public health

Prescription Drug Use on the Rise

Caty Taborda on November 11, 2015
Taki Steve, Flickr CC.
Taki Steve, Flickr CC.

A study published earlier this month in the Journal of the American Medical Association (JAMA) reports that over half of adults in the United States use prescription drugs, and as many as 15% of adults report using more than five prescription drugs each month. Recent coverage of these findings at NPR explores how increases in obesity and obesity-related illnesses may contribute to the increase in prescription drug use. Several sociological studies provide other potential explanations, including the increasing influence that pharmaceutical companies have over the doctor-patient relationship.

Though physicians are the ultimate gatekeepers for prescription drugs, the pharmaceutical industry drastically shapes prescription drug use. Through internal research studies and trials, pharmaceutical companies produce new knowledge about illnesses and treatment options. Pharmaceutical companies can even play an increasing role in medicalization—the process of constructing issues as specifically medical problems. By promoting the idea that something is a medical problem, pharmaceutical companies then offer a solution. Pharmaceutical salespeople aggressively promote their wares to clinicians, even promoting the off-label use of drugs to increase distribution.
Direct-to-consumer advertising may also lead to increase prescription drug use. Patients who see such ads may be more likely to self-diagnose and directly request drugs, and patients who request medication (whether a specific drug or just drug treatment in general) are more likely to be prescribed medication. Despite the potential for over-prescribing, direct-to-consumer advertising also encourages positive interactions between patients and physicians by providing patients with more information about current and undiagnosed conditions.

Vexed by Vaccination Refusals

Caty Taborda on February 9, 2015

As the outbreak of measles in Southern California continues its spread, public health officials have turned their attention toward the rising number of parents forgoing vaccinations for their children. Once based on the now discredited study linking vaccines to autism, the choice not to vaccinate is now considered an issue of individual choice, albeit one made at the expense of public health.

Vaccinating has become highly politicized. With conflicting information about potential side effects and the increase in mandated vaccines, some parents have grown anxious and distrustful—they are now known as “anti-vaxxers.”
Social networks and institutions help distrust spread. For instance, you can’t “catch” autism from other people, but as parents near each other share information and experiences, the chances that a child will be diagnosed with autism increases.
When parents who distrust medical advice about vaccines consider other parenting practices, such as breastfeeding and nutrition, they also seek out institutions like private schools, which are more friendly to alternative choices. The parents’ networks are thus made smaller.
Although anti-vaxxers are not necessarily motivated by religious values, sociologists study how multiple sources of authority, such as religious and political affiliations, impact scientific distrust and result in deeply held personal beliefs that may place facts and values at odds.

Foraging in the Urban Jungle: Food Security and Homelessness

Matt Gunther on October 28, 2014

According to a new report making headlines this week, 21 American cities have passed laws designed to stop residents from sharing food with homeless people since 2013. The finding, which comes from the National Coalition for the Homeless, highlights an increasingly popular belief that hunger motivates troubled individuals to make lifestyle changes. Food aid, in this view, keeps the homeless complacent. In an interview with NPR, one consultant argued that “Street feeding is one of the worst things to do… it’s very unproductive, very enabling, and it keeps people out of recovery programs.” Many city officials quoted in the report have extended this line of thinking to community soup kitchens and food pantries as well. They see those offerings as well-intentioned, but ultimately misguided attempts to help. One, a police captain from Cincinnati, remarked “If you want the bears to go away, don’t feed the bears.” Research shows this isn’t the case, and these attitudes may actually harm people experiencing homelessness.

Social scientists have amassed a great deal of knowledge about the connection between homelessness and hunger. Over and over, they’ve shown that people with stable food access tend to fare better in other aspects of life.
More importantly, these people aren’t animals and homelessness is no mere matter of individual laziness or poor choice. A number of well known structural factors cause and sustain homelessness, including social stigma, poor access to affordable housing, limited employment opportunities, mental health factors, and physical disabilities.

For more on homelessness, check out TROT posts on last year’s polar vortex and this year’s VMAs.

Ebola and the Epidemic Mindset

Evan Stewart on August 5, 2014

While President Obama is hosting an economic summit with African leaders this week, the Ebola outbreak is overshadowing major economic news. Experts argue that the epidemic can be curbed, but note rampant distrust toward aid organizations in rural communities makes treatment and prevention difficult. Social scientific research helps explain how media and governments shape the way citizens respond to outbreaks.

We usually think media fans the flames of mass panic, but research on previous Ebola shows media sources actually turn toward a “containment” narrative, emphasizing that it’s hard to catch Ebola and the outbreak is “somewhere else.”
It isn’t that local communities “don’t understand” that aid workers are there to help. Epidemics often manufacture misunderstandings and mass panic. Recently, in New York City’s Chinatown, Asians were “stigmatized during the SARS epidemic despite having no SARS cases.”
Political context also matters, including the actions of national governments and international NGOs. Comparative work on Uganda and South Africa’s approaches to HIV/AIDS has shown top-down strategies don’t calm the infection rate. Bottom-up approaches, like changing hygiene behaviors, are more effective at the local level. However, this tactic requires an environment of “representation and democratic participation” that governments and international organizations have to build and frame.

Religion, Reproduction, and the Supreme Court

Jacqui Frost on July 16, 2014

The recent Hobby Lobby, and subsequent Wheaton College, Supreme Court rulings that exclude organizations with “sincere religious objections” from the Affordable Care Act’s birth control mandate have raised a plethora of fears and heated commentary about access to birth control, women’s rights, and the slippery slope of religious exemption. Sociological research, however, suggests that this ruling’s infringement on access to reproductive services and women’s rights is far from straightforward.

The language of birth control mandates varies by state, and the more ambiguously worded the mandate, the less likely there is to be a challenge. Instead, it is the more precisely worded statutes that have prompted court cases, as they allow for less interpretation and compromise.
The moral framing of religious exemption cases is key to making them effective. When actors frame an issue in moral terms, as opposed to scientific or technical, their arguments are usually too divisive to be completely adopted, however, they are often able to thwart their opponents by defining an issue in ways that make it difficult for legislators to support progressive causes.
A woman’s access to birth control is not only influenced by her insurance policy or the religion of her employer. Race, class, and cultural understandings of what it means to be a “responsible reproductive subject” all play a role in why women seek reproductive services such as birth control, infertility treatment, and abortion, as well as which services they are more likely to have access to.

For more on the Hobby Lobby decision and the history of birth control in the U.S., check out these great pieces by fellow sociology bloggers families as they really are and Girl w/ Pen.

Waitlists and Worse: Rebuilding VA Health Care

Amy August on June 3, 2014

Eric Shinseki resigned last Friday as head of the Department of Veterans Affairs, stating that “the VA needs new leadership”. This comes in the wake of scheduling issues at VA medical centers leading to extended delays for veterans’ healthcare—issues he now recognizes as a “systemic lack of integrity” involving a widespread cover-up. According to a new VA audit report prompted by a series of CNN investigations, deadly delays in care were being suppressed by clinics driven to meet performance targets. The VA report concluded that the 14-day wait time performance target was “simply not attainable,” and it called for a “long-term, comprehensive reset” of the broken system. While  Shinseki acknowledges these problems, how reasonable is it to expect his successor to fix them? Research shows that scheduling issues are only one barrier among many to veterans’ accessing care.

When predicting which people will seek care, sociologists take into account patients’ prior experiences with the system such as health outcomes and customer satisfaction. Poor service doesn’t just hurt the veterans who seek care—it may keep them from seeking care in the first place!
Some veterans are eligible for both Medicaid and VA services. The largest group of these vets relies on Medicaid rather than VA care or a combination of the two.
Issues with gender in the military also have an effect. Female veterans have less access to VA healthcare relative to males, with 19% of women reporting delayed health care or unmet needs. Knowledge gaps about VA care, perceptions that providers are not gender-sensitive, and a history of military sexual assault predicted women’s likelihood to delay or forgo treatment.

 

How to Give Birth the “Right” Way

Jacqui Frost on May 19, 2014

Mila Kunis recently announced that she will be giving birth naturally, saying “I did this to myself – I might as well do it right.” By “natural,” Kunis means that she will be using a midwife when she gives birth and opting out of the hospitalized, medically-induced birthing experience that dominates in American society today. Kunis is just one, albeit highly publicized, instance in a larger move away from the hospitalized birthing experience to “home birth.” However, this shift is not without its conflicts, and Kunis’ statement that natural birth is “doing it right” points to deeper societal perceptions of the right way to give birth and how those perceptions of what is “natural” might be changing.

The media often frames this increase in home births as potentially dangerous and problematic, but women were giving birth at home long before they started going to hospitals. The medicalized model of childbirth is a fairly recent product of a larger shift in societal acceptance of professional science over local knowledge.
This “medicalization of childbirth” has huge impacts on how society, and women themselves, see women’s bodies and safety. Sociologists argue that this increased medical monitoring during pregnancy is a form of social control that constrains women both physically and emotionally.

For a great history of homebirth and the reproductive rights movement, check out Christa Craven’s 2010 book Pushing for Midwives: Homebirth Mothers and the Reproductive Rights Movement.

New Nutrition Labels—A Healthier Choice?

Jacqui Frost on April 3, 2014

The Food and Drug Administration recently proposed a slew of changes to the nutrition labels on packaged foods. The first to be made in over 20 years, these changes will include placing a bigger emphasis on total calories and added sugars as well as highlighting certain nutrients, such as Vitamin D and potassium. They are also proposing to make changes to the serving size requirements, making them more “realistic” about what portions of a product people actually consume in a single sitting. The purported goal of these changes is to help consumers “make healthy food choices”, but sociologists show that these choices are not necessarily available to everyone.

The media, as well as most consumers, see diet and eating habits as a personal choice. However, research shows that not all consumers are financially, or even geographically, able to make conscientious decisions about the calories they consume.
The choices made at the federal level about dietary guidelines and labeling are not just about making sure we all get the right amount of Vitamin D. The food industry is a profit-making business just like any other, and its influence on government nutrition policies runs deep.
The media coverage of this proposal is largely positive, framing it as a step towards curbing America’s “obesity epidemic”. This kind of media coverage furthers the intense stigmatization of obese people and reinforces norms that equate thinness with moral virtue and social worthiness.

For more on culture and obesity, check out Abigail Saguy’s “Office Hours” interview where she discusses her book What’s Wrong with Fat?

 

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E-Cigarettes and “Acceptable” Substance Use

Jacqui Frost on March 14, 2014

As e-cigarettes are fairly new to the market, there is little research on their long-term effects, but their recent popularity has sparked debates about their use and regulation—are they healthier than combustible tobacco, should they have the same restrictions in terms of age and public use, and are they a “gateway” to real tobacco for teen smokers? While a majority of the e-cigarette conversation focuses on whether they are better for you, the desire for healthy lungs is not the only factor contributing to these debates. The e-cigarette debates are the newest chapter in a long history of substance use regulation that is as much about social stigma as public health.

These debates are also influenced by social factors such as unemployment, youth populations, political battles for and against government regulation, and a much broader, but more subtle, process of stigmatization when cigarette smoking— which was once perfectly acceptable in society—slowly slides out of favor.
As smoking loses favor in public opinion, so do smokers. While these debates are about health on the surface, the underlying message to smokers is that they are deviant. Research has found that smoking, and substance use in general, occurs in higher numbers among lower income and minority groups, revealing much deeper power dynamics influencing smoking policy and the public image of smokers.

 

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Affordable Healthcare: Job Loss or Job Lock?

Evan Stewart on February 26, 2014

Controversy continues to rage over the alleged “job-killing” effects of the Affordable Care Act and potential increases in the federal minimum wage. Kathleen Sebelius recently weighed in on the Congressional Budget Office’s report about the ACA, reminding us that the CBO’s “2 million jobs lost by 2017” figure comes from Americans cutting their work hours, not employers cutting their jobs to cover healthcare costs. With a new poll showing Americans think the job market is the number-one problem today, however, why would we see these trends? The ACA and a higher minimum wage may not be a job-killers—instead they remind us that employees can demand better working conditions.

We shouldn’t necessarily think of coverage programs in terms of “jobs lost.” Instead, giving employees affordable health coverage may actually free them from “job lock.” Economic research shows that benefit programs can give low-income workers the security and potential mobility to seek out better jobs.
While benefits can give employees the opportunity to quit, organizational characteristics like group job satisfaction and flexibility in the workplace also affect the likelihood that employees will want to quit.

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