Ethical issues in moral and social enhancement

 
5.2.4. Efficacy and the sociological view of medicalization 
The bad name of medicalization is partly rooted in instances when medicalization 
proceeded despite little evidence for its benefits. For example, there has been a 
growing concern that the medicalization of birth may be going too far (Johanson et 
al. 2002). While WHO guidelines prescribe that maximum rates of caesarean 
sections associated with good maternity care should not exceed 15 per cent of all 
births, almost every developed country exceeds this threshold (Walker et al. 2002). 
Maternity care routinely offered in western countries seems to have reached the 
‘perinatal paradox: doing more and accomplishing less’ (Rosenblatt, 1989) 
For sociologists, the discussion about efficacy of medical treatments may be less 
compelling, or at least marginally relevant to their pursuits. Conrad claims that: 
‘Although medical interventions are judged by how 
efficacious 
they 
are, 
the 
social 
consequences 
of 
medicalization occur regardless of medical efficacy. They 
are independent from the validity of medical definitions or 
diagnoses or the effectiveness of medical regimes.’ (1992, p. 
223)
Conrad thus distinguishes between social effects and medical effects, but attends 
only to the former.
Although such a distinction may serve a purpose – by ensuring, for example, that 
one’s investigation remains within one’s scope of expertise – normative judgements 
should derive from the integration of all relevant evidence and perspectives. 
Therefore, while sociological critiques of medicalization provide a relevant 
perspective which is particularly useful in identifying social consequences, it is 
important not to abandon concern about the comparative efficacy of particular 
medical interventions and various solutions to the same problem. Efficacy should 

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be established by comparing a given medical intervention to both medical and non-
medical solutions.
14
There is some tendency to discuss therapies as if they existed 
in ‘the ideal state’, without equally careful attention given to the side effects and 
costs.
15
For example, when SSRIs and other ‘new’ antidepressants enjoyed their 
hey-day, media reports emphasised the prospect of addressing depression with less 
severity of side-effect 
compared to the previously available medication
. Patients 
may discontinue medication due to various – as yet poorly researched – side effects, 
which they may not have been exposed to if they had undergone an initial course of 
psychotherapy. Thus, perhaps we should aim at knowing the ‘net efficacy’ of an 
intervention, established by taking into consideration both the benefits and side-
effects. Moreover, taking into account both medical and non-medical benefits and 
harms is important because we do not want to be ill, and even if medicalization 
comes with some social costs, we may fear medicalization less than we fear 
illness.
16
Efficacy remains an important component of discussions focused on the 
use of medical approaches to problems in life.