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
