Panacea!!

The evidence assembled by Moynihan and Henry in their book “Selling Sickness: How the World’s Biggest Pharmaceutical Companies Are Turning Us All Into Patients” is extensive. A good illustration of the general of the general pattern is a confidential plan to market GlalxoSmithKline’s drug Lotronex in Australia by transforming the perception of irritable bowel syndrome. “IBS must be established in doctors’ minds as a significant and discrete disease state,” notes the plan, written by a medical marketing company. Patients “need to be convinced that IBS is a common and recognized medical disorder.” This would be accomplished by moving on several fronts simultaneously, including the creation of a penal of “key opinion leaders” who would advise the corporation on opinions in gastroenterology and “opportunities for shaping it,” drafting “best practice guidelines” for dealing with irritable bowel syndrome, launching a new newsletter to convince the “specialist market” that the condition is a “serious and credible disease,” and running ads targeting general practitioners, pharmacists, nurses, and patients. Another component of the plan is to involve a medical foundation that is described as having a “close relationship” with the plan’s drafters. The plan also calls for a comprehensive media strategy because “PR (Public Relations) and media activities are crucial to a well-rounded campaign – particularly in the area of consumer awareness.” It all came to naught, however. The U.S Food and Drug Administration received reports that Latronex caused serious and even fatal adverse reactions. The big push was abandoned, and the drug is now prescribed only to women with severe symptoms.

This is much bigger than advertising. It is about nothing less than shifting the line between healthy and diseased, both in consumer’s perceptions and in medical practice itself. Steven Woloshin and Lisa Schwartz, doctors and researchers at the Dartmouth Medical School were among the first to analyze this process. In 1999, they published a paper examining proposals by various professional associations to change the thresholds for diagnosis of high blood pressure, diabetes, high cholesterol, and obesity. In every case, the new thresholds made it easier for people to be qualified as having these conditions. They then calculated that if all the new standards were put in place, 87.5 million otherwise health Americans would suddenly be deemed to have at least one chronic conditions – and there-quarters of all Americans would be considered “diseased.”

Erectile dysfunction, female sexual dysfunction, hair loss, osteoporosis, restless leg syndrome, shyness: These are just a few of the conditions whose seriousness and prevalence have been systematically inflated by drug companies seeking bigger markets. Language is one of the most basic means of medicalizing a problem, the critical first step is getting people to ask their doctor for a pill. ……………………….

“The rhetoric surrounding disease mongering suggests that it will promote health,” writes Iona Heath, a British physician, in the ‘Public Library of Science Medicine,’ “but the effect is in fact the opposite. Much disease mongering relies on the pathologizing of normal biological and social variation and on the portrayal of the presence of risk factors for disease as a disease state in itself. When pharmaceuticals are used to treat risk factors, the vicious circle is completed because anyone who takes medicine is by definition a patient.”

There’s no better example of this than the warning about cholesterol on my doctor’s wall. High cholesterol is not a disease, merely a risk factor for cardiovascular disease. There are many such risk factors, including lack of exercise, smoking, an unbalanced diet, high blood pressure, obesity, and diabetes. Most of these can be improved with simple lifestyle changes. Cholesterol, however, can be reduced with pills. And so drug companies singled out cholesterol and promoted it as if it were a disease in itself. In 2003, Pfizer led a major “public awareness” campaign, ostensibly to raise awareness of heart disease and heart attack in France and Canada. The ads were shockingly blunt. On Canadian television, a woman with two young children weeps in a hospital waiting room. A doctor emerges and says her husband is dead. Then time reverses. We see the man wheeled down the hospital hall, in the ambulance, and collapsing at a sunny picnic. It’s high cholesterol, we are told. Even if you seem healthy, it can kill you. Get tested. Then the man and his kids are shown smiling and laughing – their grim fate has been averted.

Responding to the French version of Pfizer’s campaign, Jonathan Quick and colleagues in the Department of Essential Drugs and Medicines Policy of the World Health Organization wrote a stinging letter to the British medical journal ‘The Lancet.’ “Of all the major factors accepted as cardiovascular disease risks, only cholesterol is addressed – the campaign’s stated aim is not pursued. No mention is made of an actual medical product, by the campaign coincided with publication, in ‘The Lancet,’ of (a study) showing reductions in major cardiovascular events after use of atorvastatin.” Atorvastatin is the proper name of Lipitor, Prizer’s lucrative anticholesterol drug. “We believe the campaign could have worried patients, encouraging them to request a prescription for statins.” Quick and his colleagues added that the “information used contained misleading statements and omissions likely to induce medically unjustifiable drug use or to give rise to undue risks.” For that reason, Quick concluded, the ads “did not respect several of WHO’s ethical criteria.” Barbara Mintzes, a professor of health care and epidemiology at the University of British Columbia, was more pointed in an article in the ‘Public Library of Science Medicine’: Pfizer, she wrote, is using the “fear of death” to promote sales.

The subterfuge of public information campaign is necessary in most Western countries because only New Zealand and the United States allow full, direct-to-consumer advertising of pharmaceuticals. But even in the United States, federal regulations require ads to follow public-interest guidelines, and the pharmaceutical industry insists that its advertising simply provides solid information and is therefore in the public interest. Many observers think this is nonsense. Writing in the ‘Annals of Family Medicine,’ Douglas Levy of the University of Southern California School of Medicine and David Kessler, the former head of the U.S. Food and Drug Administration, noted that drug company spending on TV ads in the United States “doubled from $654 million in 2001 to a staggering $1.19 billion in 2005. Nearly one-third of the 2005 spending was only one category: sleep medicines. Yet sleep disorders, however problematic and serious they may be, are almost inconsequential when compared to the major causes of death in the United States: Cardiovascular disease, cancer and unintentional injuries. No matter how much the industry claims its advertising provides public health benefits, the amount spent promoting drugs for conditions of varying severity begs the question of whether the industry truly is acting for public benefit.”

~ Excerpts from Pages 129 to 135