[e-drug] Disease mongering

["E-Drug" <e-drug@healthnet.org>]

E-DRUG: Disease mongering
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[The concept of "disease mongering" - perhaps best described as "corporate definitions of diseases with a primary interest in making profits rather than a concern for the public health" is, naturally, a hotly contested one. The BBC news item below  - here as "fair use" - shows the ABPI reaction. Finally, the UK Guardian newspaper on "disease mongering". Copied as "fair use". Crossposted with thanks from Druginfo. WB]


To coincide with the inaugural Conference on Disease-Mongering, being held in Newcastle New South Wales, Australia from 11-13 April  2006 (see http://www.diseasemongering.org/), PLoS Medicine has published a series of articles, policy fora and correspondence (see http://collections.plos.org/diseasemongering-2006.php)

The entire collection can be downloaded at http://collections.plos.org/pdf/plme-03-04-diseasemongering.pdf (warning - 21.5MB).

The papers are as follows:

* The Fight against Disease Mongering: Generating Knowledge for Action by Ray Moynihan, David Henry  - http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0030191

Bigger and Better: How Pfizer Redefined Erectile Dysfunction by Joel Lexchin - http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0030132

Medicine Goes to School: Teachers as Sickness Brokers for ADHD by Christine B. Phillips - http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0030182

Female Sexual Dysfunction: A Case Study of Disease Mongering and Activist Resistance by Leonore Tiefer - http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0030178

The Latest Mania: Selling Bipolar Disorder by David Healy - http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0030185

Pharmaceutical Marketing and the Invention of the Medical Consumer by Kalman Applbaum - http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0030189

Combating Disease Mongering: Daunting but Nonetheless Essential by Iona Heath - http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0030146

Giving Legs to Restless Legs: A Case Study of How the Media Helps Make People Sick by Steven Woloshin, Lisa M. Schwartz - http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0030170

Cholinesterase Inhibitors: Drugs Looking for a Disease? by Marina Maggini, Nicola Vanacore, Roberto Raschetti - http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0030140

Disease Mongering in Drug Promotion: Do Governments Have a Regulatory Role? by Barbara Mintzes - http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0030198

Awareness and Attitudes about Disease Mongering among Medical and Pharmaceutical Students by C. Jairaj Kumar, Abhizith Deoker, Ashwini Kumar, et al. - http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0030213

The paper by Tiefer lists these major disease-mongering tactics (as identifi ed by Lynn Payer - see Payer L (1992) Disease-mongers: How doctors, drug companies, and insurers are making you feel sick. New York: Wiley & Sons. 292 p.):

1. "Taking a normal function andimplying that there's something wrong with it and it should be treated"
2. "Imputing suffering that isn't necessarily there"
3. "Defining as large a proportion of the population as possible as suffering from the 'disease'"
4. "Defining a [condition] as a deficiency disease or disease of hormonal imbalance" 
5. "Getting the right spin doctors" 
6. "Framing the issues in a particular way" 
7. "Selective use of statistics to exaggerate the benefits of treatment"
8. "Using the wrong end point" 
9. "Promoting technology as risk-free magic" 
10. "Taking a common symptom that could mean anything and making it sound as if it is a sign of a serious disease" 

Mintzes' paper lists these forms of disease mongering:
* Promotion of anxiety about future illhealth in healthy individuals
* Infl ated disease prevalence rates
* Promotion of aggressive drug treatment of milder symptoms and diseases
* Introduction of questionable new diagnoses*such as PMDD or social anxiety disorder*that are hard to distinguish from normal life
* Redefinition of diseases in terms of surrogate outcomes (i.e., osteoporosis becomes a disease of low bone density rather than fragility fractures)
* Promotion of drugs as a first-line solution for problems previously not considered medical, such as disruptive classroom behaviour or problematic sexual relationships.

regards
Andy

~~~
http://news.bbc.co.uk/1/hi/health/4898488.stm
Drug firms 'inventing diseases'  
 
Disease-mongering is putting people at risk, researchers say Pharmaceutical firms are inventing diseases to sell more drugs, researchers have warned. 
Disease-mongering promotes non-existent diseases and exaggerates mild problems to boost profits, the Public Library of Science Medicine reported. 

Researchers at Newcastle University in Australia said firms were putting healthy people at risk by medicalising conditions such as menopause. 

But the pharmaceutical industry denied it invented diseases. 

~~
DISEASE-MONGERING
Restless legs - Prevalence of rare condition exaggerated Irritable bowel syndrome - Promoted as a serious illness needing therapy, when usually a mild problem Menopause - Too often medicalised as a disorder when really a normal part of life ~~ Report authors David Henry and Ray Moynihan criticised attempts to convince the public in the US that 43% of women live with sexual dysfunction. 

They also said that risk factors like high cholesterol and osteoporosis were being presented as diseases - and rare conditions such as restless leg condition and mild problems of irritable bowel syndrome were exaggerated. 

The report said: "Disease-mongering is the selling of sickness that widens the boundaries of illness and grows the markets for those who sell and deliver treatments. 

Campaigns 

"It is exemplified mostly explicitly by many pharmaceutical industry-funded disease awareness campaigns - more often designed to sell drugs than to illuminate or to inform or educate about the prevention of illness or the maintenance of health." 

The researchers called on doctors, patients and support groups to be aware of the marketing tactics of the pharmaceutical industry and for more research into the way in which conditions are presented. 

They added: "The motives of health professionals and health advocacy groups may well be the welfare of patients, rather than any direct self-interested financial benefit, but we believe that too often marketers are able to crudely manipulate those motivations. 

"Disentangling the different motivations of the different actors in disease-mongering will be a key step towards a better understanding of this phenomenon." 

But Richard Ley, of the Association of the British Pharmaceutical Industry, said the research was centred on the US where the drugs industry had much more freedom to promote their products to the public. 

"The way you can advertise is much more restricted in the UK so it is wrong to extrapolate it. 

"Also, it is not right to say the industry invents diseases, we don't. It is up to doctors to decide what treatment to give people, we can't tell them." 
 

----

http://society.guardian.co.uk/health/news/0,,1751361,00.html
Drug firms accused of turning healthy people into patients * Companies exaggerating ailments, reports claim * Emphasis on minor illnesses 'may affect NHS' 
Ian Sample, science correspondent
Tuesday April 11, 2006
The Guardian 

You are lying on the sofa after a hard day at work and should be relaxing. But you are overcome by an insatiable urge to kick your legs about. As you struggle to control yourself, your kids run riot in the room. And to cap it all, your sex life is rubbish.

Just an everyday scene in many people's ordinary lives, or the combination of three newly identified medical conditions that can be treated at the pop of a pill?

The latter, according to some of the world's biggest, most profitable pharmaceutical companies, which have come up with a range of new drugs to treat "restless legs syndrome", attention deficit hyperactivity disorder in children, and female sexual dysfunction. But according to reports published today, the truth is more complicated. Healthy people are being turned into patients by drug firms which publicise mental and sexual problems and promote little-known conditions only then to reveal the medicines they say will treat them.

The studies, published in a respected medical journal, accuse the pharmaceutical industry of "disease mongering" - a practice in which the market for a drug is inflated by convincing people they are sick and in need of medical treatment.

The "corporate-sponsored creation of disease" wastes resources and may even harm people because of the medication they turn to, the researchers add.

In 11 papers in the journal Public Library of Science Medicine, experts from Britain, the US and elsewhere argue that new diseases are being defined by specialists who are often funded by the drug industry.

According to the researchers, the campaigns boost drug sales by medicalising aspects of normal life such as sexuality, portray mild problems such as irritability in children as serious illnesses and suggest that rare health conditions, such as the urge to move ones' legs, are common.

"Disease mongering exploits the deepest atavistic fears of suffering and death," said Iona Heath, a general practitioner at the Caversham Practice in London who contributed to the journal. She added: "It is in the interests of pharmaceutical companies to extend the range of the abnormal so that the market for treatments is proportionately enlarged."

In the journal's editorial, guest editors Ray Moynihan and David Henry write: "Informal alliances of pharmaceutical corporations, public relations firms, doctors' groups and patient advocates promote these ideas to the public and policy makers, often using mass media to push a certain view of a particular health problem."

In one of the reports, Dr Joel Lexchin, a drug safety expert at York University in Toronto, alleges that Pfizer, the maker of Viagra, devised ways to "ensure that the drug was seen as a legitimate therapy for almost any man", and "took steps to make sure Viagra was not relegated to a niche role of just treating men with [erectile dysfunction] due to organic causes, such as diabetes or prostate surgery".

The message from adverts and Pfizer's website, "is that everyone, whatever their age, at one time or another, can use a little enhancement," he claims.

In a statement, Pfizer said it "only promotes prescription medicines to healthcare professionals and only in line with its licensed indications. Pfizer does not promote any of its prescription medicines to the general public and does not recommend, or promote the use of Viagra, outside of its licensed indications."

It added: "Viagra has been available in the UK for over seven years and is an important treatment for erectile dysfunction. All promotion of Viagra is aimed at educating health professionals on this serious condition, to enable them to effectively treat patients with this condition."

According to Leonore Tiefer, clinical professor of psychiatry at New York University, a textbook case of disease mongering is the creation and promotion of "female sexual dysfunction". The campaign by a number of drug companies has been especially successful in the US, he notes, where there has been a heavily contested attempt to convince the public that 43% of women live with the condition.

In another paper, David Healy, director of the department of psychosocial medicine at the University of Wales, Bangor, describes how a TV advertisement from Lilly Pharmaceuticals encouraged people to find out about mood disorders via a website sponsored by the company. "This advert markets bipolar disorder," he writes in the journal.

Dr Graham Archard, vice-chair of the Royal College of General Practitioners, said it was inevitable that drug companies benefited from such campaigns.

"If a company produces a product, they are going to want to market it in the best way they can and if they can increase public awareness of a condition that may or may not exist, then a person may well believe they have that condition and look for treatment," he said. "There's a limited amount of cash in the NHS and if people are spending limited resources on areas that aren't terribly important, that will detract from areas of greater importance. Potentially we could all be losers."

Lilly Pharmaceuticals said: "Bipolar disorder is one of the most debilitating and serious psychiatric illnesses there is. Appropriate treatment should be decided after the treating clinician has fully evaluated the person's condition and discussed the full range of treatment options. The advertisement that Dr Healy refers to was not designed for and was not shown to the general public in the UK. Olanzapine (Zyprexa) is not approved for use in children. Lilly does not market it for use in children."

GlaxoSmithKline said: "It's estimated that 10-15% of adults suffer from restless legs syndrome, yet it is a very underdiagnosed medical condition, which even when diagnosed, often leaves people without effective treatment. About 3% of adults experience moderate to severely distressing RLS symptoms at least two to three times a week and are likely to benefit from treatment."

Modern maladies

Erectile dysfunction
Pfizer asserts that more than half of all men over 40 have difficulties getting or maintaining an erection, a figure contested by many studies.

Attention deficit hyperactivity disorder (ADHD) Prescriptions for ADHD drugs escalated during the 1990s following the organised penetration of the education system by the pharmaceutical industry. Teachers may be most likely to report signs of behavioural disorders.

Female sexual dysfunction (FSD)
Publicised as the female equivalent of erectile dysfunction, FSD has been plagued by vague definition. In the British Medical Journal, John Bancroft, director of the prestigious Kinsey Institute, called it "preconceived" and "non-evidence based".

Bipolar disorder
Selling bipolar disorder has become "the latest mania" according to David Healy at Bangor University in Wales. Awareness campaigns have encouraged people to "mood watch".

Restless legs syndrome
A campaign launched by GlaxoSmithKline in 2003 raised RLS as a "common yet unrecognised disorder". In 2005, the company was granted approval to use its drug, Ropinirole, to treat the condition.