Med/Soc Final exam

Us healthcare system

- $11,945/person on healthcare in 2020 (highest in world; twice other high income countries) - inefficient, disorganized, wasteful, inequitable, irrational

dietary supplements

- 12billion/yr spent in US - various supplements - 1994 Dietary Supplement Health and Education Act

center of religious practice (medieval era - 1450)

- 1st phase of hospital dev. - christian beliefs emphasized that human beings were duty bound to help sick, needy, disadvantaged - roman catholic church - clergy and nuns= path to spiritual salvation + rudimentary training and expertise - community centers for care of low-class ill - provided food, shelter, prayer and healthcare

increasing lethality- guns

- 30X number rounds - 15X rounds/minute - 3X velocity - 10X range

ayurveda

- Indian technique - oils and massage - treat insomnia, GI issues, hypertension

purported but unproven benefits of marijuana

- analgesic - glaucoma - appetite loss - MS - psoriasis - PTSD - cancer (palliative effect) - antiemetic - bronchodilator - anti-inflammatory - crohn's disease - tourett's syndrome - asthma - aids in memory loss (forgetting trauma) - reduces seizures - dementia - osteoporosis

acupuncture

- ancient treatment - needles into body - treat asthma, muscle tension, allergies, addiction - 5-needle protocol for EMS

risks of weed

- anxiety attacks - affect developing brain - smoke produces high levels of carbon monoxide (higher than cigarettes) - co-occurring substance use (weed, alcohol, tobacco) (eg. blunts) - increases HR and risk of enfarto - aumenta risk de schizophrenia (especially de los with genetic predispositions)

Reasons for CAM

- availability - cultural/religious - price - displeasure with insurance and big pharma - desire for more control over life and health

popular policies to adopt for gun control

- bans on military style firearms and ammunition - bans on large-capacity magazines - waiting period for purchases - mandatory safety training courses - more detailed background checks - mental health screening - 'demonstrated need' policies gun buybacks

qualifying conditions for medical marijuana

- cachexia - cancer - HIV/AIDS - glaucoma - seizures - severe nausea - muscle spasms - severe pain - PTSD

potential problems with CAM

- can overstate benefits of natural supplements - Dr. Oz effect

compared to physicians, chiropractors;

- charge less - are friendlier - devote more time to patients - use more understandable words - help people with back issues

curanderismo healing

- curanderos/curanderas (Mexican-american healers) - god provides power - examine root rather than symptoms - request small donation - when individuals suffer, they learn (curandero helps patients accept suffering) - blend religion and folk medicine (use prayer, counseling, drugs and herbs) - based on body equilibirum (4 humors) - balance hot and cold (treat chills with hot foods and fever with cold) - witchcraft can use evil to harm - curanderos can fight evil with good

Hospital as Major Social Institution

- delivers health care (meets complex needs) - benefits to individuals (centralized) - benefits to society

pentecostal church (Gillian Allen and Roy Wallis 1976)

- devil causes illness (evil spirits can possess) - divine healing (some people can use holy spirit to heal or exorcise demons; healing possible through faith) - healing process (laying hands, anoint with holy oil, pray for health or demon removal)

geophagy

- eating earth, soil, clay - kaolin (GA) (eases GI upset) - when people move, find poor unnatural substitute (eg, detergent)

administrative

- enforces hosp. policy - may create rules, regs. for docs. - focus on efficiency

center of medical tech. late 19th century - present

- everyone now patients (including middle and upper class)// paid for private physicians and services - antiseptic practices reduce infection (better ventilation, isolation of ill, sterilized instruments, masks, gloves, gowns, hand-washing) -use of scientific methods (knowledge of bacteriology, human phys., use of anesthetics) - improved training in hospital staff

us gun-related deaths super high

- high prevalence of gun ownership - assault rifles are more letahl by design (lax regulation= concealed carry, unlocked, loaded, accessible) - high number of single-event homicides and mass shootings (children often the victims-US has ~1 mass shooting a day) - gun deaths increasing in US - affects trauma centers and healthcare professionals

schedule 1 drugs

- high risks of abuse - no documented medical use

black folk healers

- illness = misfortune - address causes rather than symptoms - problems interconnected (fixing one problem could fix others) - some illnesses are cured by magic rather than medicine illness caused by: - abuse of the environment (overeating, carousing) - punishment from god (cure through prayer, contact god through an intermediary) - best address emotional/social problems (eases anxiety and stress that underlie many health problems)(poverty, cheating, unemployment)

chiropractors

- illness caused by spine misalignment - DD Palmer (1895) - manipulate bone in spinal column - relieves pressure on nerves - can help reduce back, shoulder, neck pain - 4 yr training program (3yrs in classroom, 1 yr in practice) - no internship or residency - licensed to practice in all states - medical opposition

for profit

- increasing trend

hospitals in US

- initially housed poor but also care for ill in early 1700s - founded by private citizens in mid-1700s as nonprofits - funded by gov. in 1798 - decline in # of hospitals from 1975 to 2018

shiatsu

- japanese - acupressure - maintain well being

increasing lethality- bullets

- large caliber - armor-piercing

medical

- makes med. decisions

homeopathy

- microdoses of natural substances (boost immunity) - restore chi (energy flow) - ineffective; may cause harm

poorhouses

- mid 1500s saw reduction in monastery system - increased secular control - treat ill individuals so they can function in society (similar to boarding houses) - offer food, shelter, treatment for ill - warehouses for elderly, orphans, invalids and mentally ill

nonprofit

- most common - board of trustees provide control - don't pay federal income taxes

reducing hospital costs

- one uniform insurance claim form - universal health care - use emergency centers for emergencies only - diagnostic related group (DRG) -reduce medicalization of some conditions, inc. frailty

osteopath

- originally 'cooky' - now mainstream - DO degree - Andrew Taylor Still - Training in spinal procedures and manipulation

christian science church

- pain and sickness are illusions - disease indicates negative spiritual conditions - prayer heals bad spiritual condition - medicine unnecessary or prohibited (except for broken bones) - controversies over child's needs vs. parents (parents late 1980s did not seek medical care; 2 yr old boy with bowel obstruction- prayed to cure- boy died) - court ruling: freedom of religion doesn't include risking child's health or life

civil involuntary admission to mental hospital

- person danger to self, other people or property - consider severity, change from repeat offense, past behavior

faith healer

- promote healing with prayer, faith in a god, power of suggestion two basic beliefs (John Denton): - god intervenes - psych. processes avenue toward healing

how hospitals benefit society

- protect family from burden of caregiving - care for ill where they're less disruptive to society

herbal supplements can:

- reduce drug effectiveness - increase drug side effects - affect drugs with narrow therapeutic range

ecotherapy (nature therapy)

- reduces (stress, high BP) - improves (mood, creativity, immune system) - accelerates (illness recovery) - forest bathing

yoga, tai chi, meditation

- reduces stress, relaxes - increase balance, flexibility, core strength

spiritual healing benefits (Deborah Glik 1990)

- relieves stress - alleviates symptoms - improves life situation - acceptance of health problem - redefines condition as less serious - greater sense of support from god - adopt's ones perspective about situation

depersonalization (Goffman 1961)

- result of the way many patients are managed (embarrassed, devalued, disoriented, objectified, isolated) - related to the patient's subjective experience of feeling sick - patient may subjectively feel stigma of being ill - devalued social status (divest person of past social status, self-representations, clothes removed for hospital gowns) - lack of control of events, resources (person's belongings taken away, restrictions on visitors, control diets, sleep, social life. control items in room and info about condition) - restriction of mobility (sick people in gowns confined to wards; discharged via wheelchair)

deathhouses 18th century

- rudimentary treatment produced mixed results: - high mortality in hospitals (dirty, crowded, limited ventilation, all patients housed together) - risky medical procedures (low success rate, bloodletting, use of 'potions', unsanitary conditions)

firearm related deaths

- safety sin't regulated by a designated federal agency - little federal research funding approved - increased lethality due to military grade weapons - no background checks at some gun shows - concealed carry w/o permit - industry protected against tort-liability suits

solutions to gun violence

- sandy hook families received $73 mil. settlement against Remington from their campaign slogan 'man-card' playing into masculinity - 20 children and 6 staff killed

Denton (1978) 5 categories of healing

- self through prayer - layperson who communicates with God - official church leader - full time healer (unaffiliated with religion) - full time religious healer

coining (Gua sha)

- stimulate (blood flow, gain energy, healing, reduce fever) - potential risks (swelling, breathing difficulty, infections) - uses coin/smooth w/ tiger balm oil - bruising may disappear in 3ish days

cupping therapy

- traditional method (ancient egypt, east asia) - use heat/suction to draw skin into cup - treat pain, scars, swelling, muscle knots, blood disorders, rheumatic disease, fertility disorders, skin problems, back pain, cancer - limited effectiveness - risky (bruising, risky for thin and obese patients, more placebo than benefits)

witchcraft

- type of black folk healer - prayers, verbal spells, burning candles

sorcery

- type of black folk healers - rituals, oils, potions, perfumes

folk healers

- uncommon in US - more common among lower SES, rural areas and black, hispanic and native americans

marijuana

- use dates back several thousand years - restrictions: 1970, US classified weed as Schedule 1 drug (due to war on drugs) - Ingredients (THC, CBD, Terpenes)

shark cartilage

- used as supplement - over-poached - 'cure cancer'

hospital patient sick role

-accept hospital routine -submit to authority -cooperate

costs - extra paperwork

-clerks process insurance claims (eg. 45 full time clerks in US vs 1. in canada for a single hospital) - deductions and copays (multiple payers, including private insurance, medicare, medicaid) - tech. innovation - building and maintaining facilities

health failure according to black folk healers

-failures due to will of god

involuntary criminal admission to mental hospitals

-insanity used as a defense (mental disorder contributed to crime) -excusing condition that relieves individuals of criminal responsibility for their crimes - hospitals and courts determine release

motor vehicle deaths

-reductions major public health achievement of 20th century - safety improvements (side airbags, rear cameras, automatic emergency braking, electronic stability controls, lane departure warnings, blind-spot detection) - licensing of drivers (drivers ed) - car registration

staff rating individuals as 'good patients'

-require little time -cooperate - dont complain - often not memorable difficult patients will be scolded, sedated, and/or transferred home or to a different facility

4 phases of development of hospitals

1. center of religious practice 2. poorhouses 3. deathhouses 4. centers of medical tech.

hospitals as multipurpose institutions

1. treat patients (primary) 2. provide labs 3. train practitioners 4. conduct medical research 5. support health ed programs

costs of hospital services

2017: $3949 one-dau\y hospital stay - increased substantially over time - 90% of cost paid by third party costs= routine (room and board, employee salaries), ancillary (labs, pharmacies, operating room, x-ray rooms, medical supplies),

US makes up what percentage of world's firearms?

45%

percentage of voluntary admission to mental hospitals

70%

Which country has the highest health expenditures as percent of GDP

US (individuals pay)

dual system of authority

admin vs medical - can causes inconsistency - trained nurses do day-day work; most affected by system of authority (carry out md's orders and answer to admin)

conforming attitudes

age and education are best predictors of attitudes - old; poor= conform - young; better educated= more likely to deviate

warfarin

blood thinner

4 humors

blood, phlegm, yellow bile, black bile - imbalance causes illness

CBD

cannabidiol - no psychoactive effect

how hospitals benefit individuals

centralized - medical expertise - knowledge - technology - advanced care

risk pooling

collectively share risk of financial investment (more people= less risk) - generally works well - why socialist countries are able to have public healthcare (efficient)

St. John's wort

decrease effects of drugs - anti-anxiety, antidepressant, diabetes drugs - bc pills (increases risk of pregnancy) -transplant anti-rejection meds

unintended result of the new hospital-patient role

depersonalization

Being Mortal (Gawande)

describes alternative 'end-of-life' facilities; attempts to humanize the cold buildings that elderly and hospice patients live in - introducing animals (birds, cats, etc.) - increasing time outdoors (gardens)

percentage of GDP due to healthcare is rising; americans pay more for most healthcare costs:

doctors fees, lab tests, surgery, childbirth, hospital charges, ER visits, prescription drugs

placebo effect

experimental results caused by expectations alone; any effect on behavior caused by the administration of an inert substance or condition, which the recipient assumes is an active agent.

terpenes

flavor and aroma

1994 Dietary Supplemejt Health and Education Act

food products can be sold as cures but can't include claims of cure on labels

since 2017 what is the leading cause of injury death among ages 1-24 in US?

gun-related

nocebo effect

harm resulting from the mere expectation of harm

Hospital-patient role

hospital divided into categories: - maternity- obstetrics - pediatrics -neurology/orthopedics

Andrew Taylor Still, 1860s

illnesses caused by dislocation of bones in spinal column - founder of osteopathy

algae supplement

increase alertness

main issue with death houses

infection

government (state, fed, local)

less prestigious - relied on by low-income

"Ongoing studies suggest that spiritual experiences and practices involve a variety of neural systems that may facilitate neural 'top-down' effects that are comparable if not identical to those engaged in placebo responses"

link between spirituality and willingness to accept placebo

Navajo/ Denê folk healing

native healers to treat cause of illness - rituals (lead by singer, may last several days) - illness due to (witchcraft, taboo violation, spirit possession) - declining practices (fewer trained, relatively expensive, long ceremony) - physicians to treat symptoms (cuts, broken bones, childbirth) - sweat lodge

aromatherapy

oils -relaxation

garlic

prevent blood clots

diagnostic related group

provides fixed charge for each medical procedure

crystals

pseudoscience

herbs used by curanderas

rattlesnake oil, mineral water, sweet basil, camphor

fish oil

reduce heart attacks

Ellen Idler and Rogers and colleagues

religious attendance: - better health, longe rlives - less physical disability - lower levels of depression - better able to cope with illness - healthier behavior - strong social support and community

Deborah Glik

spiritual healing benefits

THC

tetrahydrocannabinol - psychoactive effect

levothyroxine

thyroid med

cachexia

wasting syndrome

some herbs reduce blood sugar

worrying when combined with anti-diabetes meds