[DEBATE] : Disease mongering
kerry at health-e.org.za
Thu Apr 13 08:00:27 BST 2006
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
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
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
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
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
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.
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