Saliglasa Direct Primary Care

Pile of medications of different shapes and colors

The Medicalization of Social Problems

On February 22, 2024, Reuters published an article reporting that the widespread use of weight loss drugs could boost the US economy by up to 1% in the coming years, potentially adding 100 billion dollars by the end of
the decade. This projection is astonishing not just for the enormous dollar amount but also for its implications for the medical profession and the healthcare industry.

The obesity epidemic, prevalent in the United States and other parts of the world, including developing countries, is undeniably tied to modern lifestyles. These lifestyles encompass not only our diets but also our general way of living that is confined indoors, and isolated. Although some biogenetic markers contributing to obesity remain to be fully understood, major drivers for the disease include highly processed foods, sedentary habits, chronic stress, certain medications, and environmental exposures that are integral to our contemporary life.

The influence of social conditions on medical problems is well documented. As far back as the time of Hippocrates, the “Father of Medicine,” the powerful impact of social conditions on health was recognized. He reportedly stated:

“Whoever wishes to investigate medicine properly, should proceed thus: in the first place to consider the seasons of the year, … the qualities of the waters, …he ought to consider its (the city’s) situation, …the mode in which the inhabitants live… From these things, he must proceed to investigate everything else.”

On Airs, Waters, and Places (460BC-377BC)

Since Hippocrates, extensive research has continued to highlight the strong influence of social determinants on health outcomes. Key findings include:

  1. Early life events influence later life susceptibilities to chronic diseases.
  2. Childhood exposure to violence and neglect is a risk factor for behaviors and disorders later in life, such as smoking, obesity, high-risk sexual behavior, and depression.
  3. Chronic stress and the accompanying constant neuroendocrine response (known as allostatic load) have deleterious effects on health, particularly cardiovascular health.
  4. Food systems and social factors affecting food choices, especially in low-income neighborhoods, contribute to health disparities.

The reason is clear when we consider the long and messy process that is required to re-engineer individual and community lifestyles in order to tackle conditions like obesity, stress, anxiety, and depression. Pharmaceutical drugs that can tackle these issues in a matter of few months are not only enormously profitable to the healthcare business, but they are also in high demand by patients. The ease and profitability of medicalizing social problems has thus long been the winning strategy.

Pharmaceuticals, including weight loss medications, can be lifesaving and play essential roles in disease management. However, their promise of quick fixes and high profitability makes them irresistible tools to reach for when addressing societal issues of all kinds, even those that are best tackled at the root cause. Additionally, their effectiveness notwithstanding, the long term effect of some of these drugs on patients remain unknown. What should physicians do?

Empowering patients and working together to address their social and behavioral challenges is not only sound medical practice, but also an evidence-based strategy for providing effective healthcare. Our responsibility to our patients involves assisting them in reaching their health objectives in a safe, effective, and affordable way.

When physicians are pressed for time, it is easier to yield to the strong tide that pulls toward the easier fix. Just prescribe. When we slow down enough to engage with our patients and gain their trust, more opportunities open up that can be explored jointly for health outcome improvement, with or without medications.

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