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PharmedOut is an indepen- dent, publicly funded project that empowers physicians to identify and counter
inap- propriate pharmaceutical promotion practices.
A New Epidemic
[Motivational Deficiency Disorder] YouTube
The Disease Mongering Engine can generate more than 73,000 unique disorders, syndromes and dysfunctions. Each one is
accompanied by unique description, along with universal instructions for "getting filthy rich" by marketing the
fictitious disease and selling FDA-approved pharmaceuticals to treat it. The engine, created by author and natural
health guru Mike Adams, is intended as a parody of conventional medicine and the over-diagnosis of Americans with
fictitious diseases.
Last Updated: 5 November 2008
Disease Mongering Widening the Boundaries of Treatable Disease
This page presents a collection of articles, excerpts and resources on the subject of disease mongering, or "widening the boundaries of treatable illness in
order to expand markets for those who sell and deliver treatments".1 The medicalization of everyday
life, making medical issues of behaviors and characteristics (such as we see in the evolution and broad acceptance of the
Diagnostic and Statistical Manual of Mental Disorders)2,
may be seen to predicate disease mongering. If anxiety or shyness are identified as medical issues, for instance, and cast as
problems of neurochemical imbalance that can be treated effectively with medication, the consumer may actively seek treatment,
and the provider may prescribe it, believing that it will help achieve improved health and well-being. Those objectives are
emotionally charged desire- or need-based attractors. Big drug companies make use of such attractors in the development and marketing of
pharmaceuticals. Memetic engineering3,4 is employed to
influence the behavior of others through derived (spliced, synthesized) memes which, when propagated and acted upon, promise to
satisfy the desire or need. Messages are framed or spin-doctored in a sociocultural context using, e.g., scientific terms we trust,
transhumanist themes we accept, or appeals to instinct, atavistic fears and unconscious bias. We are vulnerable to these memes,
we internalize and transmit these idea viruses, to the extent that we remain uninformed and passive.
What is "disease mongering"?
Disease-mongering — trying to convince essentially well people that they are sick, or slightly sick people
that they are very ill — is big business... Since disease is such a fluid and political concept, the providers
can essentially create their own demand by broadening the definitions of diseases in such a way as to include
the greatest number of people, and by spinning out new diseases... Disease mongering is the most insidious of
the various forms that medical advertising, so-called medical education, and information and medical diagnosis can take.
Disease mongering is the selling of sickness that widens the boundaries of illness in order to grow markets for those
who sell and deliver treatments. It is a process that turns healthy people into patients, causes iatrogenic harm, and
wastes precious resources. Disease mongering is the contemporary form of "medicalisation." It is a process now
driven by both corporate and professional interests, and it has become part of the global debate about health care.
International consumer groups now target drug company–backed disease mongering as a wasteful threat to public health,
while the global pharmaceutical industry has been forced to defend its promotion of "lifestyle" medicines for problems
like slimming and sexual difficulties.
A lot of money can be made from healthy people who believe they are sick.
Pharmaceutical companies sponsor diseases and promote them to
prescribers and consumers. Ray Moynihan, Iona Heath, and David Henry
give examples of "disease mongering" and suggest how to prevent the
growth of this practice.
There's a lot of money to be made from telling healthy people they're sick.
Some forms of medicalising ordinary life may now be better described
as disease mongering: widening the boundaries of treatable illness in
order to expand markets for those who sell and deliver treatments. Pharmaceutical
companies are actively involved in sponsoring the definition of
diseases and promoting them to both prescribers and consumers. The
social construction of illness is being replaced by the corporate
construction of disease.
Whereas some aspects of medicalisation are the subject of ongoing debate, the
mechanics of corporate backed disease mongering, and its impact on
public consciousness, medical practice, human health, and national
budgets, have attracted limited critical scrutiny.
Within many disease categories informal alliances have emerged, comprising
drug company staff, doctors, and consumer groups. Ostensibly engaged
in raising public awareness about underdiagnosed and undertreated
problems, these alliances tend to promote a view of their particular
condition as widespread, serious, and treatable. Because these
"disease awareness" campaigns are commonly linked to companies'
marketing strategies, they operate to expand markets for new
pharmaceutical products. Alternative approaches — emphasising the self-limiting or
relatively benign natural history of a problem, or the importance of personal coping strategies — are played down
or ignored. As the late medical writer Lynn Payer observed, disease
mongers "gnaw away at our self-confidence."
Although some sponsored professionals or consumers may act independently and
all concerned may have honourable motives, in many cases the formula
is the same: groups and/or campaigns are orchestrated, funded, and
facilitated by corporate interests, often via their public relations
and marketing infrastructure.
Summary points
Some forms of "medicalisation" may now be better described as "disease
mongering" — extending the boundaries of treatable illness to expand markets for new
products.
Alliances of pharmaceutical manufacturers, doctors, and patients groups use the
media to frame conditions as being widespread and severe.
Disease mongering can include turning ordinary ailments into medical problems,
seeing mild symptoms as serious, treating personal problems as medical, seeing
risks as diseases, and framing prevalence estimates to maximise potential
markets.
Corporate funded information about disease should be replaced by independent
information.
A key strategy of the alliances is to target the news media with stories
designed to create fears about the condition or disease and draw
attention to the latest treatment. Company sponsored advisory boards
supply the "independent experts" for these stories, consumer groups
provide the "victims," and public relations companies provide media
outlets with the positive spin about the latest "breakthrough" medications.
Inappropriate medicalisation carries the dangers of unnecessary labelling,
poor treatment decisions, iatrogenic illness, and economic waste, as
well as the opportunity costs that result when resources are diverted
away from treating or preventing more serious disease. At a deeper
level it may help to feed unhealthy obsessions with health, obscure or mystify sociological or political
explanations for health problems, and focus
undue attention on pharmacological, individualised, or privatised
solutions. More tangibly and immediately, the costs of new drugs targeted at essentially healthy
people are threatening the viability of publicly funded universal
health insurance systems... [Read full article]
After looking at data used to support treatment of women with slightly lowered bone
mineral density, Pablo Alonso-Coello and colleagues argue that proponents have
overstated the benefits and underplayed the harms
Osteoporosis is a controversial condition. An informal global alliance of drug companies, doctors, and
sponsored advocacy groups portray and promote osteoporosis as a silent but deadly epidemic bringing
misery to tens of millions of postmenopausal women. For others, less entwined with the drug industry,
that promotion represents a classic case of disease mongering—a risk factor has been transformed
into a medical disease in order to sell tests and drugs to relatively healthy women. Now the size
of the osteoporosis market seems set to greatly expand, as the push begins to treat women with pre-osteoporosis.
These are women who are apparently at risk of being at risk, a condition known as osteopenia that is claimed
to affect more than half of all white postmenopausal women in the United States. We examine the evidence from
four post-hoc analyses of trials of osteoporosis drugs that is claimed to support this move... [Read More]
Products approved to help smokers quit are now being groomed for a new role as permanent substitutes for smoking, even though no one knows the consequences of their long-term use.
The latest entry in disease-mongering (an art form in pharmaceutical
marketing) is tobacco dependence. Products approved for helping smokers quit are
now being groomed for a new role as permanent substitutes for smoking, on the
grounds, apparently, that the drugs kill fewer people than the cigarettes.
A recent commentary in the Annals of Internal Medicine argues
that tobacco dependence should be considered a medical disease, like asthma or diabetes. No, really, there’s a table
that compares tobacco use to diabetes. Shared characteristics apparently include the fact that each "Causes multiple
diseases/complications." For each, patients have "Increased odds of achieving treatment goals with medications,"
and therefore "Optimal treatment combines behavioral component with medications."
The most important section of this article is the conflict of interest
statement. The two authors who have advanced degrees are on the speaker’s bureau
of Pfizer and are consultants to Pfizer, Novartis, GlaxoSmithKline, and Celtic
Pharma. Pfizer makes varenecline (marketed under the brand name Chantix) and
Nicotrol, a nicotine nasal spray. GSK makes Nicorette gum, Commit nicotine
lozenges, Nicoderm nicotine patches, and Zyban (buproprion, which GSK also sells
as an antidepressant under the name Wellbutrin). Novartis makes Thrive, a
nicotine chewing gum ("thrive," which means to prosper or flourish, seems a
rather peculiar association for a delivery system for an addictive drug.) And
Celtic Pharma is developing TA-NIC, a nicotine vaccine.
It is almost as if these companies had made a joint decision to cast smoking
as a chronic disease in order to reposition their products as long-term
maintenance medications, like methadone. Smoking cessation is painted as a goal
unachievable without pharmacologic assistance. Nicotine, the addictive component
in both cigarettes and nicotine replacement products, is portrayed as harmless
in medicinal form, as is buproprion (which can cause seizures) and varenecline
(which has been linked to psychiatric disturbances, including suicidal ideation
and suicides)... [Read More]
You are suddenly sick, simply because the definitions of disease have changed. And behind those changes, a Seattle Times
examination has found, are the companies that make all those newly prescribed pills.
The Times found that:
Pharmaceutical firms have commandeered the process by which diseases are defined. Many decision makers at the World
Health Organization, the U.S. National Institutes of Health and some of America's most prestigious medical societies take
money from the drug companies and then promote the industry's agenda.
Some diseases have been radically redefined without a strong basis in medical evidence.
The drug industry has bolstered its position by marketing directly to the health-conscious consumer, leading younger
and healthier people to consider themselves at risk and to start taking medications.
Every time the boundary of a disease is expanded — the hypertension threshold is lowered by 10 blood-pressure points,
the guideline for obesity is lowered by 5 pounds — the market for drugs expands by millions of consumers and billions of dollars.
The result? Skyrocketing sales of prescription drugs. Soaring health-care costs. Escalating patient anxiety. Worst of all, millions
of people taking drugs that may carry a greater risk than the underlying condition. The treatment, in fact, may make them sick or
even kill them.
Dartmouth Medical School researchers estimate that during the 1990s, tens of millions more Americans were classified as
having hypertension, high cholesterol, diabetes or obesity simply because the definitions of those diseases were changed.
Today, three of every four Americans technically have at least one of those diseases. But millions of them are not truly
sick and may never be, even without medication. The Dartmouth researchers said it was unknown whether those people would
benefit from early detection and treatment, while it is "an open question" whether branding them diseased and feeding them
drugs may be causing significant physical or psychological harm.
The medical profession's term for these people is "the worried well." They are otherwise healthy people who have risk factors,
such as high blood pressure or high cholesterol, but may never suffer a heart attack or stroke.
Dr. Alfred Berg, chairman of family medicine at the University of Washington and a past chairman of a federal task force that
fights drug-industry influence on disease and treatment guidelines, said the best advice for many people at risk of so-called
"lifestyle diseases" is to simply change their lifestyles.
"Diet and exercise and righteous living — but nobody wants to hear that," Berg said.
Instead, he says, a "commercial prevention" industry has emerged, focused on selling drugs to people who don't really need
them but who can pay for them.
"We have a system that nobody but Big Pharma is happy with," says Dr. John Kitzhaber of The Foundation for Medical Excellence
in Portland, who was Oregon's governor from 1995 to 2003.
But the drug companies can't do it alone. They need, and receive, support from much of the world's medical establishment.
Treatment guidelines established by international and national health organizations instruct physicians on diagnosis and treatment
of disease and are meant to be scientifically pristine. But many of those groups lack any process for preventing or disclosing
conflicts of interest.
The Times found that for a broad spectrum of diseases, the experts writing the treatment guidelines had drug-company ties ranging
from research contracts to consultancies to stock ownership.
Berg's group, the U.S. Preventive Services Task Force, flatly prohibits any conflicts of interest, either in money or previous
research. As a result, it is consistently more conservative in its recommendations than other medical guideline-writing groups
and pushes fewer drugs.
Dr. H. Gilbert Welch, a Dartmouth medical professor and editor of Effective Clinical Practice, a journal of the American College
of Physicians, agrees that his profession shares the blame for what he sees as an overdose of preventive medicine.
The problem begins, he said, with the expanding definitions of disease.
"You can't tell me that three-quarters of my population is sick before I start," he said. "That just doesn't pass the laugh test.
"Our business is in a hard place right now," Welch said. "A lot of docs know it's not right."
