Medication/Enhancement

1) The “culture of biomedicine” alludes to Western medicine as a microcosm of Western culture, embodying and reinforcing the values, ideology, hierarchy, kinship structures, and power dynamics of Western culture. For example, the arrangement of allopathic medical personnel reflects the classism and gender stratification that typify Western society. As such, biomedicine replicates gender relations and represents a quasi-family in the sense that physicians have historically been a male ‘father’ character while nurses were predominately a female ‘mother’ character’, with the former endowed with more prestige and entitlements. This concept is important since, despite operating on premises of objectivity, empiricism, and universal truth, theory and organizational structure in biomedicine reflects cultural attitudes.

For example, as cited in lecture, anthropologists adopt the view of a hospital as a “miniature city, where each ward is a different suburb with its own administration, bureaucracy, workers, security, and a fluid stream of patient citizens,” demonstrating how biomedicine is a subculture embedded within a larger cultural context (Karim, 2012).  Thus, it also epitomizes socioeconomic aspects of Western culture such as a capitalist, competitive spirit between practitioners and a market-driven fee-for-service paradigm, where a hospital is a for-profit enterprise. Furthermore, the “culture of biomedicine” is aptly named because it exemplifies culture-specific rites of passage. For example, a rite of transition is illustrated by the sequestration of the sick in a hospital, which could be interpreted as a trial of ordeal in the liminal period between illness and health. Furthermore, recitation of the Hippocratic Oath is a component of the rite of incorporation whereby medical students become endowed with the esteem and privilege of a doctor. Moreover, biomedicine is cultural in that health care delivery observes taboos and rituals, including pre-operative hand washing, instrument sterilization, and use of caps, masks, and ‘booties’ in the surgical theater, despite a deficiency in literature supporting that these last practices reduce risk of infection. As Quebbeman notes, these customs “function to define ‘us’ and differentiate and distance ‘us’ from ‘them’”.

2) In my opinion, the medication-enhancement dichotomy separates drugs that can fix, as in eradicating acute illness and reversing chronic, degenerative illness, from drugs that can improve quality of life, such as preemptive treatments that forestall disease development. I think my personal view comes from labels used in the cultural of biomedicine that divide treatments of emergency or ‘medical necessity’ from those that are ‘elective’ or ‘cosmetic’. Originally, this language was likely employed by insurance companies in defining therapies for which reimbursement is possible.

3) I think that the dichotomy of medication-enhancement has emerged due to the pharmaceutical innovations that have essentially enabled the institution of medicine not only to relieve suffering, but to extend life expectancy and healthy years. On the one hand, the germ theory gave rise to vaccinations against biological threats such as polio and smallpox, showcasing the near-miraculous potential of medicine to eliminate infectious disease. Because acute, epidemic disease declined, the medical community shifted efforts to treat non life-threatening conditions and to magnify health and human potential. For example, the inception of Viagra medicalized less-than-perfect sexual performance and represented a life enhancement for those with only occasional erectile dysfunction (Cohen, 2009). Similarly, Ritalin can be a “cognitive enhancer,” augmenting working memory capacity and productivity in healthy subjects (Cohen, 2009). Furthermore, statins are now prescribed to preempt heart attacks, representing a widening of the net where medicines are now designed to treat risk factors (Cohen, 2009).  Such developments have set the stage for the impression that medicine could not only produce ‘quick fix’, magic bullet cures, but also enhance health and longevity, generating a seemingly natural medication-enhancement dichotomy.

References

Cohen, A. (Editor). (2009). Pill Poppers[Documentary]. United Kingdom: BBC Horizon.

Karim, Taz. Medical Anthropology. Michigan State University. 3 August 2012.

Quebbeman, E.J. (1996). Rituals in the Operating Room: Are They Necessary? Infectious Diseases in Clinical Practice, 5(2): S68-S70.

2 thoughts on “Medication/Enhancement

  1. The medication/enhancement dichotomy is an especially interesting relationship from my perspective because it’s something clinicians deal with on a daily basis. It is also interesting from the standpoint of insurance companies that decide whether or a not a certain health care procedure is elective or not. I definitely feel that some elective enhancement procedures such as plastic surgery or Botox are trivial and should not be considered medication. However, there are other surgeries for things like hearing implants that aren’t considered necessary, but greatly improve the quality of life for a patient. In this case I wouldn’t consider such a procedure as an enhancement but rather as medication. It is imperative for physicians to consider this dichotomy to ensure they are not dispensing unneeded medications to patients that do not require them for the betterment of their health. An implication to this could be the abuse and addiction of prescription medications.

    An alterative way to conceptualize the dichotomy between medication and enhancement would be to categorize health care as medication as long as certain procedures and practices provide some sort of physical benefit or significantly improve the quality of life for an individual. In opposition, enhancement would include all procedures and medications that are solely used for heightening ones physical appearance that provide no medical benefit. Potential benefits of conceptualizing medication and enhancement in this way would include more vast access to health care that is intended for the improvement of quality of life for some individuals while an obvious drawback would be many people having to pay for such procedures out of pocket because they are considered cosmetic and therefore not vital to ones health.

  2. I thought this was an extremely well written and insightful blog post, and interesting dichotomy choice to boot. The medication-enhancement dichotomy must be handled carefully by clinicians because while some things may obviously fall into one category, others may not be so easy to determine. Plastic surgeries like breast enhancement and face lifts would be considered enhancements to me. An enhancement would be something that is not necessary but may be beneficial to the person in some way, shape, or form. Now, a medication would be something like having Tommy John surgery that helps repair a person’s arm and get them back to normal. I consider medication as a form of treatment or healing that improves a person’s health. One thing that I thought of that is hard for me to distinguish which category it would fall under is a nose job. Now, some people get nose jobs to improve their looks, but others get them so they are able to breathe properly. This is why is important for clinicians to understand this dichotomy. People who need the treatment should be able to get it.

    Another way to look at the medication-enhancement dichotomy is in the case of weight loss. Many people take dieting pills or fat burning pills in order to shed a few pounds, while others choose the more traditional route of dieting and exercising. I would consider eating the right foods and exercising to be like the medication to a healthier life. On the other hand, I would consider dieting pills to be an enhancement. In my eyes, taking pills is the unnecessary and less healthy way to go. Though they may help a person lose weight, they can have other side effects that can cause damage to other areas of the body. That is why I wouldn’t consider pills to be a medication in this case because they are not an absolute need. The drawbacks of this dichotomy is an over use or prescription of pills by clinicians to patients.

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