Doctors connecting health and land use policies

A recent document from the American Medical Association and the Association of American Medical Colleges asks doctors to address health inequities by prioritizing structural conditions. Here is one example involving land use which first asks the conventional question and then highlights a health equity perspective:

Photo by EVG Culture on

How can we promote healthy behavior?

How can we democratize land use policies through greater public participation to ensure healthy living conditions?

The second perspective highlights a structural perspective in two ways.

  1. Healthy behavior leans more toward an individualistic perspective. A person who has health concerns should adapt their behavior in order to be more healthy. In contrast, healthy living conditions suggests there is a broader context for the individual’s health. Healthy living conditions can help lead to healthier individuals.
  2. With healthy living conditions in mind, the new question highlights two ways that healthy living conditions come about: land use policies and greater public participation. This likely refers to research and experiences certain communities have with decisions made about where to locate land uses – ranging from coal power plants to landfills to manufacturing facilities with toxic output and more – that then affect health. Such decisions involve power, race/ethnicity, and social class as well as decision-making processes.

More broadly, land use in the United States is often determined by zoning and profit-seeking. Zoning often has the goal of protecting single-family homes. Land and location can be turned into money. Health is not a primary concern in all of these decisions even as it can lead to better health outcomes for some compared to others.

h/t Conor Friedersdorf in The Atlantic.

Medical TV shows skew how Americans view doctors, health

The portrayals of medical work on television have had an effect on American viewers:

A 2005 survey by the Centers for Disease Control and Prevention found that the majority of primetime TV viewers reported learning something new about a disease or other health issue over six months of viewing. About one-third of viewers took some kind of action after learning about a health issue on TV…

As a result, “a fan of medical dramas … can develop a skewed perception of what are more or less prevalent health issues in the real world,” study author Dr. Jae Eun Chung, an assistant professor in the school of communication at Howard University, told me in an email. Heavy viewers of medical dramas in her study were less likely to rate cardiovascular disease and cancer as important societal issues (when they are, in fact, the top two causes of death in the U.S.), and when it came to cancer, they were more fatalistic, “more likely to say that cancer prevention is uncertain and that the disease is fatal.”…

Studies of modern medical shows have found fictional doctors’ professionalism disappointing at best. In an analysis of 50 episodes of Grey’s Anatomy and House, researchers found that the characters handled issues involving patient consent well 43 percent of the time. “The remainder [of the depictions] were inadequate,” the study says.

The analysis also found several incidents of doctors endangering patients without being punished, sexual misconduct (of course), and disrespect. The study notes that “88 percent of disrespectful incidents in House involved Dr. House.”

But despite all the inappropriate romances, and Dr. House’s rude mouth, the analysis found that there’s one arena in which TV doctors still shine: caring for patients.

Interesting contrast: TV doctors are caring people but to be that, they cut corners in terms of professionalism as they treat a whole range of odd medical conditions. Additionally, could there be a compelling medical TV show that addresses normal American health problems like obesity and heart disease? (Cancer does get some coverage on these shows.)

All of this makes me wonder whether all professions really would want their activities portrayed on TV. While certain fields may not get much airtime, like sociology, wouldn’t TV likely warp any of these professions in the name of entertainment and stereotypes?

Health includes social and behavioral dimensions

There may be privacy concerns about the government having behavioral and social data as part of medical records but that doesn’t necessarily mean they aren’t important factors when looking at health:

The Centers for Medicare and Medicaid Services (CMS) wants to require health care providers to include “social and behavioral” data in Electronic Health Records (EHR) and to link patient’s records to public health departments, it was announced last week.

Health care experts say the proposal raises additional privacy concerns over Americans’ personal health information, on top of worries that the Obamacare “data hub” could lead to abuse by bureaucrats and identify theft…

The “meaningful use” program already requires doctors and hospitals to report the demographics of a patient and if he smokes to qualify for its first step. The second stage, planned for 2014, will require recording a patient’s family health history.

The National Academy of Sciences will make recommendations for adding social and behavioral data for stage three, which will be unveiled in 2016.

Maybe these are separate concerns: one might argue such data is worthwhile but they don’t trust he government with it. But, I suspect there are some who don’t like the collection of social and behavioral data at all. They would argue it is too intrusive. People have made similar complaints about the Census: why exactly does the government need this data anyway?

However, we know that health is not just a physical outcome. You can’t separate health from behavior and social interactions. There is a lot of potential here for new understandings of health and its multidimensionality. Take something like stress. There are physical reactions to it but this is an issue strongly influenced by context. Solutions to it could include pills or medicine but that is only dealing with the physical outcomes rather than limiting or addressing stressful situations.

We’ll see how this plays out. I suspect, federal government involvement or not, medical professionals will be looking more at the whole person when addressing physical concerns.

Update on sociology becoming part of the MCAT in January 2015

ASA’s Footnotes for December 2012 includes an article with more details on sociological material being included on the MCAT in upcoming years:

An important change in the MCAT® (the Medical College Admission Test) has the potential to have a significant impact on sociology departments across the country. In February 2012, the Association of American Medical Colleges (AAMC) “approved changes… that will require aspiring doctors to have an understanding of the social and behavioral sciences.” (Mann, 2012). The new version of the test, which will be in place by January of 2015, includes an entire section on the social and behavioral sciences. One implication of this change is that pre-medical curricula across the country may start requiring that students take an introductory sociology course (as well as an introductory course in psychology) in preparation for taking the MCAT (see, for example, Brenner and Ringe 2012)…

The exact content of sociology and psychology test questions is not yet finalized. Starting in January 2014 the new social science section of the MCAT will be included as an “optional” section. The cohort of students who take that first updated version of the MCAT are already enrolled in college. Students who choose to complete it will be compensated in some way. These trial runs will be used to modify the section before it “counts” as part of the MCAT score. Starting in January 2015 the test will include the required section on social and behavioral sciences.

The new section of the MCAT that tests sociology and psychology is described in a Preview Guide to the MCAT2015 Exam. The descriptions contained in that guide detail specific content areas within sociology (including “understanding social structure,” “demographic characteristics and processes,” “social stratification,” and “social inequality”) that will be covered on the test (AAMC 2012:12).

Two quick thoughts:

1. I’ve mentioned this change in my Intro classes a few times and I think some pre-med students were aware of what was happening. I can’t say for sure that I’ve had an uptick in students interested in medical fields but this article suggests this could happen in coming years.

2. While I think this makes a lot of sense for medical practitioners to have some knowledge of society and social life, I am amazed at times that more fields don’t explicitly train their students or ask them to take classes in social life. For example, isn’t business often about interacting with people as well as managing employees? Wouldn’t sociology provide insights into this?

The sociology knowledge you need to take the MCAT

I noted last year that the MCAT, the exam for applicants to medical school, was changing to include knowledge about sociology. Since then, I have been curious about what exact sociological knowledge is required for the exam and a report from the American Association of Medical Colleges provides some insights. Here is “Behavioral and Social Science
Learning Outcomes at Graduation” that sociology (and psychology) can fulfill (p.24 of the document):

Accurately describe how social determinants of health influence health outcomes and how physicians can incorporate this knowledge in the care of patients.

Here is how a sociological vantage point can help deal with a particular scenario (p.16):

A woman newly diagnosed with breast cancer is searching for a physician to help her think through her situation, set goals, and develop a “health strategy.” While waiting to meet with a new physician for consultation, she tells a medical student that she has been mostly receiving “treatment options,” instead of health strategies…

• How do we conceptualize the difference between a “health strategy” and “treatment options”?
• How is the care of a cancer patient embedded in a network of friends, family, and health care providers?

And here is a more broad statement about what the social sciences can bring to medicine (p.10):

Given the daunting breadth of behavioral and social science, the contributions from this family of sciences can best be understood by attending to three core areas: 1) the use of behavioral and social sciences theory, 2) behavioral and social science research methods, and 3) core behavioral and social science concepts and contributions to the fund of medical knowledge.

On the whole, it seems like sociology is meant to help doctors and health care providers understand the social and cultural context of the patient. Added to an expanded matrix of care, sociology helps provide a more holistic approach to medical care.

It seems like these requirements could be fulfilled by an Introduction to Sociology course though without seeing the particular questions on the MCAT, it is hard to know.

Debating the merits of using the word “cancer”

Many would say that they know what cancer is. But medical experts suggest it is not so clear and perhaps the term “cancer” is not the best description for every situation that might usually be labelled with this term.

Though it is impossible to say whether the treatment was necessary in this case, one thing is growing increasingly clear to many researchers: The word “cancer” is out of date, and all too often it can be unnecessarily frightening…

“The definition of cancer has changed,” said Dr. Robert Aronowitz, a professor of history and sociology of medicine at the University of Pennsylvania.

Many medical investigators now speak in terms of the probability that a tumor is deadly. And they talk of a newly recognized risk of cancer screening — overdiagnosis. Screening can find what are actually harmless, if abnormal-looking, clusters of cells.

But since it is not known for sure whether they will develop into fatal cancers, doctors tend to treat them with the same methods that they use to treat clearly invasive cancers. Screening is finding “cancers” that did not need to be found. So maybe “cancer” is not always the right word for them.

This is an interesting discussion to read about after having recently completed reading The Emperor of All Maladies: A Biography of Cancer. Several points are found in both works:

1. Our knowledge of cancer is constantly evolving. We don’t know as much about it as the public might think.

2. Different cancers present different issues, leading to some of the issue with the term cancer. Cancers don’t have a common cause or necessarily act in the same way.

3. Screening is a big issue. Who should get screened? Is it cost-effective?

One other issue that I don’t see discussed in this article or in the book: is part of the problem with the word “cancer” the connotations that this has for people? In his book, Mukherjee suggests that cancer is associated with a bleak prognosis. When patients hear this term, they know they are in for a very difficult fight. Would changing the use of the term shift some of this conversation away from the immediate fear involving cancer to a more medical term that requires more explanation and obscures the severity a bit? Is this also in even just a little way about public relations?

Social factors as part of a medical diagnosis

This story from the Chicago Tribune tells of Dr. Saul Weiner who has been studying the effect of social circumstances, such as socioeconomic concerns, on medical diagnoses. After one of his own cases, Weiner decided to study the issue further:

Weiner arranged to send actors playing patients into physicians’ offices and discovered that errors occurred in 78 percent of cases when socioeconomic concerns were a significant factor, according to a paper published Monday in the Annals of Internal Medicine.

Weiner recommends adding a “contextual history” to the physical history that physicians usually document with first-time patients.

Treating the whole person seems like it would produce better results for the patient.