Medicalization, Markets and Consumers - Conrad e Leiter - 2004 PDF

#1921Jnl of Health and Social BehaviorVol.
45 Extra Issue45X10-conrad
Medicalization, Markets and Consumers*
PETER CONRAD
Brandeis University
VALERIE LEITER
Simmons College
Journal of Health and Social Behavior 2004, Vol 45 (Extra Issue): 158176
This paper examines the impact of changes in the medical marketplace on med-
icalization in U. S. society. Using four cases (Viagra, Paxil, human growth hor-
mone and in vitro fertilization), we focus on two aspects of the changing med-
ical marketplace: the role of direct-to-consumer advertising of prescription
drugs and the emergence of private medical markets. We demonstrate how con-
sumers and pharmaceutical corporations contribute to medicalization, with
physicians, insurance coverage, and changes in regulatory practices playing
facilitating roles. In some cases, insurers attempt to counteract medicalization
by restricting access. We distinguish mediated and private medical markets,
each characterized by differing relationships with corporations, insurers, con-
sumers, and physicians. In the changing medical environment, with medical
markets as intervening factors, corporations and insurers are becoming more
significant determinants in the medicalization process.
Delivered by Ingenta to :
MrOver
Matharu (cid three
the past 32629), ingenta
decades internal
there live a2.3.1/F4
has been (cidof75000325),
process University
medicalization of Delawareas
been transformed
Library (cid 2443)
marked increase in the medicalization of Dec
Tue, 27 soci-2005well? In an ambitious paper, Clarke and her
00:27:44
ety (Zola 1972; Conrad and Schneider 1992; colleagues (2003) argue that the technoscien-
Barsky and Boros 1995; Riska 2003). tific changes in medicine have expanded med-
Medicalization occurs when previously non- icines boundaries even further into biomed-
medical problems are defined and treated as icalization, a wide ranging process that
medical problems, usually in terms of illnesses includes complex and multi-sited transforma-
or disorders. While medicalization can be bi- tions in medical knowledge, technology, sur-
directional, there is strong evidence for veillance, and bodies. Our task here is narrow-
increases in medicalization. This growth of er and more focused. We ask, how have
medical jurisdiction is one of the most potent changes in the institution of medicine affected
transformations of the last half of the twentieth the process of medicalization? Have the shift-
century in the West (Clarke et al. 2003:161). ing power dynamics in medicine altered med-
In this same period, the institution of medicine icalization? What are current engines driving
has undergone major changes in its social increased medicalization? What factors con-
organization, with the advent of managed care, strain its growth?
the declining power of the medical profession, Most previous analyses of medicalization
and a rise in consumer advocacy and account- focused on the influence of physicians, lay
ability (Starr 1982; McKinlay and Marceau reformers, or medical and scientific discover-
2001). As medicine has changed, has the ies. This paper departs from that tack, focusing
instead on the creation of markets and the
impact of these markets on medicalization.
* Our thanks to Phil Brown, Emily Kolker, Stefan Although the players are similar, the emphasis
Timmermans, anonymous reviewers, and the editors
for comments on a earlier version of this paper. Send is different. Given the changing medical scene,
correspondence to: Peter Conrad, Department of important arenas of medicalization are moving
Sociology, MS-71, Brandeis University, Waltham, from professional to market domains.
MA 02454-9110. Email: conrad@brandeis.edu. In this paper we examine the impact of
158
#1921Jnl of Health and Social BehaviorVol. 45 Extra Issue45X10-conrad
MEDICALIZATION, MARKETS AND CONSUMERS 159

changes in the medical marketplace on the physical distress in which uncomfortable body
increasing medicalization of society. We first states and isolated symptoms are reclassified
review the extant general explanations for the as diseases . . . (p. 1931). Conrad and Potter
increased medicalization, setting these in the (2000) note that the expansion of attention
context of recent changes in the medical sys- deficit hyperactivity disorder (ADHD) from a
tem and expanding medical knowledge. The childhood to an adult disorder typically
core of the paper focuses on two aspects of the involves patients asking doctors for a diagnosis
changing medical market place: Direct-to-con- and medication. Patients have become more
sumer advertising of prescription drugs in knowledgeable, demanding, and critical of
insurance mediated medical markets and the medical care (Williams and Calnan 1996). The
emergence of new private medical markets. Internet has facilitated consumer involvement
The final section links these two aspects of the by offering easily accessible health-related
changing medical marketplace to medicaliza- information and providing a method for com-
tion and to consumers access to health care. munication among like-minded individuals
(Hardey 2001). Organized lay interests and
advocates frequently play a significant role in
AGENTS OF MEDICALIZATION medicalization, such as in the creation and
institutionalization (in DSM-III) of the diagno-
There are numerous broad social factors that sis post-traumatic stress disorder (Scott 1990).
have encouraged or abetted medicalization, However, advocates for sexual addiction
including the diminution of religion; an abid- (Levine and Troiden 1988) and multiple chem-
ing faith in science, rationality, and progress; ical sensitivity disorder (Kroll-Smith and
an increased reliance on experts; and a general Floyd 1997) have not had such success.
humanitarian trend in Western societies New medical knowledge can also contribute
(Conrad 1992:213). These factors, rather than to medicalization, especially in terms of etiol-
being explanatory, set the context in which ogy and treatment. The Human Genome
medicalization occurs. Delivered by Ingenta
Projecttoand: the attendant rise of genetics is one
MrSociologists
Matharu (cid 32629),
and other ingenta
analystsinternal live 2.3.1/F4
have identi- major(cid 75000325),
potential sourceUniversity of Delaware
of increased medical-
Library (cidization.
fied direct factors that facilitate medicaliza- 2443) If a problem can be shown to have a
tion. Foremost among these, on the Tue,supply
27 Dec 2005 00:27:44
genetic component it becomes a good candi-
side is the prestige and power of the medical date for (new or renewed) medical definitions
profession. It is well known that the medical (Conrad 2000). Similarly, the development of
profession gained great influence and authori- new medical treatments with pharmaceutical
ty in the first three quarters of the twentieth drugs can be an important factor in the med-
century, attaining both a professional domi- icalization of particular problems, such as the
nance (Freidson 1970) and cultural authority impact of Ritalin on ADHD or estrogen
(Starr 1982). Professional dominance and replacement therapy on menopause. However,
medical monopolization gave medicine juris- it is important to emphasize that new biomed-
diction over virtually anything to which the ical knowledge or interventions alone cannot
label health or illness could be attached engender medicalization. Etiology or treat-
(Freidson 1970). Studies of problems ranging ment may be a central component of a claim to
from childbirth (Wertz and Wertz 1989) to medicalization, but those claims must be
child abuse (Pfohl 1977) to the rise of behav- championed by supporters or promoters of a
ioral pediatrics (Halpern 1990) all purport diagnosis, be they physicians, patients, lay
some kind of intra-professional explanation for advocates, or commercial entities such as drug
an increase in medicalization. It should be companies.
noted, however, that sometimes problems have Many of the key medicalization studies were
been thrust onto the medical profession, which completed over a decade ago. Important
may be resisted (e.g., Kurz 1987). changes have occurred in health care since
On the demand side of medicalization, then, especially the increased corporatization
there has been growth in consumer demand for of health care (Light 2000). Light (1993) has
medical solutions. Barsky and Borus (1995) proposed the concept countervailing powers
suggest that the publics tolerance for mild to describe the changing balance of power
symptoms and benign problems has decreased, among the medical profession and related
spurring a progressive medicalization of social institutions. In American society, profes-
160 JOURNAL OF HEALTH AND SOCIAL BEHAVIOR

sional medicine historically dominated health There are, however, some medical markets
care, but we now see buyers (e.g., corpora- that do resemble classic consumer markets, in
tions that pay for employees health insurance); which goods and services are exchanged as
providers (e.g., physicians, hospitals, commodities. Over the last few decades, the
HMOs); payers (e.g., insurance companies, medical-industrial complex has grown,
governments); and consumers (e.g., patients, mainly as a response to the entrepreneurial
advocacy groups) all vying for power and opportunities afforded by the expansion of
influence over medical care. The growing health insurance coverage offering indemnifi-
influence of the biotechnology industry (espe- cation through Medicare and employment-
cially the pharmaceutical and genomics indus- based plans (Relman 1991:856). In short, the
tries), has increased the complexity of the the existence of third party funding has encour-
medical-industrial complex (Relman 1980; aged certain types of medical markets because
Clarke et al. 2003). of available insurance, although this has been
In this paper we explore how the develop- partly restrained by managed care.
ment and promotion of new technologies, con- The use of advertising, the development of
sumer demand, and the emergence of new specific medical markets, and the standardiza-
medical markets have facilitated new areas of tion of medical services into product lines have
medicalization. Using the cases of Viagra, contributed to an increased commodification
Paxil, human growth hormone, and in vitro of medical goods and services. Advertising of
fertilization (IVF) as illustrations, we contend health care has become more commonplace
that, in the climate of increased corporatization (Dyer 1997), and new medical markets have
of health care and decreased public regulation, emerged, particularly for specialty services.
the creation or expansion of new medical mar- Imershein and Estes (1996) argue that medical
kets are a significant force toward medicaliza- services are increasingly organized into prod-
tion. uct lines (with attached payment schemes),
consistent
Delivered by Ingenta to : with a market-based approach to
exchange.
Mr Matharu (cid 32629), ingenta internal live 2.3.1/F4 Cosmetic surgery
(cid 75000325), is the
University of most com-
Delaware
ON MEDICAL MARKETS modified
Library (cid 2443) of medical specialties, offering treat-
ments
Tue, 27 Dec 2005 that are often not covered by insurance,
00:27:44
Until the last decade or so, sociologists such as liposuction and breast augmentation
rarely examined medicine as any kind of mar- (Sullivan 2001). Cosmetic surgeons advertise
ketplace. But it is becoming clear that, with the to stimulate demand for their services, for
development of managed care, corporatized which patients pay cash (or borrow from
medicine, and the rise of the biotechnology finance companies that partner with cosmetic
industry, medical markets are increasingly surgeons, much like purchasing a car).
important in the analysis of health care. In the last five years, a loosened regulatory
When medical products, services, or treat- environment has given pharmaceutical and
ments are promoted to consumers to improve biotechnology companies more freedom in
their health, appearance, or well-being, we see advertising their wares, both to physicians and
the development of medical markets. The idea consumers. The Federal Drug Administration
of medical markets has been described as a Modernization Act of 1997 made several
theoretical anomaly (Light 2000:395), as changes that have facilitated medicalization.
medical markets often do not meet many of the Most relevant to our analysis, the act loosened
elements in classical definitions of a competi- the restrictions placed on the kind of informa-
tive marketplace. In a free market, consumers tion that pharmaceutical companies could
are supposed to be informed, appreciate differ- share with physicians regarding off-label
ences in quality, and have bargaining power uses of their drugs, and subsequently, the
and free choice about buying, but these information that must be included in direct-to-
assumptions are often violated in health care consumer advertisements.
markets (Lown 2000). Asymmetry of informa- The constant development of new technolo-
tion and uncertainty in the definition, recog- gies, treatments, and drugs sparks consumer
nition, and diagnosis of disease states interest in obtaining access to these new med-
(Montagne 1992:401) in particular distinguish ical goods and services, and advertising can
medical markets from other consumer mar- further increase consumer demand. Consumers
kets. may gain access to these goods and services

through one of two kinds of markets: mediated components of health care, rising at 15 percent
markets and private markets. a year, now constituting 8 percent of health
In mediated markets, there is an indirect care spending (Angell 2000). In the same year,
relationship between consumers, on the Americans purchased 2.5 billion prescriptions,
demand side, and medical producers or averaging nine per American, for a total of
providers, on the supply side, with third party $125 billion (Cohen et al. 2001). The pharma-
payers occupying an intervening role. Third ceutical industry has a long history of market-
party payers (typically private or public insuring prescription medication directly to doctors
ers) intervene in the exchange relationship through detailing, direct mail, ads in medical
between consumers and providers or producers journals, gifts, travel subsidies, and sponsoring
in two ways: by defining what is medically events (Wanzana 2000).
necessary and then paying for only those While some direct-to-consumer advertising
goods and services that they have deemed existed in the United States for over two
medically necessary. The degree of control decades (Pines 1999), recently the pharmaceu-
exercised by third party payers varies, depend- tical industry has substantially increased its
ing upon the level of management of care investment in targeting consumers directly.
being exercised. Managed care regulations Annual spending on direct-to-consumer adver-
dampen consumer demand for medical goods tising for prescription drugs tripled between
and services, particularly regarding access to 1996 and 2000; it is only 15 percent of all mar-
new technologies (Mechanic 2002), reducing keting, but by far the fastest rising segment.
consumers ability to purchase medical solu- Much of this increase has been in television
tions to perceived health problems. advertising after the Federal Drug
Consumers who want medical goods or ser- Administration Modernization Act of 1997
vices but cannot obtain them through mediated made it easier to advertise drugs to the general
markets may turn instead to private markets, public (Lyles 2002). This change allowed
depending upon the cost of the goods or ser- broadcast ads to name both the disorder and
DeliveredInby Ingenta
vices and consumers financial resources. to so
the drug : long as they also contain limited
Mr Matharu
private (cidthere
markets, 32629),
is a ingenta internal
more direct live 2.3.1/F4
econom- (cid benefit
risk and 75000325), Universitymaking
information, of Delaware
televi-
ic relationship between consumers and Library
med-(cidsion
2443)
drug advertising more feasible and more
Tue, 27 Dec 2005 00:27:44
ical producers or providers: If consumers can attractive to the pharmaceutical industry.
afford a treatment, they can most likely find a Spending specifically on television advertising
medical provider who will provide it for increased six-fold between 1996 and 2000, to
cash. Again, cosmetic surgery is one exam- $1.5 billion dollars (Rosenthal et al. 2002).
ple of private medical markets. In private med- The pharmaceutical companies claim that
ical markets, care is provided to consumers direct-to-consumer advertising has an educa-
who can afford to pay for it, and other potential tional function that creates better informed
consumers are excluded. consumers, encouraging consumers to consult
In our analysis, we examine how four rela- their physicians about underdiagnosed symp-
tively recent medical developments are distrib- toms and treatment options, and enabling
uted through mediated and private markets, patients to make better choices (Bonaccorso
and how distribution through these two types and Sturchio 2002; Lyles 2002). Critics are
of markets is related to medicalization. concerned that such advertising leads to physi-
Specifically, we look at (1) the creation of cians wasting time during medical visits
demand for new medical products in mediated explaining why a treatment is not appropriate,
medical markets; and (2) the development of can lead to unnecessary use of medical
private medical markets. resources and excessive profits for drug com-
panies, and medicalize normal conditions
(Mintzes 2002; Rosenthal et al. 2002). The
CREATING AND CAPITALIZING ON vast majority of direct-to-consumer advertis-
MEDICAL MARKETS ing focuses on a limited number of drugs; in
2000, 20 drugs accounted for 60 percent of
In 1999, the pharmaceutical industry was direct-to-consumer advertising. These include
the most profitable industry in the United a wide range of drugs, including antidepres-
States, with an 18.6 percent return on revenues sants, antihistamines, antihyperliplidemics,
(Angell 2000). It is among the fastest growing and anti-inflammatory agents.

One aspect of direct-to-consumer advertis- Viagra. Estimates of the prevalence of erectile
ing that has not been discussed is its impact on dysfunction range from 10 to 20 million men
expanding the medicalization of human prob- (Fabbri et al. 1997) to suggestions that up to
lems. So-called consumer education cam- half all American men are sexually dysfunc-
paigns are used to introduce products, bring- tional (Laumann et al. 1999). Erectile diffi-
ing new people into a market by creating a pre- culties affected not only men but their partners
viously unrecognized demand for the product as well, and they were linked to powerful
(Applbaum 2000). The direct-to-consumer issues surrounding masculinity and sexual per-
advertising may well shape the way the public formance, making erectile dysfunction cen-
conceptualizes problems and it may increase tral to masculine self esteem (Teifer
consumer demand for medical solutions. At 1994:370). Pfizer Pharmaceuticals, the manu-
least two of the top 20 drugs promoted with facturer of Viagra, tapped into this vast poten-
direct-to-consumer advertising (see Rosenthal tial market and shaped it by promoting sexual
et al. 2002) have significant implications for difficulties as a medical problem and Viagra as
medicalization: Viagra (ranked 6) and Paxil the solution.
(ranked 4). With an aging population, a high prevalence
of sexual dysfunction, and an even larger con-
cern with sexual performance insecurity, the
Viagra and Erectile Dysfunction potential American market was huge, with an
even more extensive worldwide market. The
Male impotence has been a medical problem initial advertising for Viagra was minimal
for many years. There is some evidence of (Carpiano 2001), but Pfizer soon marketed
medicalization in the Victorian era (Mumford Viagra aggressively both to physicians and the
1992), although its dominant framing through- general public. The direct-to-consumer ads
out much of the 20th century appears to have included spokesmen as mainstream as former
been as a psychogenic problem. InDelivered
the 1990s,by Ingenta
Senatortoand: Presidential candidate Bob Dole,
the
Mr problem
Matharu became redefined
(cid 32629), ingentaasinternal
sexual live
dys-2.3.1/F4
well recognized athletes,
(cid 75000325), and ordinary
University people,
of Delaware
function and its treatment was promoted by all testifying
Library (cid 2443) to the wonders of Viagra and how
urologists, the medical technology Tue,industry, it has
27 Dec 2005 changed an important part of their lives.
00:27:44
mass media, and entrepreneurs (Teifer 1994). One typical ad showed baseball star Rafael
A consensus conference in 1992 officially Palmiero with the words I take batting prac-
renamed the problem erectile dysfunction tice, indicating both that vigorous athletes can
(National Institutes on Health Consensus take Viagra and that even stars might need
Development Panel on Impotence 1993), high- some help in performance. Viagra became an
lighting its nature as a biogenic rather than official sponsor of major league baseball, as
psychogenic problem. Available treatments well as sponsoring both the Viagra car in the
such a penile surgery, implants, and injections NASCAR circuit and Spanish language soccer
were medical, although their results were broadcasts. Thus advertising expanded the
mixed (Teifer 1994). market to include virtually any man who might
In March 1998, the Federal Drug consider himself as having some type of erec-
Administration (FDA) approved Viagra (silde- tile or sexual problems.
nafil citrate) as a treatment for erectile dys- Viagra sales were phenomenal. Physicians
function. Intended primarily for the use of wrote 2.9 million prescriptions in the first
older men with erectile problems and for erec- three months of its availability; in the first year
tile dysfunction associated with prostate can- alone, over three million men were treated with
cer, diabetes, or other medical problems (Loe Viagra, translating into $1.5 billion in sales
2001), Viagra was the first non-invasive med- (Carpiano 2001). Perhaps 200,000 prescrip-
ical treatment for male sexual dysfunction. The tions for Viagra are written weekly (Tuller
medication operates by increasing the blood 2002), with untold more Viagra sold through
flow to the penis, allowing a man to achieve the Internet and other outlets. In 2000, Viagra
and sustain an erection when sexually aroused. was ranked 6th in terms of both direct-to-con-
Ingested orally, it takes effect in 30 to 60 min- sumer spending and sales, with a total of $89.5
utes and can last from 4 to 6 hours. million spent and $809 million in sales, and a
A demand for a drug for erectile problems 17 percent increase in utilization from 1999 to
surely existed before Pfizer began advertising 2000 (NIHCM 2001).

Viagra was a factor in the diagnostic expan- expansion of the concept of male sexual dys-
sion of sexual dysfunction and the increased function has prompted other companies to
medicalization of sexual performance (cf. enter and expand this market, including phar-
Conrad and Potter 2000). Prior to Viagra, med- maceutical companies either developing new
ical treatment was largely limited to major dys- drugs to compete with Viagra (Tuller 2002) or
functions (e.g., as from prostate surgery). Now seeking a female Viagra (Moynihan 2003;
it included mild dysfunctions (e.g., occasional Hartley 2003). Given the aging baby boomers
erectile problems) and could be used as an and the entrepreneurial pharmaceutical indus-
enhancement (Conrad and Potter 2004), offer- trys increased promotion of lifestyle drugs
ing a jump start or extra strength for sexual marketed directly to consumers (Mamo and
encounters (Loe 2001). Fishman 2001), the medicalization of sexual
Viagra is not an inexpensive medication: It dysfunction is likely to continue to expand, at
costs about $10 per pill. Within months of the least for the foreseeable future.
FDAs approval of the drug, many large insur-
ers (e.g., Kaiser Permanente and Aetna U.S.
Healthcare) decided that they would not cover Paxil and Social Anxiety Disorders
the drug, except at an extra cost to employers
or individuals, while others did cover the drug When the FDA approved Paxil (paroxetine
(e.g., Blue Cross/Blue Shield plans in Indiana hydrochloride) for the treatment of depression
and California, Harvard Pilgrim Health Care, in 1996, Paxil followed Prozac and several
and the Defense Departments health plan). other selective serotonin reuptake inhibitors
However, many insurers who currently cover (SSRIs) into an already saturated market for
the drug limit the number of pills per month. the treatment of depression. The manufacturer
For example, Tufts Health Plan (2002) covers of Paxil (now called GlaxoSmithKline)
four tablets every 30 days, and Blue Cross and responded to the saturated depression mar-
Blue Shield of Texas (2003) covers eight ket by requesting FDA approval for addition-
Deliveredtheby Ingenta
tablets every 30 days. In Britain, however, to :
al applications of Paxil, specializing instead in
Mr Matharu
National (cidService
Health 32629),covers
ingenta internal
Viagra onlylive
for2.3.1/F4 (cid 75000325),
the anxiety Universitypanic
market, including of Delaware
disorder
sexual dysfunction related to conditions Library
such(cidand2443)
obsessive compulsive disorder at first, and
as diabetes, prostate cancer, and Tue,
renal27 Dec 2005
failure 00:27:44
then social anxiety disorder (SAD) and gener-
(Michael Bury, University of London-Royal alized anxiety disorder (GAD). Paxils applica-
Holloway, personal communication). tion to SAD and GAD has contributed to the
The health insurance industry was involved medicalization of emotions, expanding med-
in the debate over whether sexual dysfunc- ical jurisdiction over emotions such as worry
tion was a medical necessity and whether and shyness.
Viagra should be covered by health insurance, SAD and GAD were fairly obscure diag-
resulting in mixed insurance coverage for noses when they were added to the American
Viagra. In this case, the insurance industry Psychiatric Associations Diagnostic and
attempted to counteract increased medicaliza- Statistical Manual (DSM) in 1980. According
tion of male sexual dysfunction by restricting to the DSM-IV, SAD (or social phobia) is a
access to Viagra. However, individuals with a persistent and extreme fear of social and per-
physicians prescription could of course pur- formance situations in which embarrassment
chase the drug on their own or through a range may occur (American Psychiatric Association
of Internet sites. 1994:411) and GAD involves chronic, exces-
One important social benefit from the popu- sive anxiety and worry (lasting at least six
larity and widespread use of Viagra is a reduc- months), involving multiple symptoms
tion of the stigma of sexual dysfunction. (American Psychiatric Association 1994:
Seeing ads for Viagra in so many mainstream 43536). Both conditions are defined as being
locations and making Viagra part of everyday associated with significant distress and impair-
discussions has made sexual dysfunction and ment in functioning. Horwitz (2002) notes how
its treatment appear conventional and com- small changes in wording of criteria for SAD
monplace. This has most likely also increased resulted in a tremendous growth in its estimat-
the market for Viagra, since it would be less ed prevalence (and potential market).
stigmatizing to inquire about and use it. Marketing diseases and then selling drugs to
The success of Viagra and the subsequent treat those diseases is now common in the

post-Prozac era. Since the FDA approved the its loosely defined boundaries and the aggres-
use of Paxil for SAD in 1999 and for GAD in sive marketing of it as a disease: [T]he
2001, GlaxoSmithKline has spent millions of impression often conveyed by commercials for
dollars to raise the public visibility of SAD and the drugs is clear: almost anyone could benefit
GAD, by sponsoring well-choreographed dis- from them (Goode 2002). Murray Stein, a
ease awareness campaigns. The pharmaceuti- psychiatry professor at the University of
cal companys savvy approach to marketing California at San Diego, has called the use of
SAD and GAD, which relied upon a mixture of prescription medicines such as Paxil, which
expert and patient voices, simultaneously are costly and may have significant side
gave the conditions diagnostic validity and cre- effects, cosmetic psychopharmacology
ated the perception that it could happen to any- (Vedantam 2001:1). Paxils web page
one (Koerner 2002). Soon after the FDA (www.paxil.com) stresses the elimination of
approved the use of Paxil for SAD, Cohn and symptoms (e.g., improved sleep) and improved
Wolfe (a public relations firm that was work- performance (e.g., improved ability to con-
ing for what was then SmithKline) began centrate and make decisions) as benefits.
putting up posters at bus stops with the slogan, Efforts to define SAD and GAD as condi-
Imagine Being Allergic to People. Later in tions, and market Paxil as treatment for them,
1999, a series of ads featured Paxils efficacy have been extremely successful. Paxil is one of
in helping SAD sufferers brave dinner parties the three most widely recognized prescription
and public speaking (Koerner 2002:61). drugs, after Viagra and Claritin (Marino 2002),
Barry Brand, Paxils product director, said, and it is currently ranked sixth in terms of pre-
Every marketers dream is to find an uniden- scriptions (Nittan 2001), with U.S. sales of
tified or unknown market and develop it. approximately $2.1 billion and global sales of
Thats what we were able to do with social anx- $2.7 billion. It is of course not possible to dis-
iety disorder (Vedantam 2001). tinguish how much of this was for SAD or
Through media campaigns, GlaxoSmithKline GAD and
Delivered by Ingenta to :how much of it was prescribed for
redefined
Mr Matharu SAD(cid and GAD,
32629), paradoxically,
ingenta as2.3.1/F4
internal live other (cid
problems including
75000325), depression,
University obses-
of Delaware
both common (reducing the stigma associated sive
Library (cid 2443)compulsive disorder, or post traumatic
with having a mental illness) and Tue,abnormal
27 Dec 2005stress disorder.
00:27:44
(subject to medical intervention, in the form of But there has been some recent backlash
Paxil). Prevalence estimates of both SAD and against the drug. In 2002, a federal judge
GAD range widely. For example, estimates of ordered a temporary halt to Paxil ads over the
the prevalence of SAD range from 3 percent to claim that Paxil is not habit forming (White
13 percent (American Psychiatric Association 2002). Apparently, patients and health care
1994:414), with the National Institute of providers have submitted thousands of reports
Mental Health estimating that 3.7 percent of to the FDA describing withdrawal symptoms
the U.S. population has SAD (Vedantam (Peterson 2002). Multiple lawsuits have been
2001). Higher prevalence rates are associated filed, asserting that physicians and consumers
with less stringent application of the DSM- were misled by advertisements regarding the
specified criteria for these conditions.1 severity of withdrawal (Barry 2002). Like sim-
Horwitz (2002) argues that, Because commu- ilarly marketed consumer goods, such as music
nity studies consider all symptoms, whether and clothing, it is possible that Paxils popular-
internal or not, expectable or not, deviant or ity may be waning. However, along the way,
not, as signs of disorder, they inevitably over- the GalaxoSmithKline campaign for Paxil has
estimate the prevalence of mental disorder in increased the medicalization of anxiety, infer-
the community (p.105). Likewise, the disease ring directly and indirectly that shyness and
awareness campaign focused on individuals worrying may be medical problems and that
feelings in social situations likely to evoke fear Paxil is the way to treat them.
in many people, especially public speaking,
and offered consumers symptom-based self
tests to assess the likelihood that they had DEVELOPMENT OF PRIVATE MEDICAL
SAD and GAD (www.paxil.com). This kind of MARKETS
clinical ambiguity is fertile ground for creating
an expansive medical market. When treatments or services are not covered
Some question the validity of SAD, due to by health insurance, but the demand for the

medical service or treatment remains, a private approved by the FDA only for treating hypopi-
medical market may evolve. Private medical tuitary dwarfism (or growth hormone defi-
markets emerge when an available medical ciency) and chronic renal failure. While indi-
interventionfrequently medical technology vidual cases might be disputed, the medical
or an off-label use of an approved drug profession established strict guidelines (Bercu
meets consumers willing to pay out of their 1996) to distinguish between growth hormone
pockets to receive treatment. Such markets are deficiency disorder and what has been called
sustained by consumer demand, and they can idiopathic short stature or ISS (children with
be expanded by increasing the availability of normal growth hormone who are short).3
the intervention, reducing the cost of the treat- As time went on, physicians, patients, and
ment, or expanding the range of uses or target drug companies all sought other medical uses
populations. Some of these interventions can for human growth hormone. By 1990,
be seen as medical enhancements rather than researchers and leading drug companies were
treatments for a disease, but this is a slippery investigating the possibility of administering
slope. This commercialization of medicine has human growth hormone to children with idio-
been well-developed in cosmetic surgery pathic short stature, that is normal children
(Sullivan 2001), but it exists in other areas as who were of short stature but had no deficien-
well. The relation of increasing medicalization cy of the hormone. Short stature is defined as
and private markets for biomedical enhance- the lower 3 percentiles for age and sex, which
ments and technology are illustrated through is roughly two standard deviations below the
two cases: the use of human growth hormone sex-age means. For adult males it is 64.5 inch-
for idiopathic shortness and in vitro fertiliza- es or less; for adult females it is 59.5 inches
tion for infertility. (NHANES 2000). It is estimated that 1.8 mil-
lion children in the United States and a similar
number in Europe can be characterized with
Human Growth Hormone and Idiopathic significant short stature. Only 20 percent of
Short Stature Delivered by Ingenta to referred
these are : to pediatric endocrinologists
Mr Matharu (cid 32629), ingenta internal live 2.3.1/F4 (cid 575000325),
and only percent ofUniversity
these are ofgrowth
Delaware
hor-
Library
Medications are frequently prescribed for(cidmone
2443)deficient (Hintz 1996). The vast majori-
off-label uses, as treatments ofTue, 27 Dec 2005
conditions 00:27:44
ty of short children therefore can be considered
beyond those approved by the Federal Drug idiopathic short stature, defined as a hetero-
Administration. While physicians, in practice,2 geneous state that encompasses individuals
have autonomy and authority to prescribe for with short stature, including those with FSS
off-label uses of a drug, manufacturers cannot (familial short stature), for which there is no
legally market for off-label uses. recognized cause (Kelnar et al. 1999:151).
Prior to 1985, human growth hormone The causes of short stature may well be famil-
extracted from cadavers was used to treat indi- ial (short parents), genetic, or nutritional, but it
viduals who had a growth hormone deficiency. can be seen as normal shortness as opposed
The growth hormone was in low supply and to more specific deficiency shortness.
thus very expensive and carried severe risks of A national survey of 534 pediatric endocri-
Creutzfeldt-Jacobs disease, a potentially fatal nologists documented that 94 percent of them
brain disease. In 1985 the FDA removed it had prescribed human growth hormone within
from the market. With fortuitous timing, the previous 5 years for children who were not
Genentech introduced an FDA approved syn- hormone deficient (Cutler et al. 1996:532).
thetic human growth hormone within six Genentech and, to some extent, Eli Lilly (who
months of the removal of cadaver-extracted marketed a similar hormone) worked closely
growth hormone. The recombinant hormone, with the Human Growth Foundation, a non-
marketed as Protropin, could be produced in profit advocacy group that supported short
potentially unlimited quantities (Lantos et children (Werth 1991), a more general term
al. 1989:1020) to such an extent that physi- including both hypopituitary dwarfism and
cians credited the new technology with ending idiopathic short stature. Genentech also sup-
the market shortage of the hormone ported research by pediatric endocrinologists
(Glasbrenner 1986). Genentech soon claimed and began its own longitudinal research on
75 percent of the existing $200 million U.S. healthy children who were not hormone
market (Werth 1991). The hormone had been deficient. These activities further blurred the

boundaries demarcating legitimate and off- eased limitations upon manufacturers, broad-
label use of human growth hormone.4 In ening the information that they may provide to
2003, the FDA approved Eli Lillys Humatrope physicians about off-label use of their products
to treat idiopathic short stature children in the (Stapleton 1999). In terms of shortness, the
shortest 1.2 percent of the population, which potential market is considerable, with nearly
will likely accelerate its use in potentially short four million children in the United States and
children (Kaufman 2003). Europe who could be defined as having idio-
There is some evidence that shortness (and pathic short stature. This could further increase
especially extreme shortness) often is a deval- the medicalization of short stature.
ued status and can have social consequences,
especially for males. Some researchers have
found social disadvantages of shortness, In Vitro Fertilization and the Medical
including discrimination in hiring and salaries, Treatment for Infertility
assumptions regarding maturity and compe-
tence, issues around self-esteem and perceived The development of reproductive technolo-
attractiveness, and practical problems such as gies has resulted in the medicalization of infer-
buying well-fitting clothes (see Conrad and tility. In vitro fertilization (or IVF), in which
Potter 2004). Whatever the real or imagined eggs are abstracted and fertilized and then
disadvantages of shortness, some parents have implanted inside a womans uterus, is one such
anxieties about their childrens height. With the case. When it was first practiced successfully,
availability of synthetic human growth hor- resulting in the conception of the first test
mone, parents could consider interventions tube baby in 1978, in vitro fertilization held
that would influence the height of their chil- out hope of a technological fix to an esti-
dren. mated 7 percent of couples who experience
At least 13,000 children in the United States infertility (Centers for Disease Control 2001).
with idiopathic short stature were treated
Delivered Persons
withby Ingenta to now
: perceive that not only can the
human growth
Mr Matharu hormone
(cid 1994.5 internal
32629),iningenta Research source(cid
on2.3.1/F4
live of infertility
75000325), be University
diagnosed,of
butDelaware
it can be
growth hormone treatment with idiopathic treated
Library (cid 2443) (Scritchfield 1995:139), and assisted
short children has been equivocal.Tue, It is27
debat-
Dec 2005reproductive
00:27:44 technology has transformed
able how much treatment can increase growth infertility into a clinical need (Bates and
from predicted height (cf. Hintz 1996). One Bates 1996:301).
major multi-center study, sponsored by Yet the medical market for in vitro fertiliza-
Genentech, reported that of the 80 individuals tion has remained fairly constrained because
in the study who reached final height, the many consumers do not have insurance cover-
mean gain from predicted height was 5.9 cen- age for in vitro fertilization (Neumann 1997).
timeters in girls and 5.0 centimeters in boys One study found that a minority of plans (14 to
(Hintz et al. 2000). The height gains are mod- 17 percent, depending upon the type of plan)
est; human growth hormone will not transform cover in vitro fertilization (Alan Guttmacher
a short person into a tall one, but only into a Institute 1993), and another study found that
less short one. Human growth hormone treat- 30 to 40 percent of in vitro fertilization ser-
ment costs about $20,000 a year and must be vices are covered partially and that insurance
continued for three to six years. Parents of reimburses for about half of the costs when in
idiopathic short stature children must pay this vitro fertilization is covered (Collins et al.
out of their own funds, since health insurance 1995). At first, health insurers justified their
will only cover treatment for hormone defi- exclusion of IVF from coverage on two
ciency. If the average height gain is two inch- grounds: efficacy and cost. Initially, success
es, and the average cost is $100,000, the cost of rates were estimated to be 1520 percent per
height enhancement is roughly $50,000 an attempt (Kolata 1983), and recent estimates of
inch. success rates range from 32.2 percent for
The relative ease with which manufacturers women under 35 years to 9.7 percent for
may promote and physicians may prescribe women ages 4041 (Centers for Disease
human growth hormone for off-label treatment Control 2001). Insurance companies have
has increased the range of possible uses often labeled in vitro fertilization as experi-
(Conrad and Potter 2004). The Federal Drug mental, as a result of these relatively low suc-
Administration Modernization Act of 1997 cess rates. In vitro fertilization is also a fairly

expensive treatment, costing about $10,000 on dren (American Society for Reproductive
average for one cycle (Wilcox and Rossi Medicine 2002). Earlier cases in which con-
2002), and it often requires multiple cycles to sumers claimed that infertility is an illness
produce a successful pregnancy, if a successful were sometimes successful (e.g., Witcraft v.
outcome is attained at all. Some insurance car- Sundstrand Health and Disability Group
riers provided coverage for assisted reproduc- Benefit Plan and Egert v. Connecticut General
tive technology when it first became available Life Insurance Co.). More recent consumer
but dropped that benefit (Lang 1998) or decid- claims that infertility is a disability, and that
ed to charge extra for in vitro fertilization cov- insurers lack of coverage of in vitro fertiliza-
erage (The New York Times 1998). tion constitutes discrimination under the
In response to insurers overall refusal to Americans with Disabilities Act of 1990 have
cover in vitro fertilization, many middle and had less success in the courts (e.g. Zantanian v.
upper-middle class couples pay the cost out-of- WDSU-Television Inc. and Krauel v. Iowa
pocket, using their savings and going into sub- Methodist Medical Center).
stantial debt. Pamela Madsen, the executive Insurers have fought hard against claims of
director of the New York chapter of Resolve, infertility as an illness or a disability, making
an infertility support and advocacy group, had three main defenses: (1) infertility is not an
two babies using in vitro fertilization. She illness; (2) artificial reproductive technology
described her difficulty to a reporter: (ART) is not medically necessary; and (3)
Im tapped out, mortgaged out, credit-card- ARTs are experimental (Gilbert 1996:44).
ed out. And we were lucky. We got our Regarding infertility as an illness, some argue
babies. We still live in a one-bedroom that infertility is sought by some couples and
apartment. We had a nest egg when we got suffered by others. Therefore, it is a socially
married; we had health insurance, and the constructed neednot a medical need (Bates
system wasnt there for us (Lang 1998:12). and Bates 1996:301). Nonpregnancy is not an
Facing looming personal debt from infertili- illness. Some insurers have argued that infer-
ty treatment and substantial resistance Delivered
fromby Ingenta to :
tility treatment is elective and does not cure
Mr Matharu
health (cidmiddle
insurers, 32629),
andingenta internal class
upper-middle live 2.3.1/F4 (cid 75000325),
any sickness or diseaseUniversity
(Tischlerof1994).
Delaware
The
consumers have turned to litigation and Library
legis-(cidmedical
2443) necessity argument has been used to
lation as means of gaining rights toTue, 27 Dec 2005
reimburse- 00:27:44
exclude in vitro fertilization from coverage by
ment for in vitro fertilization. These couples drawing attention to the social aspects of infer-
have made a claim upon society to guarantee, tility and uses of IVF. Some contend that this
through whatever means possible, the capacity argument is used to control in vitro fertiliza-
to reproduce (Blank 1997:281). Thus far, nine tions fiscal impact on insurers (Hughes and
states have passed legislation regulating health Giacomini 2001), restricting the use of in vitro
insurance coverage of in vitro fertilization in fertilization to a small number of cases in
response to advocacy efforts by groups such as which the source of infertility problems can be
Resolve (the largest fertility support group in specifically pinpointed and addressed. For
the United States). Recently, there have also example, the use of in vitro fertilization to
been some calls for federal legislation to pro- bypass blocked or damaged fallopian tubes is a
tect the insurance rights of infertile couples very specific, medical use of the technology.
(McKee 2001). The use of in vitro fertilization to address
Consumers have also sought health insur- infertility associated with age or to help single
ance coverage for in vitro fertilization through or lesbian women have biological children is
the courts, claiming that infertility is an illness more social. This medical necessity argument
or a disability, but such attempts have had only has had some success in the courts (e.g.,
limited success. In this arena, consumers and Kinzie v. Physicians Liability Insurance
insurers have wrestled over the medicalization Company 1987).
of infertility and over in vitro fertilization as a Even with a few successful court cases,
treatment for infertility. The position that infer- insurers in general have not accepted con-
tility is a disease is supported by the American sumers claims that infertility is a disease or
Society for Reproductive Medicine, which disability and have not increased coverage. As
states that, infertility is a disease of the repro- a result, many consumers must still pay out-of-
ductive system that impairs one of the bodys pocket for in vitro fertilization services, and
most basic functions: the conception of chil- some fertility clinics have turned to creative

financial arrangements to increase the private mitted (e.g., for off-label uses), corporations
market for their services. These arrangements promote indirectly to providers or consumers
offer money-back guarantees or substantial (e.g., on the Internet). Consumers are the
refunds if patients do not get pregnant or if prime driver for demand, generally without
they miscarry early in the pregnancy insurance support, and must pay directly for
(Hamilton 1996; Wilcox and Rossi 2002; medical products or services. Physicians are
Wozencraft 1996). necessary facilitators for treatment but are
The private market for in vitro fertilization sometimes promoters (i.e., entrepreneurs) for
appears to be here to stay. Physicians are drawn the product as well (e.g., cosmetic surgery).
to reproductive medicine because of the cut- There may be a tension between restricted
ting edge nature of the work, as well as the access to health care and the expansion of
potential for commercial profit (Brody 1987). mediated and private markets. Private markets
In vitro fertilization clinics advertise using tend to emerge when insurers define a problem
Internet websites with links to finance compa- or treatment as not medically necessary and
nies to help pay for the procedure. Consumers therefore not subject to third party reimburse-
who wish to have biological children are drawn ment. Thus insurers here attempt to constrain
to technological solutions to infertility. Yet the access to medicalized solutions by refusing to
consumer demand for in vitro fertilization and cover particular treatments or services. These
other reproductive technologies is constrained markets are not fixed; given changes in pro-
by insurers refusals to pay for such services, motion, insurance coverage, or consumer role,
except under specific medical circum- private markets could become mediated mar-
stances. This has resulted in the creation of a kets and vice versa. In operation, such markets
private medical market for consumers who can are more on a continuum than mutually exclu-
afford to pay for in vitro fertilization or who sive in their attributes.
are willing to take on significant debt to do so. A key to all markets is the existence of a
medicalto product
Delivered by Ingenta : and consumer demand. In
Mr Matharu (cid 32629), ingenta internal live 2.3.1/F4
some (cid 75000325),
cases, University of companies
the pharmaceutical Delaware
DISCUSSION Library (ciddevelop
2443) strategies to expand their markets
Tue, 27 Dec 2005 00:27:44
(e.g., Viagra and Paxil), while in others the
We have described four cases where the markets are more consumer-driven. Table 2
development of medical markets facilitated outlines the different modes of promotion and
medicalization, and we have identified two their relation to medicalization.
forms of medical markets: mediated and pri- In two cases the development of medical
vate markets. We outline the main attributes of markets is primarily corporate driven. Viagra
these markets in Table 1. In mediated markets, and Paxil are promoted by pharmaceutical
corporate medical producers attempt to companies through direct-to-consumer adver-
increase demand for their products by promot- tising, but the goals and means differ. With
ing directly to consumers and providers, with Viagra, the goal is to increase the appeal of the
the market mediated by health insurers and product to a wider population. When first
managed care organizations. Consumers introduced, Viagra was aimed at older men or
become the target for market expansion, with others with established erectile dysfunction.
physicians largely remaining as gatekeepers However, in recent years much of the advertis-
prescribing treatment.6 In private medical mar- ing has been aimed at a younger and broader
kets, due to limits in types of promotion per- population, with the implicit message that
TABLE 1. Comparison of Mediated and Private Markets

Relation to Mediated Markets Private Markets
Corporate Direct promotion to providers and consumers Indirect promotion to providers via off-label
(direct-to-consumer advertising) use or consumers on the Internet
Insurers Problem is generally covered by insurance with Problem is not covered
relatively flexible criteria by insurance or only covered under strict
medical criteria
Consumers Targeted for market expansion Promoter of market expansion
Physicians Gatekeeper, with authority to define problem Facilitator, with authority to define problem
and prescribe treatment and prescribe treatment

TABLE 2. Promotion of Medical Markets and Medicalization
Product Promoter Goal Means Medicalization
Viagra Corporate Driven Create new populations Direct-to-consumer Expands diagnosis of
for product advertising to younger erectile dysfunction
and virile types
Paxil Corporate Driven Create new problems for Direct-to-consumer dis- Promotes disorders of
approved product ease awareness cam- SAD and GAD
paign
Human Consumer and Expand product to non- Secure off-label use of Makes short stature into
Growth Corporate Driven FDA approved uses product a medical problem
Hormone
In Vitro Redefine infertility into Seek right to treatment Further medicalizes
Fertili- Consumer Driven a health problem so through legislation infertility
zation technology is covered and litigation
by health insurance
Viagra can help them too with whatever sexual/ to achieve medical legitimacy for all kinds of
performance problems they may have. This infertility so that third parties will pay for
market expansion means offering a medical treatment. When human growth hormone for
solution to a wider range of mild or transitory idiopathic short stature and in vitro fertiliza-
erectile problems. The promoters of Paxil, on tion for infertility are not covered by health
the other hand, want to differentiate their drug insurers, consumers must pay for these ser-
from others on the market. After getting FDA vices out-of-pocket, creating a private medical
approval for new uses, GlaxoSmithKline market. This type of market has all the charac-
developed a direct-to-consumer disease teristics of any private market: Those who can
awareness campaign to alert consumers afford to pay can acquire the services.
that they might have a diagnosable problem Medical markets can change, based upon
(e.g., SAD) and that Paxil could be the right
Delivered by Ingenta to insurers
whether : deem the product to be a
choice for them. This encourages people to medical necessity and cover a service
Mr Matharu (cid 32629), ingenta internal live 2.3.1/F4 (cid 75000325), University or drug.
of Delaware
redefine their life difficulties in medical terms(cidThe
Library in vitro fertilization debate clearly turns
2443)
and creates a further demand for Tue, 27 Dec 2005
the product. on 00:27:44
whether infertility treatment is medically
In both cases the advertising aims to increase necessary; consumers say it is and should be
the consumer demand for the medical treat- covered by insurance while insurers claim hav-
ment product. Increased medicalization is a ing children is a social choice, not a medical
by-product. one. We see medical necessity reflected in the
Human growth hormone can be seen as human growth hormone and Viagra cases as
jointly corporate and consumer driven. While well, even if the term is not typically applied.
there was no direct corporate product advertis- Consumer advocates claim that human growth
ing to consumers, Genentech had to pay a $50 hormone is a medical necessity since medical
million settlement for overpromoting human treatment could mitigate the suffering, stigma,
growth hormone to medical practitioners for and discrimination due to the biological limita-
treating unapproved conditions (including tion of extreme shortness. Is the treatment of
idiopathic short stature) (Nordenberg 1999). It erectile dysfunction a medical necessity? In
is unclear how much the promotion to doctors terms of insurers, the answer is, sort of.
and hospitals stimulated the development of When insurers cover the cost of Viagra, they
the medical market for growth hormone, but is often limit it to four to eight pills a month.
safe to assume it had some effect. Genentech Does this mean sexual intercourse is a medical
and other pharmaceutical companies support necessity four to eight times a month?
consumer groups that promote hormone inter- It is also possible to see some uses of human
ventions for idiopathic short stature, but con- growth hormone, Viagra, Paxil and in vitro fer-
sumer groups are the primary advocates for tilization as biomedical enhancements rather
human growth hormone treatment (Conrad and than treatments. While there are certainly med-
Potter 2004). For in vitro fertilization, con- ically legitimated uses for each of these drugs
sumers are the main proponents pressuring for and procedures, some uses may constitute
insurance coverage. Through organizations, lit- enhancement rather than treatment.
igation, and legislation, consumers are striving Biomedical enhancements are medical inter-

ventions used to improve physical or mental Physicians in the past have provided prescrip-
characteristics or performance in those with no tions in response to patients direct requests,
identifiable pathology. Adding a few inches of even when the scientific knowledge suggested
height to ones child, insuring strong erections, that it was not appropriate, because they wor-
increasing ones social abilities, or having a ried about economics and their professional
biological child might all be improvements image and because they wanted to respond to
that could be sought by many individuals. One patients requests for help (Schwartz,
need not have a disorder to benefit from these Soumerai and Avorn 1989). But direct-to-con-
medical interventions. Peter Kramer (1993) sumer advertising has increased consumers
claimed that Prozac can make people better role in the prescribing equation. While physi-
than well. There has been some debate in the cians remain the gatekeeper to these drugs,
bioethics literature about a distinction between reflected in most direct-to-consumer ads end-
therapy and enhancement, but medicalizing ing with a statement like, ask your doctor if
human problems creates a slippery slope Paxil [or Viagra] is right for you, there is
between enhancement and legitimated medical increased pressure to respond to consumers
treatment (Conrad and Potter 2004). independent requests for medications. In the
While erectile dysfunction, anxiety, short context of current debates regarding chal-
stature, and infertility surely can impact peo- lenges to physicians professional knowledge
ples lives to varying degrees, they are not life- (Timmermans and Kolker 2004), it appears
threatening conditions nor even major health that pharmaceutical manufacturers are circum-
risks. Anti-hypertensive or cholesterol reduc- venting physicians control over knowledge
ing drugs associated with cardiovascular dis- regarding available drugs.
ease are also widely promoted, but for a well Insurers as payers exert a strong influence
established medical problem. While prevention on medical markets. In the context of the
of disease is a major market for drugs and
examples presented here, insurers including
interventions, the relatively common problemsby Ingenta to :
Delivered HMOs set the limits on some medical markets,
of
Mrlife, on the
Matharu margins
(cid 32629),ofingenta
medicine, holdlive
internal the2.3.1/F4 (cid 75000325), University of Delaware
thus acting as a constraint on access to med-
greatest potential for market expansion and (cid 2443)
Library icalized solutions to human problems. This is
medicalization. Tue, 27 Dec 2005 00:27:44
particularly clear with in vitro fertilization,
The role of physicians as providers is
where insurers definition of the treatment as
changing in the current medical marketplace,
with some areas shifting more than others. experimental and their refusal to cover it
With off-label uses of drugs like human except in very specific diagnostic situations
growth hormone for idiopathic short stature, has limited in vitro fertilization to those who
physicians play a facilitating role in the mar- could afford to pay for it. Insurers will only pay
ket. It is a physicians prerogative to prescribe for human growth hormone for children with a
medications for uses beyond those approved by diagnosed growth hormone deficiency; idio-
the FDA. Doctors commonly prescribe drugs pathic short stature children only receive treat-
for unapproved uses if, in their judgment, the ment if their families can pay for it. Few can
drug would be an effective treatment for a afford the tariff. Even with Viagra, some insur-
patients problem. Similarly, technical inter- ance plans dont cover this treatment for erec-
ventions such as in vitro fertilization would be tile dysfunction, while others limit the use. It
totally unavailable without physician involve- has long been an axiom in medicalization stud-
ment. Thus physicians still have an important ies that the only way to get human services
central role in facilitating medical markets, paid for is to turn life difficulties into medical
especially in private markets. problems. Yet under managed care insurers are
But the physicians role is challenged on responding to this medicalization by restricting
other fronts, particularly with direct-to-con- payment for these services. Insurance con-
sumer advertising undermining physicians straints do not necessarily affect the conceptu-
authority regarding which drugs to prescribe. al level of medicalization but they constrain
Physicians have always been the major conduit access to medicalized solutions at the patient
between the pharmaceutical industry and level (Conrad and Schneider 1980)7. By
patients (which is why the pharmaceutical restricting access to medical solutions in the
industry spends billions of dollars advertising name of medical necessity, insurers attempt
and promoting their wares to physicians). to limit individuals claims that they are suffer-

ing from illnesses rather than everyday life Manufacturers will likely promote off-label
(Sabin and Daniels 1994). applications to the extent legally permitted,
Consumers have a dual role related to med- perhaps expanding diagnoses (Conrad and
ical markets. In some instances the market for Potter 2000) and further medicalization.8
a problem exists long before any medical pro- Medicalization narrows the definition of
motion. Individuals have been seeking nos- health and widens the definition of sickness.
trums to improve sexual performance or votive The direct-to-consumer advertising focuses on
objects to insure fertility for centuries, while help seeking advertisements (Lyles 2002),
short people have often tried to appear taller which try to create an awareness of symp-
(think elevator shoes and high heels). In a toms or conditions among consumers.
sense, there is a ready-made market demand Consumer education campaigns are used to
for a product. Consumers and medical interests introduce new products or extended applica-
are already allied, and consumers may become tions, essentially bringing new people into a
the dynamic force for market creation. In other market by creating a previously unrecognized
cases, the public constitutes potential con- demand for a product (Applbaum 2000). The
sumers who must be shaped into a market. This marketing of Viagra expands the bounds of
involves persuading consumers of the necessi- erectile dysfunction, implying that it is not
ty or utility of a product offered or creating healthy or normal to have variation in
consumer demand. Direct-to-consumer adver- penile erections. Paxil ads emphasize that it
tising for Paxil exemplifies this, although it is may be pathological to be anxious or shy in
partly true for Viagra as well. Such promotion social situations and that this can be changed
can induce people to self-label their problems by using the drug. Employing human growth
as medical entities and seek more medical ser- hormone to treat short stature indicates a nar-
vices. This medical commodification shifts rowing of the range of normal height as well as
both definition and solution into the medical reinforcing the notion that shortness is deviant
sphere. and undesirable, and that it should be altered.
Recent changes in FDA regulations Delivered
allowby Ingenta to :
The marketing of Paxil, Viagra and, to a lesser
Mr aMatharu
for different(cid 32629),
kind ingenta
of drug internal
marketing live 2.3.1/F4
by loos- degree,(cidhuman
75000325),
growthUniversity
hormone oftargets
Delaware
rela-
ening off-label provisions and enablingLibrary
televi-(cidtively
2443)healthy people. Drug companies search
Tue, 27facili-
sion advertising of prescription drugs, Dec 2005 00:27:44
for markets creates broader disease definitions
tating the emergence of new medical markets. for their products, indirectly reducing what is
Broadcast ads can now name the disorder and normal.
the drug, so long as they include limited risk
and benefit information (Lyles 2002). As
noted, corporate pharmaceutical spending on CONCLUSION
television advertising increased six-fold from
1996 to 2000, and ads for products such as We highlight the increasing importance of
Paxil and Viagra have become common. pharmaceutical companies, insurers, and con-
Off-label uses of FDA approved drugs is one sumers for medicalization as they are involved
of the easiest routes to the expansion of med- in the creation of medical markets. The med-
ical markets. Once a drug has been approved ical profession has a diminished but still key
for one use or population, it can be prescribed role in medicalization. Given the changes in
for broader purposes. Ritalin is approved for medicine and its organization, important are-
childhood ADHD, but for the past decade it has nas of medicalization are moving from profes-
been used widely with adults (Conrad and sional to market domains.
Potter 2000). Provigil (modafinil) is approved It is not new knowledge or technology that
for sleep disorders, such as narcolepsy and engenders medicalization but how they are
hypersomia, but in its direct-to-consumer used. Corporate and medical promotion of
advertising, Cepahlon, the manufacturer, has products, treatments, and drugs underlies the
touted that the drug can drastically reduce the emergence of new medical markets. With our
amount of sleep required without affecting corporatized medical-industrial complex, the
performance (Wolpe 2002). While drug com- creation or expansion of medical markets
panies have been limited in their advertising becomes an important conduit to medicaliza-
for off-label uses, FDA regulations allow for tion. Consumer demand is not simply unfet-
considerably more latitude in promotion. tered desire for medical solutions, but it is

shaped by the availability and accessibility of terion that has produced the most contro-
medical interventions. This creates a new set of versy (Lantos et al 1989; Bercu 1996). For
relationships among corporate entities, insur- example, peak growth hormone levels
ers, physicians, and consumers. between 7 and 10 are considered a gray
In the context of the changing balance of zone, and different methods of assessing
power among the medical profession and relat- growth hormone levels produce varying
ed institutions, the engines of medicalization results (Lantos et al. 1989).
are found in the marketplace nexus of the 4. In 1994, several federal agencies began a
biotechnology industry and rising con- series of investigations targeting Eli Lilly
sumerism. The brakes take the form of insur- and Genentech for overpromoting their
ers, including private and government spon- growth hormone products, that is, market-
sored managed care. As corporate entities and ing them for non-approved uses (for details,
consumers pursue the goals of promotion or see Conrad and Potter 2002). The FDA
reception of new medical interventions, we are alleged and documented that, by the end of
likely to see the development of new medical 1985, Genentech had begun marketing
markets along with a growing pressure to med- Protropin for use in the treatment of med-
icalize the troubles and problems of everyday ical conditions for which it did not have
life. FDA approval (Nordenberg 1999:33).
From 1985 to 1994, Genentech marketed
Protropin to a variety of medical practition-
NOTES ers (doctors, hospitals, and others) for treat-
ing unapproved conditions, including idio-
1. According to the DSM, the diagnostic crite- pathic short stature (Nordenberg 1999).
ria for SAD include: a marked and persis- Genentech paid $50 million in settlement,
tent fear of social or performance situations including a $20 million penalty to reim-
in which embarrassment may Deliveredoccur, anby Ingenta
burseto : Medicaid and CHAMPUS
Mrimmediate
Matharu (cidanxiety response,
32629), ingentaainternal
recognition (Nordenberg
live 2.3.1/F4 1999).University of Delaware
(cid 75000325),
that the fear is excessive or unreasonable,
Library (cid5.2443)
This is an extrapolation. In 1994, about
avoidance of the situation orTue, endurance
27 Dec 2005 7,000 children were believed to suffer from
00:27:44
with dread, interference with daily routine short stature due to human growth hormone
or marked distress about the phobia, and the deficiency but 20,000 children were treated
fear not being due to substance effects or with human growth hormone (Biotechology
other conditions (American Psychiatric News, 1994). Therefore at least 13,000 chil-
Association, 1994:411). dren were treated for idiopathic short
2. Professional medicine has long approved of stature that year.
off-label uses of drugs. In 1999, the 6. There is increasing advertising on the
American Medical Association approved a Internet for Viagra, human growth hor-
position statement (Resolution #528), intro- mone, and other prescription medications.
duced by the Society of Cardiovascular and While it is assumed that a doctor must eval-
Interventional Radiology, on off-label use uate the short forms consumers need to
of devices and medications. In summary, complete before ordering medications, the
the AMA permits physicians to decide what wide availability of medications through the
to prescribe for their patients and for what Internet sources compromises the physi-
medical conditions, because physicians are cians gatekeeper role.
best able to base these decisions on current 7. Some have suggested that direct-to-con-
clinical standards and not just FDA- sumer advertising is in part a reaction to
approved indications. managed care. Lyles (2002) notes that,
3. Criteria include (1) height of less than three managed care controls that limit the physi-
standard deviations below the mean for a cians prescription authority also reduce the
childs age and sex, (2) abnormal growth potential of promotional activities targeting
velocity (less than 25th percentile for bone physicians; consequently pharmaceutical
age), and (3) growth hormone provocative companies have responded by seeking alter-
testing results with peak growth hormone of native ways to influence physician prescrib-
less than10 (g/L in a polyclonal radioim- ing (p. 27).
munoassay (Bercu 1996). It is this latter cri- 8. A recent case illustrates this. Parke-Davis, a

major pharmaceutical company, developed Blank, Robert H. 1997. Assisted Reproduction and
a marketing strategy to promote their Reproductive Rights: The Case of In Vitro
epilepsy drug, Neurontin, for four off-label Fertilization. Politics and the Life Sciences
uses. The company estimated it could earn 16:27988.
Blue Cross and Blue Shield of Texas. 2003.
$150 million by promoting the drug to doc-
Quantity Versus Time Limits List. Retrieved
tors for social phobias, panic disorder, bipo- August 25, 2004 (http://www.bcbstx.com/
lar illness, and neuropathic pain in journals provider/pdf/qvtdruglist.pdf).
and at medical conferences rather than Bonaccorso, Silvia N. and Jeffrey L. Sturchio. 2002.
embarking on the clinical trials and lengthy Direct to Consumer Advertising is
process of seeking FDA approval. 80 per- Medicalizing Normal Human Experience:
cent of the prescriptions for Neurontin are Against. British Medical Journal 324:91011.
for off-label uses. U.S. sales for 2002 are Brody, Eugene B. 1987. Reproduction without
estimated as $2 billion. The company SexBut with the Doctor. Law, Medicine and
claims it was only distributing materials for Health Care 15:1525.
Carpiano, Richard M. 2001. Passive
educational purposes, but critics saw it as
Medicalization: The Case of Viagra and Erectile
an unethical form of marketing (Kowalczyk Dysfunction. Sociological Symposium 21:
2002). 44150.
Centers for Disease Control. 2001. 1999 Assisted
Reproductive Technology Success Rates.
REFERENCES Washington, DC: Centers for Disease Control.
Clarke, Adele E., Janet K. Shim, Laura Mamo,
Alan Guttmacher Institute. 1993. Uneven and Jennifer Ruth Fosket, and Jennifer R. Fishman.
Unequal: Insurance Coverage and Reproductive 2003. Biomedicalization: Technoscientific
Services. New York: Alan Guttmacher Institute. Transformations of Health, Illness, and U.S.
American Psychiatric Association. 1994. Biomedicine. American Sociological Review
Diagnostic and Statistical Manual of Mental 68: 16194.
Disorders, 4th ed.. Washington, DC: American Cohen, David, Michael McCubbin, Johanne Collin,
Psychiatric Association. Delivered by Ingenta
and to :
Gilhme Prodeu. 2001. Medications as
Mr Matharu
American (cid 32629),
Society ingenta internal
for Reproductive live 2.3.1/F4
Medicine, (cidPhenomena.
Social 75000325), Health
University of Delaware
5:44169.
Ethics Committee. 1998. Shared-risk orLibrary
Refund(cidCollins,
2443) J. A., M. Bustillo, R. D. Visscher, and L.D.
Tue, 27
Programs in Assisted Reproduction. Dec 2005 00:27:44
Fertility Lawrence. 1995. An Estimate of the Cost of In
and Sterility 70:41415. Vitro Fertilization in the United States. Fertility
American Society for Reproductive Medicine. and Sterility 64:53845.
2002. Frequently Asked Questions About Conrad, Peter. 1992. Medicalization and Social
Infertility. Retrieved August 25, 2004. Control. Annual Review of Sociology
(http:/www.asrm.org/Patients/faqs.html). 18:20932.
Angell, Marcia. 2000. The Pharmaceutical Conrad, Peter. 1997. Public Eyes and Private
Industry: To Whom is it Accountable? The New Genes: Historical Frames, News Constructions,
England Journal of Medicine 342:19021904. and Social Problems. Social Problems
Applbaum, Kalman. 2000. Marketing and 44:13954.
Commodification. Social Analysis 44:10628. Conrad, Peter. 2000. Genetics, Medicalization and
Barry, Ellen. 2002. Mass. Group Sues Paxil Human Problems. Pp. 32233 in The Handbook
Drugmaker. The Boston Globe, October 26, p. of Medical Sociology, 5th ed, edited by Chloe
A3. Bird, Peter Conrad and Alan Fremont. Upper
Barsky, Arthur J. and Jonathan F. Borus. 1995. Saddle River, NJ: Prentice Hall.
Somatization and Medicalization in the Era of Conrad, Peter and Deborah Potter. 2000. From
Managed Care. Journal of American Medical Hyperactive Children to ADHD Adults:
Asssociation 274:193134. Observations on the Expansion of Medical
Bates, G. William and Susanne R. Bates. 1996. Categories. Social Problems 47:55982.
Infertility Services in a Managed Care Conrad, Peter and Deborah Potter. 2004. Human
Environment. Current Opinion in Obstetrics Growth Hormone and the Temptations of
and Gynecology 8:300304. Biomedical Enhancement. Sociology of Health
Bercu, Barry B. 1996. The Growth Conundrum: and Illness 16:184215.
Growth Hormone Treatment of the Non-growth Conrad, Peter and Joseph W. Schneider. 1980.
Hormone Deficient Child. Editorial. Journal of Looking at Levels of Medicalization: A
the American Medical Association 276:56768. Comment on Strongs Critique of Medical
Biotechnology Business News. 1994. Efficacy of Imperialism. Social Science and Medicine
Growth Hormones Questioned in US. October 14A:759.
24. Conrad, Peter and Joseph W. Schneider. [1980]

1992. Deviance and Medicalization: From Kaufman, M. 2003. FDA Approves Wider Use of
Badness to Sickness. Expanded ed. Philadelphia, Hormones. Washington Post, July 26, p.A12.
PA: Temple University Press. Kelnar, C.J.H., K. Albertsson-Wikland, R.L. Hintz,
Cuttler, Leona, J. B. Silvers, Jagdip Singh, Ursula M.B. Ranke, and R.G. Rosenfeld. 1999. Should
Marrero, Beth Finkelstein, Grace Tannin, and We Treat Children with Idiopathic Short
Duncan Neuhauser. 1996. Short Stature and Stature?Hormone Research 52:15057.
Growth Hormone Therapy: A National Study of Koerner, Brendan I. 2002. Disorders, Made to
Physician Recommendation Patterns. Journal Order. Mother Jones 27:July-August, pp.5863.
of American Medical Association 276:53137. Kolata, G. In Vitro Fertilization goes Commercial.
Dyer, Allen R. 1997. Ethics, Advertising, and Science 221:116061.
Assisted Reproduction: The Goals and Methods Kowalczyk, Liz. 2002. Drug Firm Seen Skirting
of Advertising. Womens Health Issues FDA OK. The Boston Globe. November 2, p. 1.
7:14348. Kramer, Peter. 1993. Listening to Prozac. New York:
Fabbri, A., A. Aversa, and A. Isidori. 1997. Erectile Penguin Books.
Dysfunction: An Overview. Human Kroll-Smith, Steve and H. Hugh Floyd. 1997.
Reproduction Update 3:45566. Bodies in Protest: Environmental Illness and the
Freidson, Eliot. 1970. Profession of Medicine. New Struggle over Medical Knowledge. New York:
York: Dodd, Mead. New York University Press.
Gilbert, Bonny. 1996. Infertility and the ADA: Kurz, Demi. 1987. Emergency Department
Health Insurance Coverage for Infertility Responses to Battered Women: Resistance to
Treatment. Defense Counsel Journal 63:4257. Medicalization. Social Problems 34:6981.
Glasbrenner, K. 1986. Technology Spurt Resolves Lang, Anne Adams. 1998. For Infertility
Growth Hormone Problem, Ends Shortage. Treatments, Now Youre Covered, Now Youre
Journal of the American Medical Association Not. The New York Times, January 15, sec. 15,
255:581584, 587. p. 12.
Halpern, Sydney. 1990. Medicalization as a Lantos, John, Mark Siegler, and Leona Cutler. 1989.
Professional Process: Post War Trends in Ethical Issues in Growth Hormone Therapy.
Pediatrics. Journal of Health and Social Journal of the American Medical Association
Behavior 31:2842. 261:102024.
Hamilton,
Mr Matharu Joan. 1996.
(cid A Pregnant
32629), ingentaClause: Fertility
internal Laumann,
live 2.3.1/F4 (cidEdward O., Anthony
75000325), Paik, of
University andDelaware
Raymond
Clinics are Offering Controversial Guarantees. C. Rosen. 1999. Sexual Dysfunction in the
Library (cid 2443)
Business Week, March 25, p. 46. Tue, 27 Dec 2005 United 00:27:44States. Journal of the American Medical
Hardey, Michael. 2001. E-Health: The Internet Association 281:53744.
and the Transformation of Patients into Levine, Martin P. and Richard R. Troiden. 1988.
Consumers and Producers of Health The Myth of Sexual Compulsivity. Journal of
Knowledge. Health, Communication and Sex Research 25:34763.
Society 4:388405. Light, Donald W. 1993. Countervailing Power: The
Hartley, Heather. 2003. Big Pharma in our Changing Character of the Medical Profession in
Bedrooms: An Analysis of the Medicalization of the United States. Pp. 6980 in The Changing
Womens Sexual Problems. Advances in Gender Medical Profession: An International
Research 7:89129. Perspective, edited by F.W. Hafferty and J.B.
Hintz, Raymond L. 1996. Growth Hormone McKinlay. New York: Oxford University Press.
Treatment of Idiopathic Short Stature. Light, Donald W. 2000a. The Medical Profession
Hormone Research 46:20814. and Organizational Change: From Professional
Hintz, Raymond L., Kenneth M. Attie, Joyce Dominance to Countervailing Power. Pp.
Baptista, and Alex Roche. 2000. Effect of 20116 in The Handbook of Medical Sociology,
Growth Hormone Treatment on Adult Height of 5th ed., edited by Chloe Bird, Peter Conrad and
Children with Idiopathic Short Stature. New Alan Fremont. Upper Saddle River, NJ: Prentice
England Journal of Medicine 30: 50207. Hall.
Horwitz, Allan V. 2002. Creating Mental Illness. Light, Donald W. 2000b. The Sociological
Chicago: University of Chicago Press. Character of Health Care Markets. In
Hughes, Edward H. and Mita Giacomini. 2001. Handbook of Social Studies in Health and
Funding In Vitro Fertilization Treatment for Medicine, edited by Gary L. Albrecht, Ray
Persistent Subfertility: The Pain and the Fitzpatrick, and Susan C. Scrimshaw. San
Politics. Fertility and Sterility 76:43142. Francisco: Sage Publications.
Imershein, Allen W. and Carroll L. Estes. 1996. Loe, Monika. 2001. Fixing Broken Masculinity:
From Health Services to Medical Markets: The Viagra Technology for the Production of Gender
Commodity Transformation of Medical and Sexuality. Sexuality and Culture 5:97125.
Production and the Nonprofit Sector. Lown, Bernard. 2000. Market Health Care: The
International Journal of Health Services Commodification of Health Care. Philosophy
26:22138. and Social Action 26:5771.

Lyles, Alan. 2002. Direct Marketing of Drug Company to Alter Ads. The New York
Pharmaceuticals to Consumers. Annual Review Times, August 21, p. C1.
of Public Health 23:7391. Pfohl, Stephen J. The Discovery of Child Abuse.
Mamo, Laura and Jennifer Fishman. 2001. Potency Social Problems 24:31023.
in All the Right Places: Viagra as a Technology Pines, W. L. 1999. A History and Perspective on
of the Gendered Body. Body and Society Direct-to-Consumer Promotion. Food and Drug
7:1335. Law Journal 54:489518.
Marino, Vivian. 2002. All Those Commercials Pay Relman, Arnold S. 1980. The Medical Industrial
Off for Drug Makers. The New York Times, Complex. New England Journal of Medicine
February 24, sec. 3, p. 4. 303:96370.
McKee, Aaron C. 2001. The American Dream: 2.5 Relman, Arnold S. 1991. The Health Care
Kids and a White Picket Fence: The Need for Industry: Where is it Taking Us? New England
Federal Legislation to Protect the Insurance Journal of Medicine 325:85459.
Rights of Infertile Couples. Washburn Law Resolve. 2002. Facts. Retrieved August 25, 2004.
Journal 41:191208. ( h t t p : / w w w. r e s o l v e . o rg / m a i n / n a t i o n a l /
McKinlay, John B. and Lisa D. Marceau. 2002. The advocacy/insurance/facts).
End of the Golden Age of Doctoring. Riska, Elianne. 2003. Gendering the
International Journal of Health Services Medicalization Thesis. Advances in Gender
32:379416. Research 7:6189.
Mechanic, David. 2002. Socio-cultural Rosenthal, Meredith B., Ernst R. Berndt, Julie M.
Implications of Changing Organizational Donohue, Richard G. Frank, and Arnold M.
Technologies in the Provision of Care. Social Epstein. 2002. Promotion of Prescription Drugs
Science & Medicine 54:45967. to Consumers. New England Journal of
Mintzes, Barbara. 2002. For and Against: Direct to Medicine 346:498505.
Consumer Advertising is Medicalising Normal Sabin, James E. and Norman Daniels. 1994.
Human Experience: For. British Medical Determining Medical Necessity in Mental
Journal 324:90809. Health Practice. Hastings Center Report
Montagne, Michael. 1992. The Promotion of 24:513.
Medications for Personal and Social Problems. Schwartz, Rebecca K., Stephen B. Soumerai, and
Journal of Drug Issues 22:389405.Delivered by Ingenta JerrytoAvorn. : 1989. Physician Motivations for
Mr Matharu
Moynihan, (cid
Ray. 32629),
2003. Theingenta
Making internal live 2.3.1/F4
of a Disease: (cid 75000325),
Nonscientific University of
Drug Prescribing. Delaware
Social Science
Female Sexual Dysfunction. British Library
Medical(cid 2443)
& Medicine 28:57782.
Journal 326:4547. Tue, 27 Dec 2005 00:27:44
Scott, Wilbur J. 1990. PTSD in DSM-III: A Case of
Mumford, Kevin. 1992. Lost Manhood Found: the Politics of Diagnosis and Disease. Social
Male Sexual Impotence and Victorian Culture in Problems 37:294310.
the United States. Journal of the History of Scritchfield, Shirley A. 1995. The Social
Sexuality 3:3377. Construction of Infertility: From Private Matter
National Institute on Health Consensus to Social Concern. Pp. 13146 in Images of
Development Panel on Impotence. 1993. NIH Issues: Typifying Contemporary Social
Consensus Conference: Impotence. Journal of Problems, edited by Joel Best. New York: de
American Medical Association 270:8387. Gruyter.
Neumann, Peter J. 1997. Should Health Insurance Stapleton, Stephanie. 1997. More Off Label Drug
Cover IVF?: Issues and Options. Journal of Promotion in the Offing. American Medical
Health Politics, Policy and Law 22:121539. News, August 2330, p. 1.
New York Times. 1998. Aetna to Charge Extra for Starr, Paul. 1982. The Social Transformation of
In Vitro Fertilization. The New York Times, June American Medicine. New York: Basic Books.
21, p. A15. Sullivan, Deborah A. 2001. Cosmetic Surgery: The
National Institute for Health Care Management. Cutting Edge of Commercial Medicine in
2001. Prescription Drug Expenditures in 2000: America. New Brunswick, NJ: Rutgers
The Upward Trend Continues. Washington, DC: University Press.
National Institute for Health Care Management. Tiefer, Leonore. 1994. The Medicalization of
Nordenberg, Tamar. 1999a. Social Phobias Impotence: Normalizing Phallocentricism.
Traumas and Treatments. FDA Consumer Gender and Society 8:36377.
33:2733. Timmermans, Stefan and Emily Kolker. 2004.
Nordenberg, Tamar. 1999b. Maker of Growth Shifting Knowledge and The Medical
Hormone Feels Long Arm of Law. FDA Professional: Sociological Professionalization
Consumer 33 (September/October):33. Theories and Clinical Practice Guidelines.
Overman, Stephanie. 1998. Warning: Viagra May Journal of Health and Social Behavior 45(Extra
Cause Headaches for Health Insurers. HR Issue):17793
Magazine 43:10409. Tischler, Rhonda S. 1994. Infertility: A Forgotten
Petersen, Melody. 2002. Advertising: Judge Orders Disability. The Wayne Law Review 41:24971.

Tuft Health Plan. 2002. Drugs in Pharmacy White, Ronald D. 2002. Judge Stays Order Halting
Management Programs. Tufts Health Plan Paxil Ads. Los Angeles Times, August 24, part
Physician Newsletter 14:67. 3, p. 2.
Tuller, David. 2002. Competitors to Viagra get Wilcox, Melynda Dovel and Josephine Rossi. 2002.
Ready to Rumble. The New York Times, What Price a Miracle? Kiplingers Personal
September 23, sec. F, p. 7. Finance. 56(September):11719.
Vendantam, Shankar. 2001. Drug Ads Hyping Williams, Simon J. and Michael Calnan. 1996. The
Anxiety Make Some Uneasy. Washington Post, Limits of Medicalisation?: Modern Medicine
July 16, p. A01. and the Lay Populace in Late Modernity.
Wanzana, A. 2000. Physicians and the Social Science and Medicine 42:160920.
Pharmaceutical Industry: Is a Gift Ever Just a Wolpe, Paul Root. 2002. Treatment, Enhancement,
Gift? Journal of the American Medical and the Ethics of Neurotherapeutics. Brain and
Association 283:37380. Cognition 50(3):387395.
Werth, Barry. 1991. How Short is Too Short? Wozencraft, Ann. 1996. Its a Baby, or Its Your
Marketing Human Growth Hormone. New York Money Back. The New York Times, August 25,
Times Magazine, June 16, pp. 1416, 2829, 47. sec. 3, p. 1.
Wertz, Richard and Dorothy Wertz. 1989. Lying In: Zola, Irving Kenneth. 1972. Medicine as an
A History of Childbirth in America, expanded ed. Institution of Social Control. Sociological
New Haven, CT: Yale University Press. Review 20:487504.
Peter Conrad is Harry Coplan Professor of Social Sciences at Brandeis University, where he is also Chair
of the Health: Science, Society and Policy program. He has published numerous books and articles and is
currently completing a book on the medicalization of society.
Valerie Leiter is Assistant Professor of Sociology and Director of the Society and Health Program at
Simmons College. Her work focuses on the social construction of childhood disability and the provision of
health and therapeutic care to children with disabilities.
Mr Matharu (cid 32629), ingenta internal live 2.3.1/F4 (cid 75000325), University of Delaware
Library (cid 2443)
Tue, 27 Dec 2005 00:27:44

Medicalization, Markets and Consumers - Conrad e Leiter - 2004 PDF

Caricato da

Informazioni sul documento

Titolo originale

Copyright

Formati disponibili

Condividi questo documento

Condividi o incorpora il documento

Opzioni di condivisione

Hai trovato utile questo documento?

Questo contenuto è inappropriato?

Copyright:

Formati disponibili

Medicalization, Markets and Consumers - Conrad e Leiter - 2004 PDF

Caricato da

Copyright:

Formati disponibili

#1921Jnl of Health and Social BehaviorVol.

Medicalization, Markets and Consumers*

MEDICALIZATION, MARKETS AND CONSUMERS 159

160 JOURNAL OF HEALTH AND SOCIAL BEHAVIOR

MEDICALIZATION, MARKETS AND CONSUMERS 161

162 JOURNAL OF HEALTH AND SOCIAL BEHAVIOR

MEDICALIZATION, MARKETS AND CONSUMERS 163

164 JOURNAL OF HEALTH AND SOCIAL BEHAVIOR

MEDICALIZATION, MARKETS AND CONSUMERS 165

166 JOURNAL OF HEALTH AND SOCIAL BEHAVIOR

MEDICALIZATION, MARKETS AND CONSUMERS 167

168 JOURNAL OF HEALTH AND SOCIAL BEHAVIOR

TABLE 1. Comparison of Mediated and Private Markets

MEDICALIZATION, MARKETS AND CONSUMERS 169

170 JOURNAL OF HEALTH AND SOCIAL BEHAVIOR

MEDICALIZATION, MARKETS AND CONSUMERS 171

172 JOURNAL OF HEALTH AND SOCIAL BEHAVIOR

MEDICALIZATION, MARKETS AND CONSUMERS 173

174 JOURNAL OF HEALTH AND SOCIAL BEHAVIOR

MEDICALIZATION, MARKETS AND CONSUMERS 175

176 JOURNAL OF HEALTH AND SOCIAL BEHAVIOR

Potrebbero piacerti anche