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Health beyond clinical protocol: institutional traps and limitations of modern medicine

stmm. 2023 (3): 90-115

DOI https://doi.org/10.15407/sociology2023.03.090

Full text: http://stmm.in.ua/archive/ukr/2023-3/8.pdf

SIARHEI KANDRYCHYN, PhD in Sociology, autonomous scholar, Graduate School for Social Research, Polish Academy of Sciences (72, Nowy Świat St., Warsaw, 00-330)

kandrych02@yahoo.com

https://orcid.org/0000-0001-8509-2554

The article is aimed to describe the ineffective health care mechanisms and find ways to overcome them. Some variants of institutional dysfunctions (or institutional traps) in medical practice are considered. The resort to natural methods of healing and self-healing is regarded as a way to overcome various institutional dysfunctions. The work combines several qualitative methods: a non-standardized survey of experts (doctors), included observation (25 years of work as a doctor and independent use of natural healing methods for the past 12 years), and analysis of documents, literary sources and messages on the topic of self-healing in relevant Facebook groups. The themes of the talks with doctors were health self- management and alternative healing practices (intensive physical exercises, medical fasting, and breathing exercises). During conversations with the doctors found that only some senior doctors have positive experience of using therapeutic fasting and breathing exercises (both personal and clinical), and young doctors who have been working in medicine for over 10-20 years are not familiar with these methods ("because this treatment is not carried out according to the approved clinical protocols”, and “we treat according to modern protocols"). The most problematic points of the use of such health practices and the reasons for their increase in society are discussed. It is concluded that both in the institutional and ideological aspect, the essential component of the public health institute should be outside the scope of official medicine, which is aimed at the use of medicinal and high-tech means of treatment and prevention.

Keywords: modern medicine, institutional traps, self-healing, therapeutic fasting, respiratory gymnastics

References

Amosov, N.M. (1987). Thought About Health. [In Russian]. Moscow: Physical Culture and Sports.

Arney, W., Bergen, B. (1984). Medicine and the Management of Living. Chicago: Chicago University Press.

Arthur, W.B. (1988). Self-reinforcing mechanisms in economics. In: K. Arrow, P. Anderson (Eds.), The Economy as an Evolving Complex System (pp. 9-31). New York: Addison-Wesley. https://doi.org/10.1201/9780429492846-2

Brainerd, E., Cutler, D. (2005). Autopsy on an Empire: Understanding Mortality in Russia and the Former Soviet Union. Journal of Economic Perspectives, 19, 107-130. https://doi.org/10.1257/0895330053147921

Dzau, V.J., Antman, E.M., Black, H.R. et al. (2006). The cardiovascular disease continuum validated: clinical evidence of improved patient outcome. Part II: Clinical trial evidence (acute coronary syndromes through renal disease) and future directions. Circulation, 114, 2871-2891. https://doi.org/10.1161/CIRCULATIONAHA.106.655761

Ealey, K.N., Phillips, J., Sung, H.K. (2021). COVID-19 and obesity: fighting two pandemics with intermittent fasting. Trends in Endocrinology and Metabolism, 32(9), 706-720. https://doi.org/10.1016/j.tem.2021.06.004

Eyre, H., Kahn, R., Robertson, R.M. (2004). Preventing Cancer, Cardiovascular Disease, and Diabetes. A common agenda for the American Cancer Society, the American Diabetes Association, and the American Heart Association. Diabetes Care, 27, 1812-1824. https://doi.org/10.2337/diacare.27.7.1812

Fisher, D.B. (1996). Self-Managed Care: The most cost effective managed care. National Empowerment Center Newsletter, Spring. Retrieved from: http://www. power2u.org/articles/managed/managed_care.html

Foucault, M. (1973). The Birth of the Clinic. New York: Pantheon Books.

Grady, P.A., Gough, L.L. (2014). Self-management: A comprehensive approach to management of chronic conditions. American Journal of Public Health, 104, e25-e31. https://doi.org/10.2105/AJPH.2014.302041

Hannan, M.A., Rahman, M.A., Rahman, M.S. et al. (2020). Intermittent fasting, a possible priming tool for host defense against SARS-CoV-2 infection: Crosstalk among calorie restriction, autophagy and immune response. Immunology Letters, 226, 38-45. https://doi.org/10.1016/j.imlet.2020.07.001

Kandrychyn, S.V. (2015). Quantity of scientific publication on therapeutic fasting in historical perspective: A global survey. [In Belarussian]. Military medicine, 1, 107-110.

Kessler, D.P., McClellan, M.B. (1996). Do Doctors Practice Defense Medicine? Quarterly Journal of Economics, 111(2), 353-390. https://doi.org/10.2307/2946682

Kessler, D.P., McClellan, M.B. (2002). How liability law affects medical productivity. Journal of Health Economics, 21(6), 931-955. https://doi.org/10.1016/S0167-6296(02)00076-0

Libanova, Е.М. (Ed.). (2007). Mortality of Workable Population in Ukraine. [In Ukrainian]. Kyiv: Institute of Demography and Social Studies, NAS of Ukraine.

Mesle, F., Shkolnikov, V.M., Hertrich, V., Vallin, J. (1996). Tendences recentes de la mortalite par cause en Russie 1965-1994. Serie: Donйes Statistiques, 2, INED, Paris.

Mikheenko, O.I. (2017). Personal responsibility for own health as a strategic principle of health practice. [In Ukrainian]. In: Yu.D. Boychuk (Еd.), General theory of health and healthcare: a collective monograph (pp. 238-244.). Kharkiv: Publisher Rozhko S.G.

North, D. (1990). Institutions, Institutional Change and Economic Performance. Cambridge: Cambridge University Press. https://doi.org/10.1017/CBO9780511808678

Pakholok, O. (2012). Transformation of culture of health in civilization process. [In Ukrainian]. Sociology: Theory, Methods, Marketing, 1, 115-132.

Pavlenko, S.М. (1967). The doctrine of sanogenesis - the most important issue of Medicine. [In Russian]. Pathological Physiology and Experimental Therapy, 7, 11(3), 91-95.

Polterovich, V. (2007). Institutional Trap. New Palgrave Dictionary of Economics. Retrieved from: https://ssrn.com/abstract=1751839 https://doi.org/10.1057/978-1-349-95121-5_2717-1

Raposo, V.L. (2019). Defensive Medicine and the Imposition of a More Demanding Standard of Care. Journal of Legal Medicine, 39(4), 401-416. https://doi.org/10.1080/01947648.2019.1677273

Ray, W.A., Chung, C.P., Stein, C.M. et al. (2021). Association of Rivaroxaban vs Apixaban with major ischemic or hemorrhagic events in patients with atrial fibrillation. JAMA, 326(23), 2395-2404. https://doi.org/10.1001/jama.2021.21222

Romanova, A.P., Krasko, O.V. (2018). The influence of change in age structure on gender-specific mortality rate differences in the context of the demographic transition. [In Russian]. Meditsinskie novosti, 10, 52-60.

Shapiro, R.S., Simpson, D.E., Lawrence, S.L. et al. (1989). A survey of sued and nonsued physicians and suing patients. Archives of Internal Medicine, 149(10), 2190-2196. https://doi.org/10.1001/archinte.1989.00390100028008

Summerton, N. (1995). Positive and negative factors in defensive medicine: a questionnaire study of general practitioners. BMJ, 310(6971), 27-29. https://doi.org/10.1136/bmj.310.6971.27

Tancredi, L.R., Barondess, J.A. (1978). The problem of defensive medicine. Science, 200(4344), 879-882. https://doi.org/10.1126/science.644329

Vynnytskyi, M. (2022). Why the Kremlin read Ukraine incorrectly and and where does the bees: sociologist explains. [In Ukrainian]. LIGA.net. [electronic resource]. Retrieved from: https://life.liga.net/poyasnennya/article/pochemu-kreml-nepravilno-prochital-ukrainu-i-pri-chem-zdes-pchely-obyasnyaet-sotsiolog.

Received 18.11.2022

Health beyond clinical protocol: institutional traps and limitations of modern medicine

stmm. 2023 (3): 90-115

DOI https://doi.org/10.15407/sociology2023.03.090

Full text: http://stmm.in.ua/archive/ukr/2023-3/8.pdf

SIARHEI KANDRYCHYN, PhD in Sociology, autonomous scholar, Graduate School for Social Research, Polish Academy of Sciences (72, Nowy Świat St., Warsaw, 00-330)

kandrych02@yahoo.com

https://orcid.org/0000-0001-8509-2554

The article is aimed to describe the ineffective health care mechanisms and find ways to overcome them. Some variants of institutional dysfunctions (or institutional traps) in medical practice are considered. The resort to natural methods of healing and self-healing is regarded as a way to overcome various institutional dysfunctions. The work combines several qualitative methods: a non-standardized survey of experts (doctors), included observation (25 years of work as a doctor and independent use of natural healing methods for the past 12 years), and analysis of documents, literary sources and messages on the topic of self-healing in relevant Facebook groups. The themes of the talks with doctors were health self- management and alternative healing practices (intensive physical exercises, medical fasting, and breathing exercises). During conversations with the doctors found that only some senior doctors have positive experience of using therapeutic fasting and breathing exercises (both personal and clinical), and young doctors who have been working in medicine for over 10-20 years are not familiar with these methods ("because this treatment is not carried out according to the approved clinical protocols”, and “we treat according to modern protocols"). The most problematic points of the use of such health practices and the reasons for their increase in society are discussed. It is concluded that both in the institutional and ideological aspect, the essential component of the public health institute should be outside the scope of official medicine, which is aimed at the use of medicinal and high-tech means of treatment and prevention.

Keywords: modern medicine, institutional traps, self-healing, therapeutic fasting, respiratory gymnastics

References

Amosov, N.M. (1987). Thought About Health. [In Russian]. Moscow: Physical Culture and Sports.

Arney, W., Bergen, B. (1984). Medicine and the Management of Living. Chicago: Chicago University Press.

Arthur, W.B. (1988). Self-reinforcing mechanisms in economics. In: K. Arrow, P. Anderson (Eds.), The Economy as an Evolving Complex System (pp. 9-31). New York: Addison-Wesley. https://doi.org/10.1201/9780429492846-2

Brainerd, E., Cutler, D. (2005). Autopsy on an Empire: Understanding Mortality in Russia and the Former Soviet Union. Journal of Economic Perspectives, 19, 107-130. https://doi.org/10.1257/0895330053147921

Dzau, V.J., Antman, E.M., Black, H.R. et al. (2006). The cardiovascular disease continuum validated: clinical evidence of improved patient outcome. Part II: Clinical trial evidence (acute coronary syndromes through renal disease) and future directions. Circulation, 114, 2871-2891. https://doi.org/10.1161/CIRCULATIONAHA.106.655761

Ealey, K.N., Phillips, J., Sung, H.K. (2021). COVID-19 and obesity: fighting two pandemics with intermittent fasting. Trends in Endocrinology and Metabolism, 32(9), 706-720. https://doi.org/10.1016/j.tem.2021.06.004

Eyre, H., Kahn, R., Robertson, R.M. (2004). Preventing Cancer, Cardiovascular Disease, and Diabetes. A common agenda for the American Cancer Society, the American Diabetes Association, and the American Heart Association. Diabetes Care, 27, 1812-1824. https://doi.org/10.2337/diacare.27.7.1812

Fisher, D.B. (1996). Self-Managed Care: The most cost effective managed care. National Empowerment Center Newsletter, Spring. Retrieved from: http://www. power2u.org/articles/managed/managed_care.html

Foucault, M. (1973). The Birth of the Clinic. New York: Pantheon Books.

Grady, P.A., Gough, L.L. (2014). Self-management: A comprehensive approach to management of chronic conditions. American Journal of Public Health, 104, e25-e31. https://doi.org/10.2105/AJPH.2014.302041

Hannan, M.A., Rahman, M.A., Rahman, M.S. et al. (2020). Intermittent fasting, a possible priming tool for host defense against SARS-CoV-2 infection: Crosstalk among calorie restriction, autophagy and immune response. Immunology Letters, 226, 38-45. https://doi.org/10.1016/j.imlet.2020.07.001

Kandrychyn, S.V. (2015). Quantity of scientific publication on therapeutic fasting in historical perspective: A global survey. [In Belarussian]. Military medicine, 1, 107-110.

Kessler, D.P., McClellan, M.B. (1996). Do Doctors Practice Defense Medicine? Quarterly Journal of Economics, 111(2), 353-390. https://doi.org/10.2307/2946682

Kessler, D.P., McClellan, M.B. (2002). How liability law affects medical productivity. Journal of Health Economics, 21(6), 931-955. https://doi.org/10.1016/S0167-6296(02)00076-0

Libanova, Е.М. (Ed.). (2007). Mortality of Workable Population in Ukraine. [In Ukrainian]. Kyiv: Institute of Demography and Social Studies, NAS of Ukraine.

Mesle, F., Shkolnikov, V.M., Hertrich, V., Vallin, J. (1996). Tendences recentes de la mortalite par cause en Russie 1965-1994. Serie: Donйes Statistiques, 2, INED, Paris.

Mikheenko, O.I. (2017). Personal responsibility for own health as a strategic principle of health practice. [In Ukrainian]. In: Yu.D. Boychuk (Еd.), General theory of health and healthcare: a collective monograph (pp. 238-244.). Kharkiv: Publisher Rozhko S.G.

North, D. (1990). Institutions, Institutional Change and Economic Performance. Cambridge: Cambridge University Press. https://doi.org/10.1017/CBO9780511808678

Pakholok, O. (2012). Transformation of culture of health in civilization process. [In Ukrainian]. Sociology: Theory, Methods, Marketing, 1, 115-132.

Pavlenko, S.М. (1967). The doctrine of sanogenesis - the most important issue of Medicine. [In Russian]. Pathological Physiology and Experimental Therapy, 7, 11(3), 91-95.

Polterovich, V. (2007). Institutional Trap. New Palgrave Dictionary of Economics. Retrieved from: https://ssrn.com/abstract=1751839 https://doi.org/10.1057/978-1-349-95121-5_2717-1

Raposo, V.L. (2019). Defensive Medicine and the Imposition of a More Demanding Standard of Care. Journal of Legal Medicine, 39(4), 401-416. https://doi.org/10.1080/01947648.2019.1677273

Ray, W.A., Chung, C.P., Stein, C.M. et al. (2021). Association of Rivaroxaban vs Apixaban with major ischemic or hemorrhagic events in patients with atrial fibrillation. JAMA, 326(23), 2395-2404. https://doi.org/10.1001/jama.2021.21222

Romanova, A.P., Krasko, O.V. (2018). The influence of change in age structure on gender-specific mortality rate differences in the context of the demographic transition. [In Russian]. Meditsinskie novosti, 10, 52-60.

Shapiro, R.S., Simpson, D.E., Lawrence, S.L. et al. (1989). A survey of sued and nonsued physicians and suing patients. Archives of Internal Medicine, 149(10), 2190-2196. https://doi.org/10.1001/archinte.1989.00390100028008

Summerton, N. (1995). Positive and negative factors in defensive medicine: a questionnaire study of general practitioners. BMJ, 310(6971), 27-29. https://doi.org/10.1136/bmj.310.6971.27

Tancredi, L.R., Barondess, J.A. (1978). The problem of defensive medicine. Science, 200(4344), 879-882. https://doi.org/10.1126/science.644329

Vynnytskyi, M. (2022). Why the Kremlin read Ukraine incorrectly and and where does the bees: sociologist explains. [In Ukrainian]. LIGA.net. [electronic resource]. Retrieved from: https://life.liga.net/poyasnennya/article/pochemu-kreml-nepravilno-prochital-ukrainu-i-pri-chem-zdes-pchely-obyasnyaet-sotsiolog.

Received 18.11.2022

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