Aldous Huxley wrote that “Medical science has made such tremendous progress that there is hardly a healthy human left”
Disease mongering can generate tremendous debate and arguments for and against it. However, it is pertinent to briefly review on this subject.
Disease mongering is selling of sickness that widens the boundaries of illness in order to grow the markets for those who sell or deliver the treatment. Lynn Payer who campaigned for Listerine mouth was against Bad Breath (halitosis) coined this term in 1992. She had addressed this issue in her book: Disease Monger- How Doctors, Drug Companies and Insurers Are Making You Feel Sick. She wrote that trying to convince essentially well people that they are sick or slightly sick people as very ill- is big business.
Some of the conditions that are being highlighted as part of disease mongering include prediabetes, restless leg syndrome, bipolar disorder, female hyposexual disorder and a new entity called motivational deficiency disorder. Major concerns are many therapies are being promoted for milder and milder conditions leading to overtreatment, risk of adverse effects and waste of resources.
Disease mongering is a form of medicalisation, a process driven by pharmaceuticals and healthcare professionals. Arthur Caplan from University of Pennsylvania told that you can turn almost anyone into a disease if you have money to advertise and want to stir up worry in the public. Payer and Caplan both highlighted that the routine human conditions are increasing being re-defined as disease.
Unhappiness, boredom, laziness is being re-defined as disease. Mild depression, osteoporosis, irritable bowel syndrome, and adult attention deficit disorder (ADD) all are leveled as serious illnesses. “Shyness” once considered as a general trait of a person is now labeled as “social phobia” requiring treatment with antidepressants.
In one of the advertisement by a US company for its first approved drug for adult ADD photographed an uptight looking model with a headline as “Distracted? Disorganized? Frustrated? Modern Life or Adult ADD? Such advertisement will worry the common adults and compel them to think about ADD rather a day to day stress. The company and physicians defend their stand on this point by arguing that the treatment is approved by regulatory authorities so it is defined as a disease and require treatment.
Australian journalist and visiting editor of British Medical Journal Ray Moynihan has written in his book Selling Disease: How Drug Companies are Turning Us All into Patients, describes the process as‘corporate-sponsored drug creation’. It involves companies, physicians and patients group to create such condition. This process is driven by doctors with sponsoring companies and so called key thought leaders (KTLs) amongst top medical experts lubricate the whole strategy. These experts taking money from the company lose their credibility for being true and honest. Public is unaware of the whole process and become the victim of newer diseases or newer thresholds of known diseases.
Campaigning or promotion about condition and its treatment changes the perception of people about their experiences. Statistics about diseases are presented in such a way that every person feel that he is or a potential sufferer of the particular illness. Citing one in five or one in eight person distort the perception of disease reality and scare the public on its occurrence. Most of the chronic illnesses are stated as under diagnosed and undertreated. This creates a perception even in the doctors’ mind to over prescribe or unnecessary prescribe the medications. This is evident with rising prescriptions of antidepressants, tranquillizers, multivitamins and other nutrients. The classic examples of over promotion are recently seen with increasing uses of Vitamin D3 and Vitamin B12. Almost every person visiting doctor’s clinic is enquired for the status of Vitamin D3 and Vitamin B12 and majority of them end up going for blood testing and treatment. The overuse of Vitamin D3 has been also been reported to cause serious side effects requiring hospitalization in tertiary hospital. Moreover, recent studies are inconclusive of the benefits of Vitamin D3 in majority of the people. These studies are never highlighted or discussed with the stakeholders.
Target values for diabetes, high blood pressure, high cholesterol (dyslipidemia) are periodically been revised resulting into more people falling in the scope of the treatment.
Prediabetes is another condition now recommended for drug treatment. The drug is prescribed to prevent diabetes. In fact proper diet and exercise done regularly may tackle this condition in majority of the cases. It is unlikely that all persons with prediabetes will develop frank diabetes. The study has shown that people with known prediabetes developed depression and were prescribed treatments with antidepressants. Antidepressants and depression both are linked with increased body weight enhancing the risk of diabetes or other metabolic diseases. Prevention of a disease by drug is more attractive option for both doctors and company. Moreover, the concept of prediabetes has grown the market not only in developing countries but also in emerging markets. There are no meticulous deliberations on age, ethnicity or geography deciding the threshold for a particular condition.
There is another new entity recently
termed as Motivational Deficiency Disorder that is characterized by extreme laziness,
and apathy. Severe cases can be fatal as it reduces the motivation to breathe. It
is claimed to affect up to one in five Australians.
Neurologist Leth Argos told that this condition is poorly understood, under diagnosed and undertreated. Argos is advisor to a biotech company involved in development of a drug for the same condition. Though certain people might have severe motivational disorder and require treatment, the estimates of one in five is exaggerated and carries risk of diagnosing and treating even ordinary laziness.
Certain people have even gone on saying that companies not only manufacture medicines but also invent diseases for their new drugs. This might be slightly being harsher on them as drug approval process is fairly regulated and this criticism may not be fully valid. In fact between the two extremes of over promoting pill- for-every ill and criticism of disease being invented, a middle approach would be ideal. In fact politicians in some of the advanced countries have started raising the issue of drug mongering concerning medicalisation of the society.
Drug mongering can be regulated by stricter means of disease and drug campaigns. Increasing number of free medical checkups and screening of diseases without discussing its clinical significance is adding more apprehensions and worry to the people. People go for unnecessary investigations and medical consultations to various doctors and experts to alleviate their concerns.
The practices that include disease mongering are as follows:
- Normal human without any obvious abnormality require treatment.
- Exaggeration of common symptoms as a serious disease
- Promotion of treatment as safe without major side effects.
- Misuse of statistics to exaggerate benefits and safety (no harm) of the treatment.
- Defining disease as an imbalance of nutrients, hormones etc.
- The given condition involves large population to enhance the business.
- Facilitating health campaign and enhance public debate on the subject.
- Unclear objective in clinical trial
- Medical advertising in the umbrella of medical education.
With increasing healthcare cost and burden of diseases, it is becoming prudent to scrutinize each and every disease or condition on the basis of scientific merits and human ethics. Merely diagnosing the illness or finding a new condition to increase the scope of business should be strongly condemned and discouraged. In this endeavor the role of a doctor is of paramount importance. He should practice medicine with scientific acumen, human ethics and kindness to justify the novelty of his profession.