So you run a family pizza joint in Podunk and as an astute small business man you know that to increase your income you must either sell more pizzas to your existing clientele (by, for example, creating “new” pizzas, modifying existing recipes – add pineapple!) or you must convince others that they will be happier and live more fulfilling lives if they become customers and buy your fabulous pizza.
Big Pharma operates in a similar paradigm.
It can make lots of money if it (a) develops a drug for a small number of critically ill folks, like cancer patients, and sells it at an exorbitant price or (b) sells a cheaper drug to lots of not critically ill folks, convincing them that they will live happier, more fulfilling lives if they buy and use it. Profits can be even greater if the drug already exists and can be modified slightly to treat a condition for which it was not originally intended.
Enter malady or disease mongering.
It is impossible not to notice the raft of drug company advertisements on television. They are especially prevalent during the 6:30 national news broadcasts each evening. Lately they have been pushing several new “diseases” for which there is now – voila! – a treatment!
I feel so much better already! It should be noted here that only the United States and New Zealand permit drug companies to advertise directly to consumers. “Talk to your doctor and ask about the latest treatment for RLS!” That’s “restless leg syndrome” for the uninitiated.
“Pharmaceutical companies regularly pathologize everyday experiences, convince doctors that they are serious problems, tell a hypochondriacal public it needs help and offers the cure: a new drug. Against the onslaught of billions of dollars in marketing campaigns each year, however, researchers’ warnings about these tactics have gone largely unheeded.”
The pharmaceutical industry “medicalizes” normal life by making a vague, highly relatable, everyday condition symptomatic of a newly invented disease. In other cases, pharma exaggerates the prevalence or severity of an existing condition to entice more customers.
“Marketing for a drug can start seven to 10 years before they go on the market. Because it’s illegal to promote a drug before it goes on the market, what they’re promoting is the disease. That’s not illegal to do because there’s no regulation on creating diseases.”
Disease-awareness campaigns may seem educational but are often just marketing in disguise. The campaigns often follow three basic steps: lower the bar for diagnosis, raise the stakes so people want to get tested and spin the evidence about a drug’s benefits and risks. These steps were seen in campaigns on testosterone deficiency, bipolar disorder and restless leg syndrome.
Low testosterone was among the biggest cases of disease mongering — a huge increase in prescribing a drug before the benefits and harms of treatment were established.
Manufacturers claimed ‘low T’ — not aging or other medical conditions — was the reason why older men might have less energy, worse sports performance or even feeling more tired after dinner than younger men. There are no specific rules about how companies can talk about symptoms in awareness campaigns.
Health conditions occupy a spectrum from clearly sick to clearly well, but there’s a large gray area in-between. When does a mildly bothersome experience become the symptom of a disease? In many casees the pharmaceutical industry draws these lines aggressively so the boundaries of normal get smaller and smaller. And they do so unilaterally — no regulators are watching.
Not too long ago a blood pressure reading of 140/80 was considered normal. Now it is called “Pre-hypertensive” and the patient is treated with medication as if he had high blood pressure. Rarely is the patient told that diuretics and Beta blockers may cause E.D. as a side affect.
“Everyone’s legs feel restless now and then, or they feel occasional stinging or burning sensations in their eyes. But far less people have symptoms severe enough to need medical treatment. The problem is that manufacturers increasingly target people with mild symptoms in order to turn them into patients. ”
The low T campaign was essentially a template for how diseases are sold. Are you a middle-aged man who sometimes feels tired? Has your athletic ability declined at all since your early 20s? Well, that used to be called aging. But these un-validated online quizzes might suggest you suffer from low T. Lucky for you, Abbott Laboratories manufactures Androgel.
“Do you ever find things funny that other people don’t find funny?” and “Do you cry easily?” The question is part of a recent “quiz” from a drug company in a TV ad I recently viewed. Virtually all women and most men would answer yes.
You may have PBA! A treatable condition!
The test on pseudobulbar affect (PBA), which manifests itself when specific brain damage leads to laughing or crying that is inappropriate and unconnected to a person’s emotions, suggested that normal human expressions could be signs of PBA.
“The trouble is that people are very reluctant to believe that things that sound so scientific and medical and are promoted so aggressively by scientific and medical experts could be mythical or at the very best exaggerated,”
Gastroesophageal reflux disease (GERD) is essentially what used to be called heartburn. Doctors used to tell patients to eat less, drink less alcohol, not go to sleep on a full stomach and take Tums as needed. But the problem with heartburn is that customers would only need a drug when they are experiencing it.
“What’s really brilliant about having people take it chronically is when they stop they get a high acid rebound syndrome that will cause them to be in pain. They think, ‘Oh I really need this drug,’ and go back on it.”
The 1998 approval of Viagra for “erectile dysfunction” — formerly known as impotence — created a “sea change” in the field of urology and sexual function. People immediately started asking about Viagra for women.
The only way to redefine “what a woman wants” — and build a case for a drug to “treat” it — was to turn “it” into a medical condition. Without widespread agreement on its definition or clinical manifestations, Female Sexual Dysfunction (FSD) was created. It is a textbook case of disease mongering by the pharmaceutical industry.
No other medical specialty has turned more aspects of human life into diagnoses than psychiatry. Not coincidentally, no other medical specialty shares a cozier relationship with the pharmaceutical industry.
“Dr. Marcia Angell, the editor of the New England Journal of Medicine for more than 20 years, in a two-part 2011 essay in the New York Review of Books singled out psychiatry for its “subjective and expandable” diagnostic categories. She noted that in the fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-V), to be published in 2013, “diagnostic boundaries will be broadened to include even precursors of disorders, such as ‘psychosis risk syndrome’ and ‘mild cognitive impairment’ (possibly early Alzheimer’s disease).”
As Angell said, “It looks as though it will be harder and harder to be normal.”
Entirely new diseases can be, and have been, invented to extend a manufacturer’s patent on a highly profitable drug. Eli Lilly stood to lose a lot of profits once the patent expired on its hugely popular antidepressant Prozac. “So they positioned this new condition, PMDD (Pre-Menstrual Dysphoric Disorder), and then went to physicians and the FDA with their highly paid experts who said PMDD is a tragic disease, and they got approved for Sarafem, the same drug. It’s an on-label use for a repackaged drug; they created the disease and then got a drug re-approved that was going off patent.”
A number of drugs used to treat Parkinson’s are now approved to treat Restless Leg Syndrome. Is shyness a social anxiety disorder? If you’re shy then Paxil is for you!
Recently I have been bombarded with ads for a new condition which needs drug treatment – hyperhidrosis. Excessive sweat. For decades there have been anti-perspirants on the market which will turn your pits into the Sahara for days. But now there may be a “treatment!”
Over 15 million people suffer from hyperhidrosis, a real medical condition. And many don’t know it.
You can read about it and take the quiz to see if you have the “condition” here:
And of course opioids are a cure for just about anything.