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How Cultural Factors Drive Medical Care

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In the late 18th century, Scottish physician James Makittrick Adair wrote about “fashionable diseases,” or physical ailments that became popular and common after afflicting someone famous. He decried the phenomenon of people assuming a disease merely to follow current cultural trends. The fact remains that this continues to our day, with many diagnoses “trending” in our current world.

Much of this comes from searching for answers to everyday non-pathologies — from the financial incentive of pharmaceutical companies to conjure diseases in order to sell medications to political factors. Medicine has thus become less a science than a reflection of our collective societal angst.

While Adair’s reflections underscore how our propensity for mimicking certain illnesses (whether consciously or subconsciously) has long been around, the trend continues. Multiple illnesses lack scientific basis yet have become relatively common in certain pockets of the developed world.

In general, there seems to be something that draws us not only to illness but to a certain group belonging with others. One prime example is non-celiac gluten sensitivity, a condition that can cause gastrointestinal symptoms that sometimes improves with removal of gluten from one's diet (as per its name, this does NOT include celiac disease). Multiple popular books in the last decade have demonized gluten, and multiple celebrities have further promoted the fad.

Gluten has been accused of causing such diseases as autism, anxiety, and type 2 diabetes (among others) without scientific evidence. Do the GI symptoms exist in these individuals? Often yes. Are they pathological to the point where clinical diagnosis is justified? That’s debatable. But once popular culture picked up on this and pushed it into the mainstream, people who hadn’t had significant or any symptoms were all of a sudden convinced that this was something from which they suffered.  

It has been well-documented the many examples of pharmaceutical “disease-mongering,” or the medicalization of normal physiologic conditions in order to sell medications. Do men’s levels of testosterone decrease as they age? Yes. It’s also a normal part of aging that is questionable as to whether it actually causes any medically relevant symptoms. And yet, thousands (maybe millions) of people have “asked their doctor” about testosterone replacement for “Low T.” The sensation of restless leg syndrome was not a common complaint until there was all of a sudden a pharmaceutical treatment for it. These conditions are pushed through broad and misleading advertising, advocacy organizations — many of which are created by pharmaceutical companies to “increase awareness” of the condition, and by perks to physicians for prescribing. Thankfully these perks are decreasing, but the remaining strategies continue to confuse a willing public.

Politics also play a large part in potential diagnoses. Homosexuality was considered a pathological condition worthy of conversion therapy for decade. (Obviously this notion is still present in some smaller circles today, though thankfully not by society as a whole). The change away from treating this “condition” was largely driven by a political and cultural forces. The political winds surrounding autism have obviously driven people away from vaccines, the connection to which has been disproven multiple times over but is still spouted by many politicians and “advocates” as a legitimate concern. This is not even to mention the big political drivers of the health care system that push us into various corners for the supposed “good” of the collective.

We as physicians were trained to diagnose and treat medical conditions in our patients, to assist in improving and prolonging life. However, much of what we do is not driven by actual diagnoses but by the whims of society. Many of the symptoms we see are simply related to normal life and are not a pathology. These are but some examples whereas many more exist. It is thus crucial for us to remember our Hippocratic Oath so as to avoid over-treating and over-medicalizing our patients as much as possible.

Dr. Kyle Bradford Jones is a board-certified family physician at the University of Utah School of Medicine. He practices at the Neurobehavior HOME Program, a patient-centered medical home for individuals with developmental disabilities. He is very interested in how technology and social media can be used to improve overall health and clinical care.

Dr. Jones is a 2018–2019 Doximity Author.

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