David Caraway

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There is a bias in this country against people whose medical condition is perceived to be “their fault”– in other words, the result of their own lifestyle choices. The thinking goes that these people not only harm themselves, but they create a burden for the healthcare system, the costs of which we all must bear.

As a result, there is a stigma attached to certain conditions that are associated with poor lifestyle choices. While not everyone attaches a stigma to these conditions, it is an attitude that can be common among co-workers, friends, relatives, and even physicians of those who have these conditions. This attitude can result in diminished quality of care that can increase costs. 

Some of the conditions most likely to be associated with stigma include: Lung cancer and emphysema, which are often linked to smoking; diabetes, especially Type 2 diabetes, which can be associated with poor eating or exercising habits; andpain, especially those who take opioids. That is, when someone who smokes gets lung cancer, when someone who “eats too much” gets diabetes, or when someone who regularly seeks treatment for pain becomes addicted to pain killers, there is a tendency to think that these people brought these health problems on themselves. 

Of course, it’s true that lifestyle choices can make a difference to our health. But it is unfair, even biased, to make value judgments about people who have conditions that may be affected by lifestyle choices. For one reason, lifestyle choices are not always the factor or even a factor in why patients have associated conditions. Smoking is a common cause of lung cancer, but there are other causes. The same is true with diabetes–environmental factors and genetic disposition are causes for both Type 1 and Type2 diabetes, which are very different conditions but are associated with the same types of complications. 

Some people hope that people with certain conditions can be “shamed” into making better lifestyle choices that will improve their health. Unfortunately, the reality is that shaming can make things worse–that has been proven to be the case by research on “fat shaming.” The more people are exposed to weight bias and discrimination, the more likely they are to gain weight; in fact, fat shaming is also linked to depression, anxiety, low self-esteem, eating disorders and exercise avoidance.

Even if patients are coerced by social pressure into making better lifestyle choices, these choices may notbe enough to reverse their condition. For example, people with Type 2 diabetes can have complications even though their diabetes is relatively well-controlled; in fact, there are no cures for diabetic neuropathy since nerve damage is irreversible. Rather, blaming patients for their own conditions can have harmful effects by adding stress and shame to patients’ lives and creating obstacles to them getting effective treatment. 

To combat stigma and its harmful effects, there needs to be broader understanding, even among medical professionals, that:

Lung cancer, diabetes, and pain–whatever their cause–are conditions that cause real suffering and pose real limits on the lives and livelihoods of those who live with them.

There are often non-lifestyle factors that contribution to these conditions, including genetic disposition and environment.

People with these conditions need–and deserve–effective treatments.

Consider patients with painful diabetic neuropathy (PDN): they may face stigma due to both their diabetes and their pain, which causes suffering and debilitation. Unfortunately, conventional medical management is often ineffective for these patients and/or can be accompanied by debilitating side effects. That’s why effective non-drug alternatives, such as HFX™ for PDN, or high frequency spinal cord stimulation, are important. HFX™ is a comprehensive solution that includes a Senza spinal cord stimulation system and support services for the treatment of chronic pain.

Besides having been shown to be effective and durable in treating painful diabetic neuropathy for patients who do not get sufficient relief from conventional medical management, high frequency spinal cord stimulation has other benefits as well. 

These patient benefits include improved sensory function and other neurological benefits, less sleep disturbance due to pain, and no uncomfortable burning or prickling sensation called paresthesia. This type of therapy not only is clinically effective, but it is cost effective, too. 

Research shows that the first six months of high frequency spinal cord stimulation appears to result in a reduction of hospitalization rates and length of stay, the largest health-related cost drivers, in patients with painful diabetic neuropathy. 

Denying or limiting treatment based on bias and false assumptions hurts patients, payers and the overall health system. We need to better embrace the idea that all patients who suffer from life-limiting conditions need and deserve effective treatment.

David Caraway, M.D., Ph.D., is Chief Medical Officer of Nevro.

Articles

There is a bias in this country against people whose medical condition is perceived to be “their fault”– in other words, the result of their own lifestyle choices. To combat stigma and its harmful effects, there needs to be broader understanding, even among medical professionals.

David Caraway

Articles

Dismantling Stigmas: How to Stop the Blame Game and Get Patients the Care they Need