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array:23 [ "pii" => "S0014256513002932" "issn" => "00142565" "doi" => "10.1016/j.rce.2013.08.012" "estado" => "S300" "fechaPublicacion" => "2014-03-01" "aid" => "839" "copyright" => "Elsevier España, S.L.. All rights reserved" "copyrightAnyo" => "2013" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "prp" "cita" => "Rev Clin Esp. 2014;214:104-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 984 "formatos" => array:2 [ "HTML" => 476 "PDF" => 508 ] ] "itemSiguiente" => array:18 [ "pii" => "S0014256513003858" "issn" => "00142565" "doi" => "10.1016/j.rce.2013.11.015" "estado" => "S300" "fechaPublicacion" => "2014-03-01" "aid" => "877" "copyright" => "Elsevier España, S.L." "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Rev Clin Esp. 2014;214:108-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 896 "formatos" => array:2 [ "HTML" => 550 "PDF" => 346 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Correspondencia</span>" "titulo" => "Dermatomiositis asociada a linfoma no-Hodgkin folicular" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "108" "paginaFinal" => "109" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Follicular non-Hodgkin lymphoma-associated dermatomyositis" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 709 "Ancho" => 1900 "Tamanyo" => 232643 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A) Eritema palpebral en «heliotropo» y B) pápulas de Gottron.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "L.V. Maldonado-Romero, W.A. Sifuentes Giraldo, C. Larena-Grijalba, J. Bachiller-Corral" "autores" => array:4 [ 0 => array:2 [ "nombre" => "L.V." "apellidos" => "Maldonado-Romero" ] 1 => array:2 [ "nombre" => "W.A." "apellidos" => "Sifuentes Giraldo" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Larena-Grijalba" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Bachiller-Corral" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256513003858?idApp=WRCEE" "url" => "/00142565/0000021400000002/v2_201404030127/S0014256513003858/v2_201404030127/es/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S0014256513002920" "issn" => "00142565" "doi" => "10.1016/j.rce.2013.09.004" "estado" => "S300" "fechaPublicacion" => "2014-03-01" "aid" => "838" "copyright" => "Elsevier España, S.L." "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "prv" "cita" => "Rev Clin Esp. 2014;214:103" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 611 "formatos" => array:2 [ "HTML" => 267 "PDF" => 344 ] ] "es" => array:9 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">El artículo del mes</span>" "titulo" => "Eficacia de los regímenes de inducción-remisión en las vasculitis asociadas a anticuerpos anticitoplasma de neutrófilos" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "103" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "C. Busca Arenzana" "autores" => array:1 [ 0 => array:2 [ "nombre" => "C." "apellidos" => "Busca Arenzana" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256513002920?idApp=WRCEE" "url" => "/00142565/0000021400000002/v2_201404030127/S0014256513002920/v2_201404030127/es/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Humanities in Medicine</span>" "titulo" => "Medicalization, wish-fulfilling medicine, and disease mongering: Toward a brave new world?" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "104" "paginaFinal" => "107" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "H. Blasco-Fontecilla" "autores" => array:1 [ 0 => array:3 [ "nombre" => "H." "apellidos" => "Blasco-Fontecilla" "email" => array:1 [ 0 => "hmblasco@yahoo.es" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Child & Adolescent Psychiatrist, Villalba Mental Health Center, IIS-Puerta de Hierro Hospital, CIBERSAM, Madrid, Spain" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Medicalización, medicina del deseo e invención de enfermedades: ¿hacia un mundo feliz?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">“[…] He remained obstinately gloomy the whole afternoon; wouldn’t talk to Lenina's friends (of whom they met dozens in the ice-cream soma bar between the wrestling bouts); and in spite of his misery absolutely refused to take the half-gramme raspberry sundae which she pressed upon him. “I’d rather be myself,” he said. “Myself and nasty. Not somebody else, however jolly.”</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Brave new world- <span class="elsevierStyleItalic">Aldoux Huxley</span></span><p id="par0010" class="elsevierStylePara elsevierViewall">The limits of current Medicine are becoming more and more blurred as increasingly more advances are made. Our focus begins to shift from what can we treat to what should we do treat as doctors. Aldous Huxley, a seminal author of the 20th Century, predicted the <span class="elsevierStyleItalic">medicalization</span> of life events. For instance, unhappiness is nowadays treated with antidepressants. We could speculate about which is our <span class="elsevierStyleItalic">soma</span> (the ideal pleasure drug taken by everybody in Aldous Huxley’ famous novel <span class="elsevierStyleItalic">Brave New World</span>) nowadays, but we do not need to look far: the prescription of antidepressants has tripled from 1994 to 2003 in Spain.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Two atypical antipsychotics, aripiprazol (Abilify®, Otsuka, Bristol-Myers Squibb) and quetiapine (Seroquel®, AstraZeneca), and one antidepressant (Duloxetine, Cymbalta®, Eli Lillly) are among the ten best selling prescription drugs in the U.S. (<a id="intr0005" class="elsevierStyleInterRef" href="http://www.businessinsider.com/10-best-selling-blockbuster-drugs-2012-6%3Fop=1">http://www.businessinsider.com/10-best-selling-blockbuster-drugs-2012-6?op=1</a>). This might lead one to think that massive <span class="elsevierStyleItalic">soma</span>-medication of the population has already occurred. Has the <span class="elsevierStyleItalic">medicalization</span> of everyday problems gone too far?</p><p id="par0015" class="elsevierStylePara elsevierViewall">People are using novel medications in dangerous ways; for example, some adolescents use cognitive enhancers to improve cognitive function and some have even died in the aftermath of Viagra<span class="elsevierStyleSup">®</span> use. On the other hand, the pharmaceutical industry is very interested in developing <span class="elsevierStyleItalic">mood brighteners</span> or <span class="elsevierStyleItalic">happiness pills</span> to meet increasing demands. And the lack of a prescription is hardly a problem anymore because you can easily get what you want at a modest price delivered to your door thanks to the Internet.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In this context, it is complicated to understand current <span class="elsevierStyleItalic">Medicine</span> without using three concepts: <span class="elsevierStyleItalic">medicalization</span>, <span class="elsevierStyleItalic">wish-fulfilling Medicine</span>, and <span class="elsevierStyleItalic">disease mongering</span>. Quite surprisingly, there are no previous studies addressing the relationship among all three concepts. The concept of <span class="elsevierStyleItalic">medicalization</span> gained importance in the seventies, and it can still be considered a classical term in Sociology and Medicine. In the eighties, researchers began to speak about <span class="elsevierStyleItalic">wish-fulfilling medicine</span>. Lastly, the first article on <span class="elsevierStyleItalic">disease mongering</span> indexed in the PUBMED was published in 2002. Could this latest interest on disease mongering reflect the preoccupation of researchers on the type of medically controlled societies we are creating? Are we headed toward <span class="elsevierStyleItalic">a brave new world</span>?</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Medicalization: from patients to clients</span><p id="par0025" class="elsevierStylePara elsevierViewall">Western societies are characterized by a growing <span class="elsevierStyleItalic">medicalization</span> of life events such as puberty, menopause, pregnancy, aging, or even death.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The term <span class="elsevierStyleItalic">medicalization</span> refers to problems previously regarded as normal or as a deviance of normal that are now regarded as “pathologized” life events, such as menopause, baldness, or marital separation.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Specifically, <span class="elsevierStyleItalic">medicalization</span> can be defined as “a process by which nonmedical problems become defined and treated as medical problems, usually in terms of illnesses or disorders”.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Although it is difficult to establish when this term entered the social and medical vocabulary,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> its use expanded under the open-ended concept of health developed by the WHO in 1946 that stated that “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> This supposed a Copernican change, as the traditional concept of health, based on the presence/absence of illness -the medical science behind the traditional medical model has evolved through five stages: (1) symptoms, (2) syndromes, (3) tissue alterations, (4) demonstration of the causes behind these tissues alterations, and (5) treatment,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> was replaced by “a state of complete physical, mental and social well-being”. In other words, <span class="elsevierStyleItalic">happiness</span>.</p><p id="par0030" class="elsevierStylePara elsevierViewall">One of the areas where <span class="elsevierStyleItalic">medicalization</span> is clearly represented is <span class="elsevierStyleItalic">aging</span> and <span class="elsevierStyleItalic">death</span>. Life expectancy at birth is growing worldwide, particularly in industrialized countries. Even though it is still currently impossible to change our genetic code in order to live longer, we are not far from this possibility. For instance, modification of the daf2 gene can double the life span of worms.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> The possibility of extrapolating these advances to human beings has raised serious ethical concerns.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> But, not everyone concerns. The American futurist Ray Kurweil has paid for his cryopreservation along with more than 800 millionaires just in case these advances are not in the foreseeable future (<a id="intr0010" class="elsevierStyleInterRef" href="http://elpais.com/diario/2008/08/28/revistaverano/1219940508_850215.html">http://elpais.com/diario/2008/08/28/revistaverano/1219940508_850215.html</a>).</p><p id="par0035" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Medicalization</span> is also rooted in the field of mental disorders. For instance, individuals lacking personal resources to face certain life events (i.e. marital discord) are displacing the “usual” psychiatric patients (i.e. those with schizophrenia). Indeed, adaptive disorders are the most frequent disorders in public mental health centers in the <span class="elsevierStyleItalic">Community of Madrid</span> (Spain).<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Another example is the <span class="elsevierStyleItalic">medicalization</span> of deviances, such as, hyperactivity and learning disabilities.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a><span class="elsevierStyleItalic">Conrad</span> stressed that there were no hyperactive children in the People's Republic of China in the seventies whereas ten years later hyperactivity became the most prevalent diagnosis.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Some of the forces behind <span class="elsevierStyleItalic">medicalization</span> are pharmaceutical companies economic interests, but they do not stand-alone. Physicians are being increasingly pressured by the insatiable demands of their patients (or users).<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Indeed, one of the consequences of <span class="elsevierStyleItalic">medicalization</span> is the transition from patients to <span class="elsevierStyleItalic">clients (users)</span>. Clients are more pro-active in making decisions with regards to their <span class="elsevierStyleItalic">medicalized</span> desires; in essence, physicians become just a tool for fulfilling their wishes. Finally, there are also socio-political reasons explaining the extension of <span class="elsevierStyleItalic">medicalization.</span><a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> For instance, the transition from public health care services to private health care services fits perfectly well with the transition from <span class="elsevierStyleItalic">patients</span> to <span class="elsevierStyleItalic">clients</span>, as new health users have consumer mentalities.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Wish-fulfilling medicine: law of desire</span><p id="par0045" class="elsevierStylePara elsevierViewall">What do people strive for in the 21st Century? High paying jobs, money, time, to look better, to feel comfortable, pleasure, etc. (<a id="intr0015" class="elsevierStyleInterRef" href="http://www.doyletics.com/index10.htm">http://www.doyletics.com/index10.htm</a>). Thus, it is not surprising the increasing tendency for medicine to be used to fulfill personal wishes (i.e. better social skills, enhance work performance).<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a><span class="elsevierStyleItalic">Wish-fulfilling medicine</span> can be defined as “doctors and other health professionals using medical means (medical technology, drugs, etc.) in a medical setting to fulfill the explicitly stated, prima facie non-medical wish of a patient”.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> In contrast to patients, wish-fulfilling clients choose the treatment they receive from the first consultation, rather than their doctors. Thus, the role of the physician becomes that of a technician.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Buyx</span> defended that fulfilling the wishes of competent people is morally neutral<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>; however, she rejected the idea of including <span class="elsevierStyleItalic">wish-fulfilling medicine</span> in standard medical care,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> and I concur. The problem with <span class="elsevierStyleItalic">wish-fulfilling medicine</span> is that the demand for healthcare is insatiable. This is troublesome particularly in Europe where the welfare states are more and more under pressure.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The development of <span class="elsevierStyleItalic">wish-fulfilling medicine</span>, a term coined by <span class="elsevierStyleItalic">Matthias Kettner</span>,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> is probably a reflection of what is happening in our societies. “Traditional” patients, those who <span class="elsevierStyleItalic">sensu stricto</span> have diseases, demand their physicians to restore them to their previous healthy state. On the other hand, “new” clients come to their physicians demanding solutions for problems that are not considered diseases (e.g. baldness). Unfortunately, the problem here is that it is not an easy task to delineate the definition of disease that can evolve and change with regard to different socio-cultural contexts.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In this context, there are an increasing number of health issues that could be included within the concept of <span class="elsevierStyleItalic">wish-fulfilling medicine</span>. Reproductive medicine or plastic surgery are two classic examples of <span class="elsevierStyleItalic">wish-fulfilling medicine</span>.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> For instance, more than half of the genetic pre-implantation diagnoses in the U.S. are not motivated by therapeutic issues but by gender selection (<a id="intr0020" class="elsevierStyleInterRef" href="http://elpais.com/diario/2009/08/16/sociedad/1250373604_850215.html">http://elpais.com/diario/2009/08/16/sociedad/1250373604_850215.html</a>).</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Disease mongering: gas lighting?</span><p id="par0060" class="elsevierStylePara elsevierViewall">The concept of <span class="elsevierStyleItalic">disease mongering</span> was first defined by <span class="elsevierStyleItalic">Lynn Payer</span> in the 90s and refers to the attempts made by pharmaceutical companies to artificially enlarge the “market” by convincing people that they suffer from some sickness and need medical treatment.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Since pharmaceutical companies are under constant pressure to maintain sales growth, the temptation to expand the range of “diseases” treatable by a present commercialized product via marketing may be too strong.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Typical examples of <span class="elsevierStyleItalic">disease mongering</span> are social anxiety disorder, low bone mineral density, restless legs, premature ejaculation, and female sexual dysfunction, among others.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> Psychiatry is one of the medical disciplines more vulnerable to <span class="elsevierStyleItalic">disease mongering</span>,<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> specifically because Psychiatry lacks objective data (i.e. biomarkers) for diagnosing disorders.</p><p id="par0070" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Disease mongering</span> is nowadays more frequent because we are living in the Internet era. This means that “we have access to more information and more quickly than ever before in human history”, and Internet sites are the way people develop social networks.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> In other words, it is easier than ever to create novel diseases and to disseminate information on them.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> News media are key in the dissemination of these new diseases.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> For example, the emergence of the Internet may help to explain why fibromyalgia, a clinical entity that was recognized in the 1990s by the <span class="elsevierStyleItalic">American College of Rheumatology</span><a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> and apparently suffered by 2–3% of the general population,<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> did not previously create a huge social alarm.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusion</span><p id="par0075" class="elsevierStylePara elsevierViewall">There has been a Copernican change in the concept of health since the post-world war II WHO definition of health. <span class="elsevierStyleItalic">Wish-fulfilling medicine</span> is usually placed within private practise, but the limits between “traditional” medicine and <span class="elsevierStyleItalic">wish-fulfilling medicine</span> are not always clear.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> This is particularly worrying nowadays, given that some <span class="elsevierStyleItalic">Public Health Services</span> could be on the brink of collapse, as they “navigate” between the scarce resources available and the users’ insatiable health demands. Therefore, it appears there is a necessity to generate clear-cut <span class="elsevierStyleItalic">Public Health Services Port-folios</span> placing <span class="elsevierStyleItalic">wish-fulfilling medicine</span> within the limits of private practise.</p><p id="par0080" class="elsevierStylePara elsevierViewall">It appears as if we were going toward <span class="elsevierStyleItalic">a brave new world</span>. However, it is important to erase any kind of fatalism: the process of <span class="elsevierStyleItalic">medicalization</span> is by no means stationary and can be challenged.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Modern western societies are characterized, among others, by the satiety of senses and the lack of frustration. We thought that this vacuous superabundance would make us happier. But this has not been true. Desire, like <span class="elsevierStyleItalic">Eros</span>, appears to be insatiable. Instead, boredom is our punishment. It is possible that <span class="elsevierStyleItalic">Zygmunt Bauman</span> was right: in the inherent nature of desire is written its self-destruction.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conflict of interest</span><p id="par0090" class="elsevierStylePara elsevierViewall">Dr. Blasco-Fontecilla has received lecture fees from Eli Lilly, Shire, and AB-Biotics in the last three years.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:2 [ "identificador" => "xres327354" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec309019" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres327353" "titulo" => "Resumen" ] 3 => array:2 [ "identificador" => "xpalclavsec309020" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Brave new world- Aldoux Huxley" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Medicalization: from patients to clients" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Wish-fulfilling medicine: law of desire" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Disease mongering: gas lighting?" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conclusion" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflict of interest" ] 11 => array:2 [ "identificador" => "xack77751" "titulo" => "Acknowledgments" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec309019" "palabras" => array:3 [ 0 => "Medicalization" 1 => "Wish-fulfilling medicine" 2 => "Disease mongering" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec309020" "palabras" => array:3 [ 0 => "Medicalización" 1 => "Medicina del deseo" 2 => "«invención» de enfermedades" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Western societies are characterized by a growing medicalization of life events, such as pregnancy, aging, or even death. Three concepts -medicalization, wish-fulfilling medicine, and disease mongering- are key in understanding the current practise of Medicine. Quite surprisingly, not a single study has addressed the relationship between all three of these concepts. The term medicalization expanded under the open-ended concept of health developed by the World Health Organization in 1946. One of the consequences of medicalization is the transition from patients to clients. Physicians are under increasing pressure to meet the insatiable demands of their clients. The term wish-fulfilling medicine refers to the increasing tendency of medicine to be used to fulfill personal wishes (i.e. enhanced work performance). The insatiable demand for healthcare is troublesome, particularly in Europe, where the welfare states are more and more under pressure. Finally, the term disease mongering refers to attempts by pharmaceutical companies to artificially enlarge their “markets” by convincing people that they suffer from some sickness and thus need medical treatment. Typical examples of disease mongering are social anxiety disorder, low bone mineral density, and premature ejaculation. Currently, some Public Health Services could be on the brink of collapse as they “navigate” between the scarce resources available and the users’ insatiable health demands. Therefore, it appears necessary to generate clear-cut Public Health Services Port-folios.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Las sociedades occidentales se caracterizan por una creciente medicalización de la vida cotidiana (p. ej., embarazo, envejecimiento y muerte). Tres conceptos –medicalización, medicina del deseo e invención de enfermedades– son fundamentales para entender la práctica actual de la Medicina. Resulta sorprendente que la relación entre los 3 términos apenas haya recibido atención en la comunidad científica. El término <span class="elsevierStyleItalic">medicalización</span> se expandió bajo el paraguas del concepto de salud ilimitado desarrollado por la Organización Mundial de la Salud en 1946. Una de las consecuencias de la medicalización es la transición de pacientes hacia clientes. Los médicos están cada vez bajo una mayor presión por parte de las insaciables demandas de salud de sus clientes. El término <span class="elsevierStyleItalic">medicina del deseo</span> hace referencia precisamente a la tendencia creciente a usar la Medicina para satisfacer los deseos personales (p. ej. aumento del rendimiento laboral). Esta insaciable demanda de salud es problemática, particularmente en Europa, donde los Sistemas de Salud Públicos están bajo una presión creciente. Finalmente, el término «invención de enfermedades» se refiere a los intentos de la industria farmacéutica para aumentar de manera artificial sus «mercados» al convencer a la gente (clientes) que sufren una enfermedad (previamente inexistente), para la cual necesitan un tratamiento. Algunos ejemplos de este último término son la fobia social o la eyaculación precoz. En la actualidad, algunos Servicios Públicos de Salud podrían estar cerca del colapso económico derivado de unos recursos cada vez más escasos y una demanda (deseos) de salud cada vez más insaciable. 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