Mental Health Care Costs

The cost of mental health care in the United States is $148 billion dollars annually.  What is causing such a large price tag on the treatment of mentally ill individuals in the United States? It could be due to very many things, but according to a Washington Post article, mental heath dollars go mostly to prescription drugs and outpatient treatments. Inpatient treatment has declined in the last 20 years due to the deinstitutionalization of the mentally ill, and the percentage of money spent on prescription drugs has risen from just 7% in 1986 to 27% in 2005, back when the spending on mental health care was only $113 billion.  It is likely that the percentage of money spent on prescription drugs has increased even more in the last 8 years. Why are we such pill poppers in the United States?

Americans cannot deal with waiting and need immediate satisfaction.  We like our food fast.  We like things done in the least amount of time.  Taking a drug can bring about immediate satisfaction and provide that “quick fix” that Americans are looking for.  We are less likely to devote our time and energy into a method of treatment that might be significantly less costly but takes far more time.  For example, the medication of depression with antidepressants has increased significantly.  This is happening to such a large extent because patients are going to their primary care doctors complaining of sadness and feelings of worthlessness.  Primary care doctors are likely not as educated about the common symptoms of depression, compared to a mental health professional.  Primary care doctors will then simply write a prescription for an antidepressant, rather than attempt to get to the root of the problem by sending the patient to a psychiatrist or psychologist for talk therapy, which is more than likely to be successful in treating their ills and cheaper than medication.

Furthermore, in the last 20 years, increase in the use of direct-to-consumer (DTC) advertisements has contributed to this increased amount of money spent on prescription drugs.  It’s great that consumers are more aware, but it would be interesting to see how the increase in DTC advertisements has contributed to the increased amount of spending on prescription drugs for the mentally ill that was witnessed between 1986 and 2005. Depression can be blamed for a chemical imbalance in the brain that can be treated by simply taking a drug (in reality it is not always that easy).  Advertisements perpetuate this notion, and studies have shown that those that believe in the chemical imbalance theory of depression are more likely to favor prescriptions over talk therapy for treatment of depression. Have advertisements caused the increase in spending on mental health in the United States?

23andMe

The home page for 23andme.com states the words, “Get to know you. Health and ancestry start here.”  You can order the take home “DNA spit kit” for just $99.00.  Scrolling down brings you to a story of a young mother who has had stomach issues all her life and decided to get genetically tested and found she has Celiac’s disease.  The DNA spit kit will analyze your DNA to scan for genetic diseases and they advertise that this will potentially change your life.  23andMe does a simply wonderful job at promoting their product. The website is bright, its colorful and it has a simple lay out.  It is clear to consumers that this company has made millions of dollars and is quite successful. I was intrigued while watching the story of the young woman because of the involvement her doctor had in her genetic screening procedure.  I expected no doctor involvement and this was my main concern with the website. It is healthcare delivered directly to the consumers, without the typical doctor in between to act as a liaison, which can lead to problems.

            I wonder how many people actually have this experience with 23andMe.  What would be my incentive to get this genetic testing done? Can’t I just get this done through my doctor?  I recall a few weeks ago visiting my doctor who asked me about the history of breast and ovarian cancer in my family.  She told me that I have the option to get tested to see if I have a gene that could make me more susceptible to breast cancer in the future.  I declined, but I’m assuming I can get this done through my doctor and that she was not going to forward me to the 23andMe website.  So what is the incentive to by-pass the doctor and deliver health services directly to the consumers? I think it is mostly an issue of money and insurance companies.  I am not completely convinced that this service is a benefit to the community if it can just be done through your doctor.  Furthermore, upon reading the articles on genetic testing, it is clear that these procedures are not exactly accurate and reliable techniques to actually predict later-in-life diseases or illnesses.

            The website gives us three positive aspects of genetic testing: it can tell you if you are a carrier for a specific disease, it can tell you about your potential health risks, and it can outline potential responses to drugs.  How much of this do we want to know?  I think I would like to know if I will have a reaction to a specific drug, but I don’t think I would want to know that I would someday develop Alzheimer’s or Parkinson’s disease.  It is my personal opinion that I think this type of knowledge would damage my current mental state, cause my life in general to be less productive and successful, and damage my current relationships with friends and loved ones.  My outlook on life would be dismal and pessimistic because I would know my eventual fate. 

            Another thing I found scary about the website is that they give a very explicit list of what you can expect to be tested on. The list of “traits” is especially concerning because this is not healthcare or medically related at all.  I think in the future this would lead to a society in which we are able to genetically select certain traits for our children.  I think that pretty soon we will start to discriminate on the basis of genetics, and 23andMe.com only will exacerbate the discrimination. 

Venezuela’s Ideal of Beauty

I actually find a surprisingly large amount of relevant and interesting news posted to my Facebook news feed. I suppose I have a large population of socially conscience “friends” as we so colloquially refer to them as. Anyway, I recently came across a posting of a New York Times video article. First of all, I had no idea this section of the website exists but they have a large amount of video news reporting on here: link.  I came across a video that highlights the amount of plastic surgery that is happening in Venezuela. The news team interviewed two select people: the creator of mannequins that go into the stores in Venezuela and an owner of a store who dresses these mannequins. It starts off with a comparison of the old mannequins, that typically look like what you find in the U.S. with relatively small breasts. Then it shows them making the new mannequins, which look like they have had plastic surgery. The difference in the mannequins was enough to increase the sales of the store owner, who says that her customers would rather look at the new mannequins. She believes that her customers want to look like these mannequins. 

The women in Venezuela are affected by the culture of beauty pageants and the idealized notion of beauty. The beauty pageants do not require “natural beauty” and will accept anyone who has undergone plastic surgery. Therefore the “regular” citizens watching these pageants believe that what they see on TV is what is beautiful. As a result, the number of women undergoing plastic surgery procedures has increased dramatically. What kind of world are we living in? I didn’t realize that this idealized notion of beauty has spread to other countries as well and is perhaps even worse than it is in the U.S. I think this definitely demonstrates that most industrialized countries have similar reactions to television and the media. The way beauty is portrayed in the media in America is not unique only to our country. 

I would be interested as a result of this finding to see what other countries are experiencing these problems of increase plastic surgery use. I surely did not expect to find this happening in Venezuela, not that I know a whole bunch about the country to start with. I feel bad for women who do not think of themselves as “good enough” and must undergo dangerous procedures in order to simply feel better about themselves. Perhaps we should be getting to the root of the problem, which in this case I believe to be self-esteem issues. On a positive note, I still do believe that there are women who do not succumb to the societal pressure to undergo surgery to be “beautiful”. What do you think?

Herbal Supplements and Their Safety

A recent The New York Times article delves into the true nature of herbal supplements. I was sincerely shocked while reading this article and I admit that my jaw dropped a few times while reading as well (I strongly suggest taking a look at this article!). In summary, there have been various tests done on various herbal supplements to determine what truly lies within the supplements. The main test they use is called “DNA barcoding” in which they take the contents of the pill and “scan” them to determine the make up. They have found that about one third of the herbal supplements, things like St. John’s Wort and Echinacea, do not actually contain ANY of the herbs that the packaging claims they contain and in fact contain either toxic plants from far-away countries or things like nuts or gluten that could bring about a severe allergic reaction in some users.  

A few years ago, in a Botany class, I did a presentation on herbal supplements and learned a lot about FDA regulations (or lack there of) on herbal supplements. The FDA does not require companies to get approval for herbal supplements before they go on the market, nor do they regulate herbal supplements that are currently being sold unless there is a complication that arises with the supplement. There are certain requirements for what has to be displayed on the packaging, but clearly the manufacturers have been lying about what these pills actually contain. The FDA requires that if a manufacturer receives a complaint about an adverse reaction to their supplement, they are required to both investigate further the claim as well as submit the claim to the FDA so that they can do their own investigation and potentially remove the drug from the market. So in other words, it basically functions on an honor system. 

I think this says a lot about who the public trusts when it comes to what they are putting in their body. Those individuals that are taking herbal supplements likely trust that the manufacturer is being honest.  Either that, or these individuals believe that the FDA is regulating these drugs and would not let the manufacturers of herbal supplements lie to consumers. I hope that a lot of people have read or will read this article in the newspaper in print or online so that they can better investigate what is in their herbal supplement (if they are indeed taking one). I think it also says a lot about the trust we put in news sources for reporting accurate and up to date information. I trusted The New York Times when reading this article and believed that it was accurate and unbiased in its portrayal of the facts of the matter. I did no further research into this topic to read some other potentially opposing articles claiming that herbal supplements are in true to the facts of the bottle. How are we able to distinguish the good news sources from the bad news sources? How long did it take The New York Times to gain this reputation that allows its readers to have such strong faith in the truth behind the articles? 

Celebrities in Healthcare

Celebrities in my generation have not been subjected to as many health issues than those individuals from older generations. This primarily is simply because as we age, we tend to have more health issues. However, there is one disease that comes to mind that starts earlier in life: Type I diabetes. Especially for those that are exactly my age, we are all aware that teen celebrity Nick Jonas, who is currently 21 years old, suffers from diabetes. He is actually a stronger advocate for awareness of the disease than I had originally imagined, spending some time at Congress attempting to increase federal funding for research into the disease. A New York Times article tells the story of Nick and two other Hollywood celebrities, including Mary Tyler Moore, chairwoman of the Juvenile Diabetes Research Foundation, and “Sugar” Ray Leonard, on a panel before Congress in 2009. At the time, Nick Jonas was only 16 years old, and he was brave enough to speak in front of Congress to request funding for this disease. We know there are celebrities advocating for funding for their own disease (take Michael J. Fox for example) but how many of these advocates are only 16 years old? 

Nick Jonas was at the time quite a famous individual and part of a popular boy band with his brothers, called the Jonas Brothers.  Nick actually sang one song about suffering with the disease, titled “A Little Bit Longer”. We normally see and hear about awareness campaigns for certain diseases that are typically in the form of commercials or “walks” for a disease or just events in general. How many songs do we hear that are trying to raise awareness for a disease? How many can you count? I’m guessing not a whole lot. I think it is really interesting that this one boy got his message across to an entire generation of children and teenagers through the use of one quite popular song via a boy band. My generation, immersed in the Jonas Brothers on television, in the movies, and in music, will never forget that Nick Jonas has diabetes. 

What about those children who were diagnosed with type I diabetes and then turned on the radio to hear a young teenage boy singing about his problems with diabetes? How did this affect them? I believe that Nick Jonas, for them, turned out to be more than a celebrity teenager and became a strong role model for these children.  Imagine a 14 year old girl with type I diabetes, a huge fan of the Jonas Brothers, finds out that the boy she has been idolizing is suffering from the same disease she is. How does this affect her outlook on life? How does this affect her dreams and wishes? I think this will have nothing but a positive effect on others who have type I diabetes. This young girl will see Nick and his successes and life and feel less limited by her disease. She will be more positive and as a result, this could increase her overall health.  This also raised awareness for the disease among children of a younger generation, who are now aware of the presence of diabetes in general. Kudos to you Nick Jonas. 

Rhode Island Laws

Recently while studying, I was listening to Pandora radio and a commercial came on in between my music. It was an advertisement seeking to educate the public about the current laws concerning cell phone use while driving in the state of Rhode Island. The ad stated, “If you are under 18 and you’re behind the wheel, drive now and text, play, call, e-mail, and update later.” A minor caught using their phone for anything while driving will receive a $50 fine the first two times, followed by a $100 fine on the second offense and restriction of your license until the age of 18 [source]. I have been living in the state of Rhode Island now for almost four years, and this is the first time I have ever heard anything about laws of cell phone use while driving. I had no idea it was still legal to use your phone while driving if you are over 18. Frankly, I am shocked that Rhode Island has this law put in place. I think all cell phone use while driving for anyone, any age, should be illegal. I am also shocked that I have never heard anything about cell phone laws while driving. 

Being from Connecticut, I am well aware of the law that all cell phone use while driving is prohibited. I think this is the way it should be. I am also aware that on all major roadways entering the state of Connecticut, there is a huge sign that says “Driver use of handheld telephones prohibited,” in order to inform the drivers entering the state that the laws have changed and there are are laws in place that prohibit the use of cell phones while driving. There are no signs when entering the state of Rhode Island that say anything about cell phone use. 

Upon listening to this advertisement, I thought to myself, “so that means for me, it is okay and safe for me to use my cell phone while driving.” This is misleading to those who are not under 18. It makes it seem like it is only dangerous for minors to use their cell phones while driving because they are less experienced drivers.  This is not the case. This also could lead the under age drivers to assume that they are “experienced” enough to be able to use a cell phone while driving and therefore that it is okay. Im my opinion, this law is not sound and needs to be changed and fixed. 

Upon consultation with my roommate, who is also from Connecticut, she told me she “heard on the streets” that the law in Rhode Island is that texting while driving is illegal but it is okay to use your cell phone to make calls. She had no idea about the law concerning minors and the use of cell phones while driving. Mostly, I think it is interesting how the state of Rhode Island chose to advertise the law that is in place. I hope that they also go through a campaign to advertise the cell phone laws concerning adults as well. I feel confused about what I can and cannot do with my phone while driving. 

Direct-to-Consumer (DTC) Advertising and its affects on Consumers

Upon doing some research for my upcoming term paper, I came across an interesting study performed in the late 1990s in the Sacramento county of California about Direct-to-Consumer (DTC) advertising: the advertising of prescription drugs on television. Researchers performed an interview type survey by calling random phone numbers and asking for permission to partake in the survey. Researchers asked participants about their prescription drug advertisement awareness: whether or not they had seen any advertisements for 10 drugs on television or in a magazine. They asked about faith in regulation: a series of true/false questions in which participants were asked if they believed the government had regulating power over what type of drug advertisements were displayed on TV and in magazines. They asked about attitude concerning DTC advertising and about the influence of these ads on talks the patients had with their doctors. They asked about their health insurance access and current and past medical conditions. 

The researchers found that awareness was relatively high, with ads receiving “substantial attention.” Most interestingly, the researchers found a correlation between medical condition and awareness of advertisements on TV. For example, they found that 70% of asthmatic subjects reported being aware of an advertisement for an asthma drug compared to only 40% of non-asthmatic subjects. Also, those individuals that were the most aware of DTC advertisements were those who were currently taking a prescription drug. 

In the realm of faith in regulations of advertisements, the researchers found that 50% of participants believed that advertisements had to be submitted to the government before approval, which was a false statement. This demonstrates that in reality, consumers watching television ads have a significant amount of faith in the regulation of what they are watching. This was shocking to me that viewers thought these ads are actually regulated by the government in any way. They government indeed has no say in what is advertised on TV with respect to drugs. 

The researchers also found that over 50% of participants had reported talking to their doctor about a drug that they had seen advertised on television, demonstrating that these advertisements do have a significant effect on the viewer and their behavior after viewing the advertisement. At the end, the researchers found that in general consumers do not have either strongly positive or strongly negative attitudes about DTC advertising.  I found this interesting as well because I would have assumed that consumers might have been mostly bothered by viewing drug advertisements on TV. 

I recall learning about the advent of drug advertising on TV in my health policy 101 class and being awed at the transformations that took place when the American family started watching television in the 60s and the transformations that are still taking place to this day because of what we watch on television. It is honestly amazing to me that such a small (for some) box in my room has such a large societal role. Do you think these advertisements increase awareness of and discussion about diseases? Is this “good” awareness or “bad” awareness? For example, are viewers becoming falsely convinced that they had a disease they saw on TV and requesting a prescription for the drug? 

One more thing about DTC advertising of drugs I also found interesting. All other forms of advertisement are meant to lead a consumer to go to the store and purchase the good in the advertisement. If you see an ad on TV for reese’s peanut butter cups, you can go to the supermarket and buy reese’s peanut butter cups to you heart’s desire. However, when you see an advertisement on TV for prozac, you cannot simply go to the store and buy some prozac. Doctors and physicians are essential tools in the proper functioning of DTC advertising. It is the doctor that will lead to the consumer purchasing the drug. Without a doctor and a prescription, DTC advertising of drugs would not function in a prosperous way. 

Genetic Engineering: Our Future?

In Gattaca, in the future every human person is genetically engineered to be perfect. Those who are genetically engineered are considered “valid” while those who are genetically inferior are termed “invalid.” The story follows a young man name Vincent who wants to sail into space but unfortunately he is genetically inferior as he is a product of regular sexual intercourse and was not designed in a lab like his brother Anton. As a result, he is stuck in a menial job working as a janitor at the company that schedules the space flights. Through a series of complicated procedures and agreements, he acquires the genetic material of a man who is a paraplegic as a result of a car accident and from then on assumes his identity. He applies for a job and is accepted at this company thanks to the genetic material of someone else. Everyday before work, he cleans himself of all stray DNA matter by scrubbing himself down to remove any dead skin cells. At work, he vacuums his desk constantly trying to keep loose hair strands from being collected and analyzed to expose his true identity.
There is no need to expose the ending of the movie, but it raises a few interesting questions about our future. When will we start to discriminate on the basis of genes and genetic make-up? Is this the direction our world is heading in? Will any children be born leaving genetic identity up to chance or will someday all embryos be genetically screened to prevent future illnesses, diseases, and inferiority in general? Is the world heading in the direction toward perfection and beauty?
In contrast, take a look at Idiocracy, a movie in which a man is woken from a 500 year hibernation to find that the world has descended into stupidity, gluttony, and inferiority compared to 500 years earlier. As opposed to Gattaca, everyone is average or below average and no one is superior in any way. Citizens of America spend their time watching television and eating junk food. Is THIS our future? I think it is very interesting to analyze the way the future is portrayed in movies. I feel like people either have a positive outlook or a completely negative outlook on the future, but it is very interesting that there are two different and contrasting views in two movies that were presented to the public less than 10 years apart. Where are we heading?

50/50 Diagnosis

This semester I am taking both a healthcare in popular culture class along with a biomedical ethics class. Not too surprisingly, these two classes are overlapping. Recently in my ethics class, we were discussing the topic of lying and doctors and read two opposing articles in which the author either supports the lying of doctors to their patients or opposes said behavior. We were then assigned a short paper in which we were to give our stance on the issue either in favor or against the lying of doctors to their patients. I handed in the paper this past Friday afternoon and sided against doctors lying to their patients.

The video clip above is a scene in a movie that I recently enjoyed watching. The patient (played by Joseph Gordon-Levitt) has just found out that he has cancer by his extremely insensitive doctor who basically ignores his presence in the beginning of the clip and only addresses his patient when the patient asks a question by raising his hand and interjecting. I was shocked by the scene in this movie and asked myself, “Is this typically how doctors act?” I think that there is a good percentage of doctors who are socially awkward and are insensitive when it comes to communicating with patients. However, my experience with doctors is that they are easy to talk to and are extremely aware of the social norms when communicating with their patients.

I also asked myself, “Is this doctor lying to his patient by not giving him explicit details of his condition?” Can the doctor even give him the details in a way that will foster understanding? I think not, being that this is a rare disease that the patient has contracted. Furthermore, it doesn’t seem that the patient has a knowledge base at all when it comes to medicine and needs an explanation in simple terms. However, I definitely feel that the doctor could have done a much better job at being more sensitive toward the patient.

After this scene, you see the character going home and proceeding to use the internet to find out more about his condition because his doctor did not give him the necessary details about life expectancy and potential risks associated with treatment. This is another problem with doctors being less than honest with their patients that I had not considered when writing my paper for my ethics class. What happens when a doctor leaves out details about a patients ailments and medical condition? What avenue will the patient take in order to find out more information? From this movie and from these few scenes, I now understand even more how important it is for doctors to be very honest with their patients in order to put forth the medically accurate information.

Brain Surgeons in Popular Culture

This might seem trivial, as it is simply a 30 second television commercial for an online travel sight. The product that is being advertised is irrelevant. What I am concerned with and what sparked my attention was the portrayal of the brain surgeon in this commercial. Two things are immediately interesting: the appearance of the brain surgeon, and his conversation with what appears to be the nurse or the resident assisting with the surgery.

What do we think of when picturing a brain surgeon? I think this man fits pretty well into my schema for a brain surgeon. He is male, and appears to be old enough to have experience and a well developed set of skills. However, he does not appear old enough to be lacking in skills or to be out of practice. Why not portray a younger man? What were they thinking when casting this commercial and when writing the script for this commercial? I would be interested in reading the casting call for this script to see exactly what the producers of this commercial were looking for and how that relates to how society pictures surgeons.

The conversations he holds with the assistant is interesting as well and tells us a lot about how the media portrays a doctor. The assistant says, “This is completely unethical.” The doctor responds, “My hours are unethical…” This is how popular culture portrays doctors. They are older, more experienced and are hard working individuals who have horrible hours. This might not be the most interesting or well developed portrayal of a doctor by the media, but it definitely sparked my interest.