Disease marketing and patient coping : a research study

Thesis (S.M.)--Harvard-MIT Program in Health Sciences and Technology, 2012.Cataloged from PDF version of thesis.Includes bibliographical references (p. 80-87).BACKGROUND: There is a high prevalence of disease marketing actions in the United States that are targeted towards patients with chronic illness. However, no study has assessed the direct effects of these marketing actions on patient coping attitudes and behaviors. OBJECTIVES: This study aims to investigate whether the mere presence of disease marketing impacts patient coping and if so, how do they affect patients' coping attitudes and behaviors. METHODS: We conducted a controlled experiment using online questionnaires to assess the disease perceptions, coping decisions and disease disclosure behaviors of 108 subjects. The subjects were divided into two groups where the experimental group (N = 55) was shown marketing actions associated with a fictitious disease called Karlsen's Disease while the control group (N = 53) was not shown any marketing actions. The subjects were then asked a series of questions related to health-related coping behaviors and non-health related social behaviors. T-tests and chi-square analyses were used to analyze the behavioral differences between the experimental (high-marketing) and control (no-marketing) groups. RESULTS: Subjects in the high-marketing group were overall significantly more willing to draft a will than subjects in the no-marketing group (t(106) = 2.64, p = 0.01); High-marketing group subjects were overall significantly more likely to wear a medical ID bracelet than no-marketing group subjects (c²(1, N = 108) = 3.71, p = 0.05); Among subjects who were willing to request a menu accommodation at a dinner party, those who were in the high-marketing group were significantly more likely to disclose their disease to the party host (c²(1, N = 90) = 4.65, p = 0.03); Subjects in the high-marketing group were also significantly more likely to anticipate greater understanding from the party host towards their menu accommodation request. When controlled for gender, women in the high-marketing group were more likely to join a patient support group (t(61) = 1.75, p = 0.09), and less likely to ask family and friends to shave their heads in show of solidarity (t(18) = -1.97, p = 0.07) than women in the no-marketing group; Men in the high-marketing group were more likely than men in the no-marketing group to disclose their health condition to the dinner party host (c²(1, N = 47) = 3.61, p = 0.06). Finally, among subjects with at least a 4-year college degree, those in the high-marketing group were more willing than those in the no-marketing group to wear a face mask to protect themselves from airborne pathogens in crowded public places (t(61) = 1.79, p = 0.08). CONCLUSIONS: Based on our results, the presence of disease marketing is anticipated to have a general positive impact on patient coping attitudes and behaviors. Chronically ill patients exposed to disease marketing actions are expected to anticipate less stigma from others, have increased willingness to disclose their illness and adopt health seeking behaviors. Disease marketing is also expected to have differential impact on patients based on their gender and level of education. Follow-up studies using real patients with chronic illness should be carried out to confirm the findings from this study.by Hew Mun Lau.S.M

Bidirectional regulation of intravenous general anesthetic actions by α3-containing γ-aminobutyric acid A receptors

BACKGROUND: γ-aminobutyric acid A (GABAA) receptors mediate the actions of several intravenous general anesthetics. However, the contribution of α3-containing GABAA receptors to the action of these drugs is unknown. METHODS: The authors compared anesthetic endpoints (hypnosis, immobility, hypothermia) in response to various intravenous anesthetics in mice lacking the α3 subunit of the GABAA receptor (α3 knockout) and in wild-type mice. Furthermore, the authors generated and analyzed conditional mutant mice expressing the GABAA receptor α3 subunit exclusively in noradrenergic neurons. RESULTS: α3 knockout mice displayed decreased hypnotic and hypothermic responses to etomidate and midazolam, but an increased response to pentobarbital. The hypnotic response to ketamine was unaltered, whereas the hypothermic response was increased. In contrast, the hypnotic but not the hypothermic response to medetomidine was increased. The combination of ketamine/xylazine displayed increased hypnotic, immobilizing, and hypothermic effects in α3 knockout mice. Mice expressing the α3 subunit exclusively in noradrenergic neurons were generated to assess whether the lack of α3 subunits on noradrenergic neurons may be responsible for this effect. In these mice, the increases of the hypnotic and immobilizing actions induced by ketamine/xylazine were largely absent, whereas the increase in the hypothermic action was still present. CONCLUSION: α3-containing GABAA receptors bidirectionally regulate essential anesthetic actions: they mediate anesthetic actions of etomidate and midazolam, known to selectively act at GABAA receptors, and they negatively constrain anesthetic actions of compounds with targets partly or exclusively distinct from GABAA receptors such as medetomidine, ketamine, and pentobarbital. Furthermore, our results indicate that α3-containing GABAA receptors on noradrenergic neurons may contribute to this constraint