• I think the most surprising part of the discussion was when Cruikshank highlighted the relationship between the influence of pharmaceutical companies and the over-prescription of drugs.  While I had an idea of the sway these companies had due to their massive wealth, I was not aware of the depth of the corruption in regards to how these pharmaceutical giants incentivize healthcare professionals, medical journalists, and gerontologists to the detriment of the elderly in America.  The book highlights that healthcare professionals are incentivized to use medications without proper testing,  as “doctors conducting drug research…. receive a bounty for getting patients into drug trials (unbeknownst to patients) and those who recruit the highest number get a special reward: they are listed as the authors of the drug studies” (Cruikshank, 2013). As Cruikshank notes, even the medical journals are part of this corruption, as the “New England Journal of Medicine…  apologized for violating its own conflict-of-interest policy by publishing nineteen articles on drugs whose authors had financial ties to drug companies” (Cruikshank). Lastly, the author pointed out that “gerontology has also been compromised because its conferences and publications are subsidized by pharmaceuticals and therefore papers challenging drug industry hegemony will not be found” (Cruikshank). The varying levels of this bribery was profound to read about, and made me further question the validity of the American healthcare system which is so heavily swayed towards profits rather than the well-being of people.

• Aronson’s conversation with Dmitri’s daughter with Irina revealed the importance of physicians taking time to properly assess their client. If Aronson had not probed Svetlana about her fathers’ decline, asking what he had been like at several different points in the past, Aronson would not have been able to ascertain that his symptoms were medication related (Aronson, 2019, p. 51). Her persistence is also demonstrated at an earlier point in the conversation, when she questions Svetlana  further on the wishes her father has for his end-of-life care.  Particularly, instead of just giving up after Svetlana tells her that her father never discussed those matters with her, Aronson tried another method to ascertain what Dmitri might have wanted and, in doing so, showed respect for Dmitri as a person. This also highlights that she sees Dmitri as not just another patient, but as a person who deserves dignity. Without both perseverance and compassion, Aronson might not have been able to help her client. These traits are vital to work with the aging population.

• My take is that Cruikshank was discussing the idea of Alzheimer’s as almost an inevitable part of aging by the public and media. Although “one in ten older Americans suffers from the disease”, Cruikshank discusses that “the media creates the impression that it is far more prevalent… [and creates comparisons that paint those with the disease] as animated corpses…. [and] a terrifying threat to social order” (Cruikshank, 2013). Further, because “it accounts for 60 to 80 percent of all dementia cases”, causes fear in individuals “who have seen the illness in their parents…. And know that there is no anti-Alzheimer’s pill [that] can eradicate the disease” (Cruikshank). This pairing creates both disgust towards those with Alzheimer’s and dread towards the prospect of developing the disease later in life, and both of these feelings are the basis for the general perception of aging in American culture. She argues that this focus on the disease drives the perception of aging. Aronson, however, believes focus on the disease is necessary to change perception about aging  Aronson states that “dementia is the prototype of aging, and also its metaphor… when and how we talk about [Alzheimer’s]… what we do and don’t understand about its impact on lives, and how we have and haven’t dealt with it both societally and medically perfectly exemplifies our attitudes to the larger topic of aging” (Aronson, p. 62). She notes the pervasiveness of scientific discussions about Alzheimer’s, rather than vital knowledge about “how to diagnose or treat patients with that condition…. [or how to educate caregivers in managing] the often socially unacceptable behaviors common in that particular dementia” (Aronson, p. 62). I think we have moved slightly toward Aronson’s point in our society, in that there is better education on the more personal and delicate parts of Alzheimer’s, but I still  think that Cruikshank’s assertion still rings true for modern America. Today, popular American culture still centers on the popularized negative perception of those with dementia rather than their strengths or their needs, and the constant focus on the negative parts of Alzheimer’s related dementia continues to shape society’s view of aging.

• The article I chose, published by Frances Bennett in the British Journal of Clinical Pharmacology, discussed the harm of over-prescription in the 21st century (2020). In Cruikshank’s article, she discussed the growing trend that the elderly are receiving more medications (2013). Similarly, the author noted that “over half of those aged over 65 in the U.K. now take >3 prescribed medicines” (Bennett, 2020, p. 34). He contributed much of this problem to a few factors: “multi-comorbidity increases with age…. patients with multiple morbidities are more likely than ever to be under the care of multiple specialists… perceived patient demand [as] doctors may believe that patient satisfaction depends upon the offer of pharmacological treatment…. [and] public advertising… [by] drug companies” (Bennett, p. 35). Bennett’s point about patient demand expands on the course material’s general idea of the sick role, that, there is an assumption “that an elderly patients needs more drugs because he or she is old”, and that patients themselves might be contributing to this over-prescription due to this internal, disease-connected perception of age (Bennett, 2020, p. 35; Cruikshank).  Furthermore, the article’s last point about public advertising by drug companies is also particularly interesting, as our textbook points out that the “aggressive promotion of drugs is more common than it was a decade ago” (Bennett, p. 35; Cruikshank). Bennett furthers this idea in noting that “Johnson and Johnson was recently ordered to pay $572 million for its role in fueling Oklahoma’s opioid addiction crisis … [as] years of marketing campaigns promoting the benefits… minimized the risks of opioids [and] contributed significantly to doctors over-prescribing the drugs” (p. 35).  One question I had while I was reading that I would like to explore further, mostly because the author noted that in the U.K. “promotion of medicines…is regulated”, is it if overuse of medications is as prevalent in countries where pharmaceutical companies have stricter regulations and less power in the country’s government (Bennett, p. 35)? It would be interesting to see the statistics and compare those to the rates of over-prescription in the United States.

References

Aronson, L. (2019). Elderhood: Redefining Aging, Transforming Medicine, Reimagining Life (1st ed.). Bloomsbury US Trade.

Bennett, F., Ferner, R., & Sofat, R. (2020). Overprescribing and rational therapeutics: Barriers to change and opportunities to improve. British Journal of Clinical Pharmacology, 87(1), 34–38. https://doi.org/10.1111/bcp.14291.

Cruikshank, M. (2013). Learning to Be Old: Gender, Culture, and Aging (3rd ed.). Bloomsbury US Non-Trade.