The Breast Views Blog: Disease Mongering
"Disease mongering" by pharmaceutical companies threatens to bankrupt Canada's public health system
Authors of new book warn that drug company marketing techniques are turning us all into patients
Daily media articles say that the Canadian public health system is in jeopardy, and fingers are pointed at everything from doctor shortages to government mismanagement and bureaucratic greed. But Ray Moynihan and Alan Cassels, authors of the new book, Selling Sickness: How the world's biggest pharmaceutical companies are turning us all into patients, point the finger at another cause: drug company funded disease creation.
Using their dominating influence in the world of medical science, drug companies are working to widen the very boundaries that define illness. Mild problems are painted as serious disease, so shyness becomes a sign of social anxiety disorder and pre-menstrual stress a mental illness redefined as pre-menstrual dysphoric disorder. Everyday sexual difficulties are seen as sexual dysfunctions, the natural change of life is a disease of hormone deficiency called menopause, and distracted office workers now have adult ADD. Just being 'at risk' by having an elevated blood pressure or cholesterol level has become a 'disease' in its own right.
"Too often the aim is to lower the bar and turn healthy people into patients," says Alan Cassels, co-author of Selling Sickness, and drug policy researcher at the University of Victoria in British Columbia. "And lowering the bar makes more and more of us candidates for the latest pills promoted by the pharmaceutical industry."
Selling Sickness reveals how expanding the boundaries of illness and lowering the threshold for treatments is creating millions of new patients and billions in new profits, in turn threatening to bankrupt national healthcare systems all over the world. Canada's publicly funded healthcare system is not immune.
"From their domination of guideline committees, their involvement in physician 'education' and their marketing of fear to consumers, the pharmaceutical industry is using its immense power to drive more and more of us towards another prescription," warns Cassels. And, he notes, "a health system that allows drug companies to play a role in defining who is sick is fundamentally unhealthy."
With many health problems, there are people at the severe end of the spectrum suffering genuine illness, or at very high risk of it, who may benefit greatly from a medical label and a powerful medication. But for the relatively healthy people who are spread across the rest of the spectrum, a label and a drug may bring great inconvenience, enormous costs, and the very real danger of rare but deadly side effects.
As the authors of Selling Sickness note, with plenty of detail, pharmaceutical company marketing executives don't sit down and actually write the rules for how to diagnose illness, but they increasingly underwrite those who do. The industry now routinely sponsors key medical meetings, in Canada and around the world, where disease definitions are debated and updated. Eight of the nine 'experts' who created the most recent cholesterol guidelines in the US had undisclosed ties to the pharmaceutical industry. The new guidelines shifted the definition of 'high' cholesterol so drastically that it meant another 40 million Americans should be taking cholesterol-lowering drugs. In Canada, recent guideline changes to cholesterol treatment, if implemented, would put 500,000 more people on cholesterol-lowering drugs.
Added to this is the fact that the bulk of clinical trials on new medication is funded directly by the drug manufactures rather than the public or not-for-profit sources. And that this research is then disseminated at scientific meetings, events and conferences sponsored by the pharmaceutical industry, and often hosted by medical societies or patient groups that are themselves partially underwritten by drug companies. "The reach and the scale of the industry's influence is really quite breathtaking in its scope," notes Cassels.
"Many Canadians would be horrified to know that drug company money is also involved in funding much of the Continuing Medical Education of Canadian physicians. Yet I feel that we are never going to achieve rational prescription drug use in this country until we get the drug money out of our medical education system," argues Cassels.
And then there is the barrage of drug advertisements that hit consumers
every time they turn on the TV. While direct-to-consumer advertising of
prescription drugs is illegal in Canada, drug manufacturers here mount
'disease awareness campaigns,' which constantly urge you to 'see your
doctor' for practically everything. "There are many different
promotional strategies used in the selling of sickness, but the common
factor amongst them all is the marketing of fear," says Cassels.
Soaring sales have made drug companies the most profitable corporations on the planet during particular years of this past decade. But the flip side of healthy returns for shareholders is the unsustainable increase in costs for those funding the health system. Selling Sickness tells us that we need the pendulum to swing back towards a rational and appropriate use of pharmaceuticals for everyone who is sick. "Our health care system will collapse if we continue to allow for-profit enterprises to define who is sick and who needs treatment," says Cassels. "Now is the time to start having the conversation about whether we want to continue to allow pharmaceutical greed, not appropriate need, to be driving our health care expenditures."
For author interviews, contact:
About the Authors: Alan Cassels is a drug policy researcher at the University of Victoria, in British Columbia. He has spent most of the last ten years studying how clinical research about prescription drugs is communicated to policy makers, prescribers and consumers, and has produced several full-length documentaries for CBC Ideas, including "Manufacturing Patients," which deals with the subject of selling sickness.
Ray Moynihan has been covering the business of health care for almost a decade as an award-winning broadcast journalist and more recently with the British Medical Journal. He is a regular contributor to the New England Journal of Medicine and the Lancet and was a Harkness Fellow in health care policy based at Harvard University.
Selling Sickness: How the world's biggest pharmaceutical companies are turning us all into patients by Ray Moynihan and Alan Cassels is published in Canada by Greystone Books (2005) www.greystonebooks.ca and in the US by Avalon Publishing Group, www.avalonpub.com
Other pithy, pesky, prodding blogs that I consume myself with.
Calendar Girl Blog
My Menopause Blog