Disease Mongering: The ''Selling'' of Ailments

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A couple of years ago, a cousin of mine who is an internal medicine resident at Northwestern Healthcare in the Chicago area invited me to what she billed as a ''drug rep dinner.'' These gatherings of medical professionals hosted by drug representatives and paid for by the pharmaceutical industry are designed with one primary goal in mind: to convince physicians to prescribe patients the medication sold by the pharmaceutical company hosting the dinner. The drug companies rent out entire rooms in upscale restaurants to inform doctors, interns, and even medical students about why their drugs are the best. In exchange for their willingness to sit through a presentation about the pros and cons of the given drug, medical professionals enjoy a trendy, free meal and drinks, the effects of which the drug reps hope will not be forgotten when the doctors' see their next patients. It's not unethical, at least technically, and no decent doctor would allow such an event to inform his or her medical decisions, but it did make me wonder about the quid pro quos of the business end of the medical field . . .

The dinner I was invited to happened to be for a new drug used to treat C.O.P.D. (chronic obstructive pulmonary disease), which, while quite pervasive at its current occurrence in nearly 12 million Americans, I’m sorry to report makes for lousy dinner conversation.

But one thing did leave an impression upon me. Many times throughout his presentation, the doctor spouting the various benefits of this particular drug emphasized how C.O.P.D. was actually being underdiagnosed and physicians needed to identify it correctly to ensure that millions of people living with diminished lung capacity knew it. Eyebrows arched, I turned to my cousin, who whispered back, ''Diseasemonger!''

As it turns out, ''disease mongering'' is not an uncommon problem, especially in the pharmaceutical industry. Most medical professionals view disease mongering as the intentional selling of sickness by those who sell and develop treatments with the ultimate goal of driving up their revenues — regardless of whether treatment or even diagnosis is warranted.

Recent years have witnessed a disturbing trend by pharmaceutical companies to sell illnesses to a fearful public only too willing to self-diagnose and identify afflictions where none exist. Bipolar disease, ADHD, social anxiety disorder, and manic depressiveness are all recent examples of illnesses which have suddenly leapt to the forefront of the national consciousness, not because more people were being diagnosed as such by their physicians, but because the drug industry was carefully orchestrating a massive marketing campaign which led many people to believe that they suffered from these diseases.

But be aware that this was more than simply overzealous marketing. Overblowing isolated symptoms into full-fledged diseases is no small offense: in the wake of the success of Viagra, some drug companies are now (in tandem with a compliant media) trying to convince American women that nearly half of them are suffering from sexual dysfunction — despite the fact that no science exists which supports such a claim. The general level of scientific ignorance in the public at large certainly plays a significant hand in all of this, but there is a much larger network of culprits involved.

As Ray Moynihan and David Henry wrote in the April 2006 issue of PLoS Medicine, ''Drug companies are by no means the only players in this drama. Through the work of investigative journalists, we have learned how informal alliances of pharmaceutical corporations, public relations companies, doctors’ groups, and patient advocates promote these ideas to the public and policymakers — often using mass media to push a certain view of a particular health problem.''

It’s happened before and will certainly happen again, usually according to the following outline: 1) a new drug is unveiled; 2) the public is suddenly informed about a new medical condition being far more prevalent than was previously understood (say, restless legs syndrome); and 3) the media, driven by public interest, inflates curiosity into absolute reality for millions of healthy individuals. A couple of Oprah or Dr. Phil specials later, and the latest American epidemic has officially arrived, courtesy of the pharmaceutical industry. Ka-ching, ka-ching.

The tragedy of this situation hits on many fronts, but none more so than the fact that it distracts from those diseases which are truly underdiagnosed or misunderstood and for which no available treatment exists (and hence no organized movement to profit from its diagnosis). Case in point: autism. This developmental disorder affecting millions of children has no known cure — indeed, its causes continue to be shrouded in mystery despite decades of research. Many parents have complained of pediatricians simply dismissing signs of autism as developmental ''delays,'' but in many cases doctors cannot be held accountable because they themselves have very little understanding of the condition.

Because of this, several movements have been begun by parents and caretakers of children with autism, including Autistic Pride Day (June 18) and the UK’s Autism Awareness Year. Many professionals within the medical community believe that the reclaiming of health initiatives by individuals and a greater desire to understand the science behind medicine and medications are the most important tools the public can wield against the giant marketing campaigns trying to drive them to the pharmacy.

That being said, the pharmaceutical industry is not in the business of educating consumers about largely untreatable conditions like autism — it is, after all, a business and, like all businesses, is driven by the need to maintain profit. But creating a need where none exists while ignoring those needs which are plainly extreme is certainly one business practice that the public could easily do without.
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