health/medicine

PBS has a gallery of images of oral contraceptives that provides a nice illustration of the way product design can be used as a form of behavior modification, while also needing to adapt to the way people actual use products — or forget to do so, the ever-present problem with the pill.

Initially , the pill came in bottles, like other prescriptions:

Notice the bottle contains 100 pills; there was no effort to package it into quantities for a single month. Women were supposed to take 20 pills in a row, then none during their period. It was up to them to keep track of everything and remember when it was time to start taking the pills again.

In 1962, an engineer created a prototype of a dispenser pack, designed to hold exactly a month’s worth of pills and help women remember to take them correctly:

The first contraceptive in a pack of this type, Dialpak, appeared the next year; oral contraceptives packaging has been designed to help women remember to take them accurately ever since. This became a major selling point, with Dialpak 21 even offering a small calendar you could attach to a special watch band so you could more easily keep track of whether you’d taken the pill:

In 1965, Eli Lilly introduced a new packaging design, with differently-colored pills arranged in a sequence; however, it didn’t label the days of the week, so it didn’t help women figure out if they’d remembered to take their pill on any given day:

Norinyl came in a package that took the sequential design but added several features that enhanced compliance. An extra pill was added, so that pills with active ingredients were taken for 21 days, not 20. Then a row of placebo pills were added so that women took a pill every day of the month, so they were less likely to forget to start a new pack:

When we think about the emergence and success of the pill, we tend to focus on the product itself. But the packaging tells an interesting story on its own. The pharmacological effectiveness of oral contraceptives meant little if women forgot to take them reliably. The design of the packaging helped play a crucial role, increasing users’ ability to follow the prescribed schedule.

Today, there’s an entire trade organization, the Healthcare Compliance Packaging Council, dedicated to promoting attention to the design of packaging as an important element in all areas of healthcare. The pill was the first prescription drug sold in a so-called “compliance pack,” serving as an example of the potential effectiveness of packaging design as a way to encourage patients’ conformity to prescribed medication regimens.

This photograph is of the Love Canal neighborhood in Niagara Falls, New York, where Hooker Chemical (now Occidental Petroleum Corporation) buried 21,000 tons of toxic, chemical waste:
In 1953, Hooker Chemical sold the land that they had been using for toxic waste disposal to the Niagara Falls School Board for $1. The sale deed contained warnings about the chemical waste and a disclaimer of liability. However, planners hastily built schools and homes on the contaminated land to accommodate the city’s growing postwar population. By the late 1970s, residents were reporting a litany of illnesses and birth defects. Scientists discovered high levels of carcinogens in the soil, groundwater, and air. The community mobilized to bring attention to the situation, and President Carter declared a federal health emergency in the area.
Elizabeth Blum, a professor of history at Troy University, has written about the environmental activism of Love Canal residents. Such activism, called “popular epidemiology,” attempts to link spikes in localized health issues to their origins. Despite such grassroots movements, though, the media tends to show little interest in the causes of cancer and greater interest in finding the cure.

The many “Stand Up to Cancer” ads, for example, urge people to donate money (or just use their credit card for purchases) to help fund the development of cancer treatments:

When media attention is focused on the causes of cancer, it usually takes an individualistic tone. Risk factors (smoking, poor diet, etc.) are blamed for various forms of cancer.

The thing is: there’s no money in prevention.

Mainstream media outlets have a vested interest in not exposing the causes of cancer.  The companies that pay to advertise on their channels, and often their parent companies or subsidiaries, often traffic in known carcinogens. Pharmaceutical companies, likewise, have a perverse incentive. Healthy people make them no money, neither do dead people; sick people though, they’re a goldmine.  Many organizations, including the multi-million dollar Susan G. Komen Foundation, are in the business of raising money “for the cure,” more so than prevention.

The politics of cancer, then suffer from the individualism characteristic of modern American and capitalist imperatives, leaving the causes of the cancer epidemic invisible and, accordingly, the unethical and illegal behavior of companies like Hooker Chemical.

Dan Rose is an assistant professor of sociology at Chattanooga State Community College in Tennessee.  His research focuses on medical sociology and health inequalities in minority neighborhoods.

Lisa Wade, PhD is an Associate Professor at Tulane University. She is the author of American Hookup, a book about college sexual culture; a textbook about gender; and a forthcoming introductory text: Terrible Magnificent Sociology. You can follow her on Twitter and Instagram.

In an earlier post we reviewed research by epidemiologists Richard Wilkinson and Kate Pickett showing that income inequality contributes to a whole host of negative outcomes, including higher rates of mental illness, drug use, obesity, infant death, imprisonment, and interpersonal trust.

She summarizes these findings in this quick nine-minute talk at a Green Party conference:

See Dr. Pickett making similar arguments as to why raising the average national income in developed countries doesn’t make people happier or enable them to live longer, why unequal societies are more violent, and how status inequality increases stress.

And see more about income inequality and national well-being at Equality Trust.

Lisa Wade, PhD is an Associate Professor at Tulane University. She is the author of American Hookup, a book about college sexual culture; a textbook about gender; and a forthcoming introductory text: Terrible Magnificent Sociology. You can follow her on Twitter and Instagram.

Last week, as most of you no doubt heard, the Susan B. Komen for the Cure breast cancer awareness group announced it would no longer fund breast cancer screenings at Planned Parenthood, saying it had a policy against funding organizations that were under investigation (Planned Parenthood is currently under what many see as a politically-motivated investigation about whether it used any federal funds to pay for abortions). The decision drew a lot of attention and criticism of Komen — not just of the decision about Planned Parenthood, but of its role in the breast cancer awareness/research community more generally.

The Komen Foundation is known to many primarily because it’s often listed as a recipient of the funds companies promise to donate when we buy products branded with a pink ribbon. But many critics express concern with this type of marketing-as-awareness, and discussions of the “pinkification” of breast cancer and criticism of the policies supported by groups such as Komen surfaced as part of the debate about the organization over the weekend (which is ongoing, with the VP for Public Policy at Komen announcing her resignation today).

Given this, Dmitriy T.M. thought readers might be interested in the trailer for the documentary Pink Ribbons, which looks at the rise of pink ribbon branding and its impact on breast cancer prevention efforts. I post it with the caveat that I haven’t been able to see the whole film, but would love to hear from those of you who have, or who can speak to the issues it raises:

Dmitriy T.M. sent in a TED talk in which Ben Goldacre discusses the problems with many of the scientific findings we hear about in the media, highlighting the importance of scientific literacy and critical consumption of science reporting:

And while we’re on the topic of potentially misleading statistics, Dolores R. and Sarah E. sent in an image posted at boing boing as one of “the best set of infographics ever,” helpfully illustrating the difference between correlation and causation:

Amy H. sent in a link to a Pew Research  Center report on age and economic well-being in the U.S. The results indicate that over time, the economic situation has generally improved for older individuals in the U.S. Those over age 65 are much less likely to be poor today than they were a few decades ago, for instance:

Why the dramatic reduction beginning in the late 1960s? One important factor is the role of public policy. In 1965, the U.S. passed legislation establishing Medicare, which greatly increased access to medical care for the elderly regardless of income. Medical costs had previously been a major drain on savings; a significant illness could quickly eliminate a lifetime’s savings. Medicare reduced the risk posed by medical expenses and the percent of income spent on health care among the elderly.

Today, retirement-age Americans have significantly higher net worth than those under age 35, and the gap has widened since the 1980s. The younger age group actually lost ground, with a lower median net worth in 2009 than in 1984:

Of course, we expect individuals to become better off economically over time as they settle into jobs, save for retirement, perhaps pay off a home so that housing expenses go down. But the improving economic well-being of older Americans isn’t just a natural outcome of the lifecourse; it reflects changing public policies that have over time increasingly allowed the elderly to access medical care and other services without impoverishing themselves in the process.

In this 8 1/2 minute talk, sent in by Dmitriy T.M., AJ Jacobs recounts his efforts to perfectly follow every single piece of health advice he encountered.

Lisa Wade, PhD is an Associate Professor at Tulane University. She is the author of American Hookup, a book about college sexual culture; a textbook about gender; and a forthcoming introductory text: Terrible Magnificent Sociology. You can follow her on Twitter and Instagram.

The Physicians Committee for Responsible Medicine (PCRM) sponsored two new billboards in Albany, NY, warning residents that cheese makes you fat in what is possibly most irresponsible way ever. The first features an obese man’s disembodied torso and the words, “Your abs on cheese.” The second features an obese woman’s butt and thighs and the words, “Your thighs on cheese.” The images make a very clear statement: fat people are disgusting.
The PCRM advocates for a vegan diet. The aim of this campaign is to get Albany residents to reduce their cheese intake, as cheese is a common source of saturated fat and, according to the PRCM, a major contributor to obesity in the United States. In Albany, home to several dairy farms, 63 percent of adults are obese. This is higher than the statewide obesity level of 59 percent. Obesity prevention is a valid cause, to be sure, but at what cost to other health issues?

According to their website, the PCRM is “a nonprofit health organization that promotes preventive medicine, conducts clinical research, and encourages higher standards for ethics and effectiveness in research.” For an organization so concerned with ethical standards, the PCRM has sunk pretty low with this offensive and damaging campaign. In the jargon of health communication ethics, the PCRM have committed a common and classic misstep: the failure to consider the unintended consequences of their message.

Just like a single food item (in this case, cheese) is not responsible for the entire obesity epidemic, obesity is not the only serious health problem facing Americans. We are also struggling with our body image and self-esteem as we cope with the barrage of photoshopped and unrealistic “ideal bodies” in the media. The National Eating Disorders Association states that “in the United States, as many as 10 million women and 1 million men are fighting a life and death battle with an eating disorder such as anorexia or bulimia. Millions more are struggling with binge eating disorder.”

In the medical hegemony, physical health tends to outrank mental health in “importance.” But the line between physical and mental health issues is not always clear, especially with the confluence of obesity, body image disturbance, eating disorders, and self-esteem. The PRCM is wearing blinders to these interrelated health issues in their dogmatic pursuit of a singular, isolated objective.

Physicians are taught to “do no harm.” The PRCM needs to understand that insensitive words and pictures are absolutely harmful to our health. There are better ways to educate and motivate people to make healthier food choices; ethical health campaigns do not sacrifice one health issue to promote another.

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Leah Berkenwald is a graduate student of Health Communication at Emerson College, in collaboration with the Tufts University School of Medicine, and holds a MA in American Studies from the University of Nottingham. She is currently designing a social marketing campaign on body image for the Massachusetts Institute of Technology. She also works as the Online Communications Specialist at the Jewish Women’s Archive, and blogs at talkinreckless.com.

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