Value-Based Health Care Delivery, Preventive Medicine and the Medicalization of Public Health

The real paradigm shift for healthcare is often stated to include a transition from accentuating health care production and instead emphasize patient value by moving to a ‘value-based health care delivery’. In this transition, personalized medicine is sometimes referred to as almost a panacea in solving the current and future health challenges. In theory, the progress of precision medicine sounds uncontroversial and most welcomed with its promise of a better healthcare for all, with real benefits for the individual patient provided a tailored and optimized treatment plan suitable for his or her genetic makeup. And maybe, therefore, the assumptions underpinning personalized medicine have largely escaped questioning. The use of personalized medicine and the use of digital technologies is reshaping our health care system and how we think of health interventions and our individual responsibility. However, encouraging individuals to engage in preventive health activities possibly avoids one form of medicalization (clinical), but on the other hand, it takes up another form (preventive medicine and ‘self-care’) that moves medical and health concerns into every corner of everyday life. This ought to be of little value to the individual patient and public health. We ought to instead demand proof of these value ideas and the lacking research. Before this is in place critical appraisal and cynicism are requisite skills for the future. Otherwise, we are just listening to visionaries when we put our future health into their hands and let personalized solutions reach into people's everyday life regardless of patient safety and integrity

A Pill for the Ill? : Depression, Medicalization and Public Health

Mental disorders, especially depression, have been increasingly described as a growing burden to global public health. Critics argue, however, that the use of mental health surveys, underlying these descriptions, tends to overestimate the prevalence of mental disorders by not distinguishing everyday experiences of distress from pathological conditions. This medicalization of public health is believed to narrow the focus of public health practices. The aim of this thesis is twofold. The first objective is to describe and analyze experiences with antidepressant treatment for depression as expressed in adverse drug reaction (ADR) reports from patients, i.e. “consumers reports.” A second goal is to conduct a theoretical discussion, by looking at broad societal changes, and analyzing the consequences of mental ill health as a significant public health problem. Special attention will be given to medicalization. Reports of suspected adverse reactions regarding antidepressant mediations were submitted from 2002 to 2009 to an open Internet-based reporting system in Sweden. These were analyzed according to common psychiatric reactions and narrative experiences. Furthermore, a literature overview in a broad and general sense was performed to underpin a theoretical discussion on health, public health, mental ill health and medicalization. The main findings of this thesis were that patients reporting to an open Internet-based system in Sweden seemed, to a large extent, to experience psychiatric ADR symptoms of mental disturbances (sometimes severe), which affected them in many different ways, especially during discontinuation. These reports also suggested a negative doctor-patient interaction from the patient’s perspective. Risks leading to increased medicalization as a result of overdiagnoses of depression were found. Pharmaceuticalization resulting from overprescribed antidepressants was also deemed problematic. According to a theoretical discussion on public health and medicalization, increased medicalization as a result of excessive diagnosing risks individualizing mental problems and may divert the focus from the social and political context of public health. According to patient reports, there seems to be a potential problem as to how patients are diagnosed with depression and prescribed antidepressant medication in the medical encounter. Increased drug treatment risks lead to increased health care costs and potential harm from adverse drug reactions. Overdiagnosis and overtreatment may in turn lead to diminished trust in the health system. If depression is going to be viewed as a growing public health problem, it, therefore, calls for a distinction between ill health problems that are medical and those that are not. Arguments for increased medication must be related to a possible danger of medicalizing social problems and life crises

Extremvärme ett ökande problem för globala folkhälsan : Klimatförändringarnas negativa hälsoeffekter drabbar även Sverige

High temperatures have a direct impact on body functions. Heat waves increase mortality risks due to myocardial infarction, stroke, and pulmonary disease. Cold temperatures also increase mortality, but with a longer latency. A recent study found only a small difference between the minimal mortality temperature (MMT) and the temperatures at which mortality rose steeply, although the majority of deaths occurred at temperatures below MMT. Global climate change with increasing temperatures seriously threatens health, work capacity, and generation of household incomes, particularly among poor people in hot countries. In Sweden, heat waves increase mortality in vulnerable groups of elderly people and patients with chronic heart and lung diseases, as well as those performing intensive physical work in hot environments. The medical profession can play an important role not only in prevention of climate change, but also in adaptation to climate change with the goal of minimizing health risks

Efter sälj kommer solsken – eller? En empirisk studie av buyout-aktörers bestående värdeskapande i Sverige.

Syfte: Författarna ämnar med denna studie att undersöka hur buyout-aktörers portföljbolag presterar efter avyttring. Studien ämnar utreda prestationen genom att studera finansiella nyckeltal kopplade till operativt värdeskapande. Metod: En kvantitativ metod i form av en eventstudie med deduktiv ansats. Värdeutvecklingen efter buyout-aktörers utträde ur portföljbolag studeras under eventfönstret efter avyttring för att undersöka om över- eller underprestation sker mot ett framtaget branschsnitt. Slutligen görs flertalet statistiska tester för att urskilja eventuella signifikanta skillnader. Teoretiskt perspektiv: Med avstamp i den deduktiva metoden utgår studien från tidigare forskares teorier värdeskapande i buyout-bolag och möjliggör jämförelser med tidigare forskning och uppsatser genom applicering av metodval från dessa. Empiri: Data består av räkenskaper från portföljbolag ägda av medlemmar hos SVCA och är avyttrade mellan år 2004-2010. Detta tillsammans med räkenskaper från branschkonkurrenter samlats in för att undersöka värdeutveckling under det efterföljande eventfönstret. Resultat: Studien visar på statistiskt signifikant överprestation i portföljbolag gentemot ett branschsnitt i de operationella nyckeltalen EBITDA-marginal samt avkastning på operativt kapital under eventfönstrets första period. Avseende förändring i nettoomsättning kunde inte någon överprestation säkerställas. Detta kunde inte heller göras för EBITDA-marginal eller avkastning på operativt kapital för kvarvarande perioder av eventfönstret. Under hela den undersökta perioden om tre år påvisades ingen signifikant över- eller underprestation avseende något av de tre nyckeltalen

What can we learn from consumer reports on psychiatric adverse drug reactions with antidepressant medication? Experiences from reports to a consumer association

Background According to the World Health Organization (WHO) the cost of adverse drug reactions   (ADRs) in the general population is high and under-reporting by health professionals   is a well-recognized problem. Another way to increase ADR reporting is to let the   consumers themselves report directly to the authorities. In Sweden it is mandatory   for prescribers to report serious ADRs to the Medical Products Agency (MPA), but there   are no such regulations for consumers. The non-profit and independent organization   Consumer Association for Medicines and Health, KILEN has launched the possibility   for consumers to report their perceptions and experiences from their use of medicines   in order to strengthen consumer rights within the health care sector. This study aimed   to analyze these consumer reports. Methods All reports submitted from January 2002 to April 2009 to an open web site in Sweden   where anyone could report their experience with the use of pharmaceuticals were analyzed   with focus on common psychiatric side effects related to antidepressant usage. More   than one ADR for a specific drug could be reported. Results In total 665 reports were made during the period. 442 reports concerned antidepressant   medications and the individual antidepressant reports represented 2392 ADRs and 878   (37%) of these were psychiatric ADRs. 75% of the individual reports concerned serotonin-reuptake   inhibitor (SSRI) and the rest serotonin-norepinephrine reuptake inhibitor (SNRI).   Women reported more antidepressant psychiatric ADRs (71%) compared to men (24%). More   potentially serious psychiatric ADRs were frequently reported to KILEN and withdrawal   symptoms during discontinuation were also reported as a common issue. Conclusions The present study indicates that consumer reports may contribute with important information   regarding more serious psychiatric ADRs following antidepressant treatment. Consumer   reporting may be considered a complement to traditional ADR reporting

Non-Standard Errors

In statistics, samples are drawn from a population in a data-generating process (DGP). Standard errors measure the uncertainty in estimates of population parameters. In science, evidence is generated to test hypotheses in an evidence-generating process (EGP). We claim that EGP variation across researchers adds uncertainty: Non-standard errors (NSEs). We study NSEs by letting 164 teams test the same hypotheses on the same data. NSEs turn out to be sizable, but smaller for better reproducible or higher rated research. Adding peer-review stages reduces NSEs. We further find that this type of uncertainty is underestimated by participants

Temaledare: Global hälsa – En nödvändighet och förutsättning för att lösa globala utmaningar

Vi lever numera i en värld som blivit i allt högre grad sammankopplad, vilket har både för- och nackdelar. Å ena sidan innebär vår urbaniserade och teknologiska värld snabba kommunikationer, vilket underlättar både fysiska resor och överföring av information. Å andra sidan möjliggör denna utveckling även en snabbare global spridning av bland annat okända virusinfektioner, vilket världen under 2020 blev varse och det med besked i och med covid-19

The devil in the details: public health and depression.

Background: Mental disorders, especially depression, have been increasingly described as a growing burden to global public health. This description is, however, not without controversy, and some scholars are skeptical of how, for instance, depression is viewed as an increasing widespread ill health problem. Discussion: While public health medicine has long engaged in strategies of disease prevention and health promotion, more individualized practices of risk are argued to have become a central dimension of the politics of life in the twenty-first century. By trying to assess potential risk factors for disease and disorders at earlier stages, the concepts of illness and risk may become increasingly blurred. Non-medical problems have become medical ones with risking leading to overdiagnosis and overtreatment as the definition of what constitutes an abnormality gets increasingly broader. If normal events are misdiagnosed as depression, this will risk leaving those who are depressed untreated (extended waiting lists to health care, wrong medications or lack of resources) and thereby create undertreatment and overtreatment simultaneously. Summary: For the sake of public health, arguments for increased diagnosis must therefore be related to a possible danger of medicalizing social problems and life crises. By including people with mild problems in estimates of mental illness, we risk losing support for treating those people who have legitimate disorders