe for their patients and for what
medical conditions, because physicians are
best able to base these decisions on "current
clinical standards and not just FDA-
approved indications."
3. Criteria include (1) height of less than three
standard deviations below the mean for a
child's age and sex, (2) abnormal growth
velocity (less than 25th percentile for bone
age), and (3) growth hormone provocative
testing results with peak growth hormone of
less thanl0 (g/L in a polyclonal radioim-
munoassay (Bercu 1996). It is this latter cri-
terion that has produced the most contro-
versy (Lantos et al 1989; Bercu 1996). For
example, peak growth hormone levels
between 7 and 10 are considered a "gray
zone," and different methods of assessing
growth hormone levels produce varying
results (Lantos et al. 1989).
4. In 1994, several federal agencies began a
series of investigations targeting Eli Lilly
54. and Genentech for overpromoting their
growth hormone products, that is, market-
ing them for non-approved uses (for details,
see Conrad and Potter 2002). The FDA
alleged and documented that, by the end of
1985, Genentech had "begun marketing
Protropin for use in the treatment of med-
ical conditions for which it did not have
FDA approval" (Nordenberg 1999:33).
From 1985 to 1994, Genentech marketed
Protropin to a variety of medical practition-
ers (doctors, hospitals, and others) for treat-
ing unapproved conditions, including idio-
pathic short stature (Nordenberg 1999).
Genentech paid $50 million in settlement,
including a $20 million penalty to reim-
burse Medicaid and CHAMPUS
(Nordenberg 1999).
5. This is an extrapolation. In 1994, about
7,000 children were believed to suffer from
short stature due to human growth hormone
deficiency but 20,000 children were treated
with human growth hormone (Biotechology
News, 1994). Therefore at least 13,000 chil-
dren were treated for idiopathic short
stature that year.
6. There is increasing advertising on the
Internet for Viagra, human growth hor-
mone, and other prescription medications.
While it is assumed that a doctor must eval-
uate the short forms consumers need to
55. complete before ordering medications, the
wide availability of medications through the
Internet sources compromises the physi-
cian's gatekeeper role.
7. Some have suggested that direct-to-con-
sumer advertising is in part a reaction to
managed care. Lyles (2002) notes that,
"managed care controls that limit the physi-
cian's prescription authority also reduce the
potential of promotional activities targeting
physicians; consequently pharmaceutical
companies have responded by seeking alter-
native ways to influence physician prescrib-
ing" (p. 27).
8. A recent case illustrates this. Parke-Davis, a
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MEDICALIZATION, MARKETS AND CONSUMERS 173
major pharmaceutical company, developed
a marketing strategy to promote their
epilepsy drug, Neurontin, for four off-label
uses. The company estimated it could earn
$150 million by promoting the drug to doc-
tors for social phobias, panic disorder, bipo-
lar illness, and neuropathic pain in journals
and at medical conferences rather than
embarking on the clinical trials and lengthy
56. process of seeking FDA approval. 80 per-
cent of the prescriptions for Neurontin are
for off-label uses. U.S. sales for 2002 are
estimated as $2 billion. The company
claims it was only distributing materials for
educational purposes, but critics saw it as
an unethical form of marketing (Kowalczyk
2002).
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Peter Conrad is Harry Coplan Professor of Social Sciences at
Brandeis University, where he is also Chair
of the Health: Science, Society and Policy program. He has
published numerous books and articles and is
currently completing a book on the medicalization of society.
Valerie Leiter is Assistant Professor of Sociology and Director
of the Society and Health Program at
Simmons College. Her work focuses on the social construction
of childhood disability and the provision of
health and therapeutic care to children with disabilities.
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