Disorders for all
July 21, 2005
Balancing act ... Sydney GP Dr James Best says there is a place for pharmaceutical marketing.
Are drug companies raising unfounded fears about diseases purely for profit? Alex Wilde reports.
Imagine a world in which every health idiosyncrasy is a medical condition requiring medication, where every quirk of the body's biochemistry needs a prescription. Imagine no more, for that world has arrived, according to medical journalist Ray Moynihan.
In his new book Selling Sickness - How drug companies are turning us all into patients, co-authored with Alan Cassels, Moynihan reveals the alarming practice of "disease mongering" by pharmaceutical giants eager to increase their profit margins.
Disease mongering is defined in the literature as widening the boundaries of treatable illness in order to expand markets for those who sell and deliver treatments. Depression, menopause, social anxiety disorder, attention deficit disorder, osteoporosis, high blood pressure, high cholesterol, erectile dysfunction and female sexual dysfunction all come under the authors' scrutiny as being subject to what they call "subterranean marketing strategies".
New "illnesses", Moynihan claims, have found their way into the public vernacular thanks to drug investors trying to blur the boundaries between medical conditions and everyday life. Female sexual dysfunction, or FSD, Moynihan says, is the latest example of corporate-sponsored creation of disease.
"There has been a campaign to medicalise female sexual difficulties," he says. "In the 1990s, among a panel of 19 health professionals in the United States who wrote the definition of FSD, 18 had financial ties to 22 drug companies."
"This is not to deny that some women might have a serious medical condition. But for drug investors to suggest that 43 per cent of the American female population have FSD, as exaggerated by corporate-sponsored scientists in a 1999 paper in the Journal of the American Medical Association is an absurdity," Moynihan says.
So when does health education and awareness-raising cross the line and become disease mongering? Sydney GP Dr James Best, of Inner West General Practice in Leichhardt, agrees that disease mongering is well-known but emphasises that there is a place for pharmaceutical marketing that leads to appropriate medical screening.
"Medicalisation of the population certainly goes on," he says. "This could be productive when screening for hidden depression or the half a million people in Australian with undiagnosed diabetes.
"The problems arise when drug companies try to expand their marketing into areas that would result in inappropriate prescribing." says Best.
In terms of drugs to lower cholesterol, Best says, the pharmaceutical industry tries to promote drugs based on measures of cholesterol instead of what he says is the core issue for doctors - reducing their patients' overall risk of heart disease.
"There are people at a low risk for heart disease who may have elevated cholesterol who really shouldn't be on those drugs, but they often are," he says.
High cholesterol, says Moynihan, is a $25 billion dollar industry in the United States and ever-broadening definitions, he observes, has turned it into a disease in its own right.
"Pharmaceutical-industry-driven fear of heart disease has resulted in nations everywhere spending more on cholesterol-lowering drugs than any other category of prescription medications," Moynihan says.
Best suggests the solution to responsible prescribing lies with doctor education.
"Independent GP education is really the key to limiting the effectiveness of over promotion by pharmaceutical companies. It is up to the prescriber, independent education bodies such as the National Prescribing Service [NPS] and government regulators to make sure quality prescribing happens."
Moynihan warns that drug marketing appears in many forms, and doctor education is rife with marketing propaganda.
"A lot of scientific meetings for doctors appear as if they are educational but in fact they are pharmaceutical marketing. The independently run NPS is a tiny, but important, whisper in the ear of the GP, compared to the marketing roar of the drug industry," he says.
While most of Moynihan's examples come from the US, where, he argues, experts are riddled with conflicts of interest, drug company disease mongering is a global concern, he says, and highly relevant to Australians.
"In Australia, drug companies are not allowed to advertise their drugs as a general rule, but they seem to be able to advertise diseases directly to the public. Erectile dysfunction, for example, is promoted heavily in Australia. There should be at the very least a debate about the pros and cons of that," Moynihan says.
Selling Sickness: How drug companies are turning us all into patients by Ray Moynihan and Alan Cassels, published by Allen and Unwin ($26,95).
The inaugural International Conference on Disease Mongering is to be held in Newcastle, Australia, April 10-12, 2006 at the David Maddison Building, Royal Newcastle Hospital. http://www.mediadoctor.org.au
Thriving Healthy Women Comment:
It’s great to see that someone has put the deceptive marketing techniques of drug companies on the table.
The term and “conditions” ADD and ADHD were decided upon by a show of hands at a psychiatrists convention, in other words they were invented rather than discovered and there are now an estimated 50,000 Australian children on stimulant drugs. If that's the number for Australia think what the number is for America! The amount of money going into the drug companies pockets from all those Ritalin prescriptions defies belief.
Menopause has been turned into one of the most lucrative areas of medicine for the drug companies. For thousands of years women have gone through menopause without any synthetic hormone replacement, they were perhaps using special herbs and plants but that's it. Now we are encouraged to see menopause as a disease rather than a natural and beneficial part of being a woman one which must be aided by synthetic hormones with all the ensuing dollars going to the drug companies.