Written by a professor of Anthropology, this book explores the interaction of the cultures of medicine, pharmaceuticals, and public health and how they have impacted the modern Western perception of what constitutes health and what makes a person count as healthy.
Since I work in an academic medical library, I was immediately drawn in by this anthropological exploration of what has impacted the modern perception of health and requested it on NetGalley. Although the book can sometimes feel a bit long and repetitive, the information it contains is an even-handed look at the reasons behind so many people in the West being put on preventive prescription medication.
Since this is written by an Anthropologist, not a journalist or a doctor or pharmaceutical representative, it has neither an expose feeling to it nor a particular slant. It’s clear that the author originally was just looking at the culture surrounding healthcare, and the evidence led him down this path. Anyone who is familiar with Anthropology knows that Anthropologists are trained to attempt to avoid biases and just report what they see. Of course, everyone is human, and I definitely think that by the time Dumit finished his research he has formed an opinion that the reader can observe, however he does quite a good job of just presenting the facts.
The book is divided into six chapters, plus an introduction and conclusion. The six chapters are: responding to facts, pharmaceutical witnessing and direct-to-consumer advertising, having to grow medicine, mass health: illness is a line you cross, moving the lines: deciding on thresholds, and knowing your numbers: pharmaceutical lifestyles. The book thus moves from the culture of facts and how we respond to them, to the business of pharmaceuticals, to how public health has impacted how we treat individual health, to how the individual health care consumer responds to the information they hear from all sides. Again, all of this is presented from an anthropological perspective. If a reader has not read an anthropology-research based book before, the way in which Dumit looks at the information may be a bit confusing or surprising at first, since it is more about culture, which may not be expected at first, given the title. However, the second chapter helps this perspective make sense, so even a reader new to this perspective will most likely be able to get into it.
What inspired Dumit to conduct this cultural investigation is the sheer number of drugs the average American is prescribed.
The average American is prescribed and purchases somewhere between nine and thirteen prescription-only drugs per year, totaling over 4 billion prescriptions in 2011 and growing. The range is wide, however, and many people are prescribed few or no drugs each year. (loc 100)
What Dumit’s investigations revealed was a cultural shift from treating an illness after it negatively impacts a person’s life to attempting to prevent illness. Whereas individual doctors may prefer prescribing lifestyle changes (work out more, eat differently, stress reduction), some doctors prefer being able to simply prescribe a drug and some groups of patients may prefer to keep their lifestyle and take a preventative drug. Similarly, the pharmaceutical industry sees preventative drugs that are taken by large groups of people with risk factors as a more monetarily sound investment than generating drugs for an illness that would be taken one-time or simply for the duration of the illness or just from the time of diagnosis to the end of the person’s life. Preventative drugs are prescribed to people who have risk factors for developing an illness, and they then must be taken every day. At the same time as these situations have developed, public health, since the 1970s, has started looking at groups of people at risk for developing a disease that would have a negative public health impact and advising that people with these risk factors be treated to prevent the disease from ever occurring. All of these factors have created the environment in which we now live in the United States where people who are not yet sick are still taking multiple prescription drugs to prevent their getting sick, often in spite of dealing with side effects.
I will now discuss the elements of this overarching concept that I found most interesting. The book contains many more facts and information than this, and if you find any of this at all intriguing, I highly recommend you pick up and read the whole book.
First, there’s the fact that clinical trials are extremely expensive to produce. Pharmaceutical companies thus are most invested in clinical trials whose results would indicate treating the largest number of people for the longest amount of time and, perhaps most importantly, only for those people who are able and willing to pay for these drugs. (loc 145) What this means is that illnesses that only a small percentage of people have are not getting clinical trials for drugs. Similarly, illnesses that a lot of people have but most of those people cannot afford to pay for the drugs, such as tropical diseases prevalent in African countries, also are not getting clinical trials for drugs to treat them. The pharmaceutical companies are businesses that are interested in making money, not in improving the quality of life for everyone on the planet.
Marketers want to maximize the number of prescriptions in order to maximize profits. They see clinical trials as investments whose purpose is to increase sales of medicines. (loc 1415)
I also found the question of what constitutes health and how that has changed over the years fascinating. Originally, people generally only came to the doctor if they felt sick or as if something was off. We are now encouraged to engage in preventative care. How this impacts how we perceive of health is summed up well here:
We have a new mass health model in which you often have no experience of being ill and no symptoms your doctor can detect, but you or your doctor often discover that you are at risk via a screening test based on clinical trials that show some efficacy of a treatment in reducing that risk; you may therefore be prescribed a drug for life that will have no discernible effect on you, and by taking it you neither return to health nor are officially ill, only at risk. (loc 195)
Tied into this idea of risk factors being treated as illnesses and thus healthy people being treated as not healthy is the idea that outliers, variations, and things that are simply socially undesirable can often be reclassified as illness, particularly if doing so means that the pharmaceutical companies will make more money. (loc 1079)
Third, I was intrigued by the discussion on the public health model. Public health seeks to reduce illness in the population as a whole by treating those with risk factors, but also by treating however many it takes to reduce the occurrence of illness. An example of a community-wide public health intervention is adding fluoride to the public drinking water. This is done to everyone in the hopes that it will help prevent cavities, regardless of the actual individual risk factor for developing cavities. A public health intervention that is done only to those with a risk factor is taking statins to lower cholesterol. This is recommended for individuals whose cholesterol falls in a certain range, but there is no exact science in creating that range. In fact, the cholesterol range is frequently lowered, putting more and more people on statins, even if only a small percent (less than 10%) of people are actually helped by being on these statins. The question Dumit raises in this discussion is:
At what point are public health officials justified in intervening on a community-wide basis to protect a group of people who are not all equally at risk and who might not want to be protected? The push and pull of paternalism versus autonomy is a constant refrain in the field. (loc 1667)
Of course, the pharmaceutical companies want more and more people included in the risk factor, they even would probably be fine with everyone being on statins as a community-wide public health intervention, since this increases their sales.
Finally, I was also interested in how the book examines how the average patient population responds to all of this information about risk factors and preventative drugs and medicine and constant flow of health information. Dumit divides the response to this into three general groups: “expert patienthood, fearful subject of duties, and better living through chemistry.” (loc 2842) The expert patient is like the teacher’s pet. They know all their health numbers and risk factors, listen to their doctors, take anything prescribed, and advise others to do the same. These guys are the health seekers. The second category, fearful subject of duties, is motivated by avoiding illness, not by seeking health. The final category of patient is the one I alluded to earlier. These folks won’t change their lifestyle in response to risk factors, but will instead request a pill so that they can continue living how they prefer. Which category do you think you fall into?
I think the book in general could be a bit better organized. My notes, although taken linearly, read as a bit disjointed, with some jumping around among different ideas. The overarching concepts are not laid out as clearly and succinctly in the book as they are in my review. Similarly, some concepts can be repeated a bit too often, leaving the reader feeling like they’ve read this before. Also, sometimes the book delves a bit too deeply into anthropological concepts and methods, given the fact that it is presented as a book for a layman. Finally, I feel the title of the book is a bit too click-baity. It reads as if it was written to sound much more controversial and attacking of the pharmaceutical industry than the book itself actually is. The title reads like the book will be a heavy-hitting expose, when really it is an even-handed piece of anthropology work.
Overall, this book will appeal to anyone interested in how the United States health care culture has evolved to the point it is currently at in regards to prescribing so many drugs. The reader does not have to be a scientist or involved in medicine to understand the book, although portions of it may feel a bit repetitive or overly technical at times. Although the book could be a bit better organized, overall it presents a clear look into the culture of drug prescription in the United States, and I recommend it to anyone interested in that topic.
4 out of 5 stars
Book Review: The Alkaline Cure: Lose Weight, Gain Energy, Feel Young and Stay Healthy for the Rest of Your Life by Stephan Domenig
The introduction to the Alkaline Diet in the first half of the book is wonderfully written and easy to understand. The 14 day meal plan and lifestyle guide falters, however, with dull, complex to make meals and a shortage of exercise tips.
For those who don’t know, the Alkaline Diet basically is the idea that our bodies function best with a pH balance between 7.3 and 7.5, but modern lifestyles wreak havoc with this balance, making us too acidic. What impacts our pH balance is our food and lifestyle. Each food can be either acidic or alkaline. Stress is acidic. Meditation is alkaline. Etc… Whether or not this idea that the body should be at a certain pH balance is valid is rather irrelevant, honestly. The tips offered for creating this balance are all good, healthy ones. The book never veers into extremism, indeed cautioning that acidic foods, such as meat and processed items, do not need to be cut out of the diet entirely in order for the reader to be healthy. It encourages a 2:1 ratio. Two parts alkaline food and activities for every one part acidic food and activities. Essentially, the idea that health is not all or nothing. It is a balancing act. Indeed, balance is a theme of the book.
Your body doesn’t want extremes–it wants balance. (loc 480)
The two parts alkaline it encourages are basically fresh produce, time for self-care, and low-stress exercise. So basically, eat whole foods, stress less, and move more. Fairly common fitness and health advice. The acidic parts include processed food, meat, dairy, stress, and high-stress exercise. Again, the reader is not told to stop enjoying any of these things, but simply to find a balance. The only thing I really disagree with is I think the book underemphasizes the importance of exercise for health. In fact, the book seems a bit concerned with not doing too much “high-stress” cardio or weight lifting. It seems to be more inclined toward the lower-impact, more moderate exercises. I don’t think this is an idea that could claim to have much science behind it. Indeed, high-intensity interval training (HIIT) is written about in over 200 articles on PubMed (a free biomedical database), and most of these articles are talking about the positive effects of HIIT on abilities and cardiovascular health. (List of articles) So essentially the food and lifestyle advice is mostly good but take the exercise advice with a grain of salt. Advising moderate walking and stretching every other day or so is really only appropriate for the most beginner levels of fitness.
After introducing these ideas, the book next offers a 14 day meal plan and lifestyle plan for the person new to Alkaline. The first week is basically a cleanse, and the second week is supposed to be a model of what the non-cleanse Alkaline lifestyle is like. This is the part where I became disappointed. The recipes, including the ones for the non-cleanse week, come across as bland, dull, and labor-intensive, and this is coming from a person who does an awful lot of cooking to minimize the amount of processed foods in her diet. I usually spend at least two hours prepping food for the workweek and cook a minimum of 4 meals at home a week. This plan seemed like an overwhelming amount of work to me. I can only imagine how it might seem to a reader who normally cooks processed meals or picks up fast food most days of the week. Many of the recipes were also not particularly simple. For both of these reasons, I feel the meal plan isn’t particularly appropriate for a beginner, which is odd given that the rest of the book is toned as for a beginner. I would expect an easier, more approachable meal plan from this book.
Each day also has beauty, exercise, and lifestyle suggestions. I particularly enjoyed the beauty suggestions, as they were mostly things that are easy to do at home and seemed enjoyable, such as an alkalizing foot bath or a hair mask. The lifestyle suggestions were good for beginners who maybe are new to the ideas of meditation and stress relief. The exercise sections suffered from the same issue I went into in-depth earlier.
What the book lacks is a clear idea of who its audience is. Is it a person completely new to fitness and healthy eating who is currently a beginner in every way? Is it meant for every person wherever they are on their journey to health? Is it meant for intermediates, looking to amp up their fitness and health regime? Because it lacks a focus, the content veers around between these three options, suggesting extremely beginner level exercises but rather advanced cooking and preparation ideas. For this reason, it would probably frustrate a beginner who finds the first half of the book do-able and understandable but then finds an overwhelming amount to do for an introductory 14 day plan. It would also frustrate someone who is not new to fitness and health who wants more details on how to amp up their regime and who may be a bit insulted at the idea that they will be fine if they just go for walks every few days. Recommended to those interested in a quick introduction to the ideas behind the Alkaline Diet to tweak their diet on their own but who is not so invested in using a 14 day introductory plan.
3 out of 5 stars
Hello my lovely readers!
I hope you all had great weeks. Mine has been incredibly busy but in a fun way. The teaching sessions at work have been increasing since medical schools and medicine in general run on a calendar that starts in June (except for the first year students who start in August). I was warned things would get busier, but I must admit it still has been a bit of a shock for me! But I’m a person who enjoys being busy, so I’m loving it.
In fitness news, I had plateaued for a few months. I took a few tips from other fitness folks to increase intensity across the board. Well, this week I decided to check my measurements (I don’t weigh myself), and in the last 1.5 months I’ve lost half an inch (1.27 centimeters) on my waist! Also an inch (2.54 centimeters) on my chest and hips, but the waist is the important factor! You’re supposed 33 inches or under around the waist (for women) for cardiovascular health, and with the heart disease that is strongly prevalent in my family, that is one of the things I keep tabs on for my fitness. (source) I’m so happy to be half an inch closer! I now only have two inches to go. :-) Also this means that the changes I made in my fitness routines are working, so yay!
In other exciting news, today is the first day of the official Waiting For Daybreak blog tour! I’ll be adding links to features as they come in, but I also will be mentioning the features in every Friday Fun post for the duration of the tour, since not everyone will be clicking through to the blog tour page. Since today is the first day of the tour, there isn’t too much to talk about this week, but I do want to call attention to the reviews and interviews that have gone up that were not a part of the official tour.
Kelsey’s Cluttered Bookshelf says, “This book is recommended for Zombie fans, there are some sexual scenes and violence, but it’s not over the top which is good. This was a great first debut book for the author.” Be sure to click through to see her whole review.
Waiting For Daybreak was also reviewed on Beauty in Ruins, who said, “The writing is solid, the dialogue creatively engaging (even with Freida’s silent cat), and the novelty of the personality issue alone definitely makes this worth a read.”
Nicki J Markus says, “The pacing of this piece is well managed and the tension was maintained perfectly from start to finish.”
And Reflections appreciated Frieda, “Even though Frieda has a personality disorder and periods of extreme depression, the character was still somehow easy to relate to.”
Finally, in addition to a review best summed-up with the great phrase, “Wonderful book!” Love, Literature, Art, and Reason also interviewed me! Be sure to check out the interview to find out everything from how I deal with writer’s block to why I decided to give Frieda Borderline Personality Disorder.
Phew! No wonder I’ve been feeling so busy…..Evidence-Based Medicine, fitness, and book tours. Oh my!
Happy weekends all!
What Librarians Talk About (MLA12 Seattle: Plenary 3: Janet Doe Lecture by Mark E. Funk, AHIP, FMLA)
The first plenary is given by the MLA president, the second by someone who is not necessarily a librarian but has something interesting to say that will aid us in our profession. The third plenary, however, is given by a librarian. Mark E. Funk’s presentation was entitled, “Our Words, Our Story: A Textual Analysis of Articles Published in the Bulletin of the Medical Library Association/Journal of the Medical Library Association from 1961 to 2010.” Here are my notes.
- An analysis of the words revealed four key areas that librarians talk about: environment, management, technology, and research.
- Although we talk more about building than people, that gap is narrowing.
- We are basically almost not talking about books, but we are increasingly talking about journals.
- Reference is steady. Searching is increasing.
- Information is the #2 word.
- As our information world becomes more complicated, we are talking more and more about teaching. “I predict teaching will become ever more important.”
- We are now concerned about what we can do to improve health.
- New groups we’ve reached out to include: clinicians, consumers, and patients.
- We use management words to tell our story.
- We are no longer running our libraries like academic environments; we are running them like businesses.
- We are early adopters and write about it.
- Sometimes new technology becomes so embedded in our lives that we don’t mention it anymore. For example, you say you talked to someone but don’t mention the telephone.
- Our attention has shifted from automating to digitizing.
- We don’t talk about the internet. We talk about the web and navigation.
- The word with the sharpest rise and fall is: Gopher
- IMRaDification of our profession. (IMRaD–Intro, Methodology, Results, Discussion)
- MLA strategic plan encouraged us to do more research, and we responded.
- Hockey Stick terms–little to no use, sharp recent uptake. May indicate future usage but it could be a drastic rise and fall. Only time will tell.
- EHRs are white hot now. (EHR–Electronic Hospital Record)
- Why do we study history? It’s very good at explaining change. Answers the question, how did we get here?
- De-emphasis on physical. Emphasis on information. Prefer evidence-based.
- Emphasis on health. Expanded audience. Outside the library. Teaching people.
- Libraries more business-like. Technophiles. More research articles using IMRaD.
- History can hint at the future, but it can’t predict it.
- Our story is being written every day. We can’t skip chapters to see what happens next.
Hello my lovely readers! Sorry for the relatively smaller amount of reviews this week. I’ve finished a few books, but didn’t have the time to write up the reviews yet. This just means next week will be full. :-)
I have a relatively serious topic I want to talk about today. You guys know that I take health and the obesity epidemic seriously. One argument that I’ve heard a lot of unhealthy women make is that they put on a ton of weight to avoid men. They weren’t comfortable with the attention, etc… I remember thinking, when I, at the time, was overweight myself, “How bad could it really be?” Turns out…..pretty bad.
Over the last year, I’ve gone from a size 16 to a size 10. Over the last month, I’ve had more encounters with men who feel entitled to my body than I had over the entire two years I was overweight. I know correlation does not necessarily equal causation, but in some cases it does.
I’m a single lady. I date. I go places where single people hang out to try to meet new people. I do what single people in cities do. I dress attractively, because I WANT to, but also because I’ve worked damn HARD for this body, and I’m proud of my work. I’m not saying I’m Miss America, and I wouldn’t want to be, but I definitely look happy and healthy when I go out. Much more so than when I was overweight. I get hit on. I get asked on dates. This also happened when I was overweight. The difference, though, is that now when I dare to say the word no a much higher percentage of them get downright angry at me.
He’ll say something like, “Do you want to go on a date?” I say, “No, thank you.” He says, “WHY?! Think you’re too good for me?!” or “Well you shouldn’t dress that way if you don’t want attention” or “Please, you obviously need a good fucking.” (I am not exaggerating. These all have been spoken or texted or what have you to me).
Worse, though, is I’ll go on a first date. Usually dinner or drinks. I have a nice enough time, but I can tell we wouldn’t work long-term, and I want a relationship at this point in my life. He leans in for a kiss, and I turn my cheek or he asks me for a second date and I say no I don’t think it’ll work out. The reaction generally is, “You owe me, I bought you dinner!” or “How can you possibly know after only one date?!” or “Well, I thought you were ugly anyway.” (That last one, btw, makes zero sense since he ASKED ME OUT TO START WITH).
What really aggravates me about these interactions isn’t their disappointment that I said no. Obviously, that is flattering. What is bothersome is the evident sense of entitlement over MY BODY that they have. I’m pretty and single. They’re available and have a penis, ergo, I must want them or I’m a horrible woman. Since when did my body become the possession of every straight man in the greater Boston area?
Oh yeah, since I started glowing with health.
It’s draining. It’s enough to make me not want to go out some nights. It’s enough to make me want to stick my earbuds in in public and ignore everyone. Of course, I’m me, so I’m not going to do these things. I’m going to keep being my awesome self and feminist hulksmashing the douchebags (verbal smack-down, folks, not a physical one), but. If I didn’t have such a strong personality or had personal issues or WHATEVER I could totally see this being a thing that would make me stop working out, stop eating healthy, stop it all and just hide to protect myself.
Do you see where I’m going here? This misogynistic entitlement to women’s bodies is a poison to our whole society. A POISON. Every time you police a woman’s body or act entitled to her or watch it happen to a woman and not stand up for her, you are essentially watching the cook poison the food and then serve it to the dinner party without saying anything or trying to stop him. It hurts everyone, and it is not ok! It is just as bad as those cultures (that I know Americans judge) that say, “Women need to cover up because they tempt men.” Our cultural impetus is the opposite. “This woman is young and healthy and available ergo I deserve her body.”
No. You. Don’t.
I vow to say something any time I hear this attitude happening, and not just to me. I vow to encourage all women to remember that our bodies are ours and our health is about US and not about THEM. I hope you all will do the same.