Monday, May 01, 2006

Disease mongering

With the passing of J.K. Galbraith it is perhaps apt to remind ourselves that one of his key ideas - that advertising or marketing efforts can create demands that need not positively enhance consumption possibilities - is alive and well. Marketing efforts can reflect corporate interests that can harm or seriously deceive consumers. This can be particularly so for pharmaceuticals.

New Scientist (15/4/06) (subscription required) discusses the case of pharmaceutical companies, like Eli Lilly, either attempting to alert consumers to the possibility that they suffer from bipolar disorder or, possibly, disease-mongering by selling people on the idea that they have a disease, even though they may not, and then selling drugs to treat it. The advertising they do conduct encourages people to see any variation from an even emotional keel as signs of an illness that requires treatment using 'mood stabiliser' drugs.

The incidence of bipolar disorders in the US population has grown from 0.1% to 5% of population since 1980. The various drugs used to treat these disorders are expensive and prescribed for sustained long-term use. Moreover, the psychiatrist David Healy, in an expanded version of the NewScientist paper here, argues that use of 'mood stabilisers' is not evidence-based and has harmful effects on suicide rates - more than doubling them among manic-depressives. Despite the dubious evidence on their effectiveness and findings that they may cause harm, these drugs are increasingly being prescribed for children.

The online open access PLOS Medicine Journal has a web page here discussing how corporations create diseases in order to sell expensive drugs. This includes the Healy paper and papers on the medicalisation of a number of other non-medical conditions, such as Attention Deficit Hyperactivity Disorder (ADHD). This raises serious issues in Australia where rates of diagnosis and treatment for ADHD differ dramatically between states and territories. If a child with ADHD lives in NSW or Queensland, he or she is 5 times more likely to be diagnosed than a Victorian child.

There has been a 20-fold increase in prescriptions for psychostimulant medication in the last 10 years in Australia. In addition the 300,000 scrips now written annually are not being shared evenly either among different regions. If a child with ADHD lives in WA, they are 5 times more likely to be treated with medication than a Victorian child, 4 times more likely than a Queensland child and 3 times more likely than one from NSW. It is difficult to understand why ADHD incidence and the need for medication should be determined by geography?

These are strong claims and raise important regulatory issues. If disease-mongering is as rife as these reports suggest, public health regulators have not been doing their job.

Update 1: Business Week survey's 'disease mongering' here.


rabee said...


Disease mongering seems to be more common in areas of medicine that are not well understood, for example psychiatry where the symptoms and effects of drugs are understood but not the diseases and their underlying causes. Basically, psychiatry is curve fitting and data mining (but by smart people). Because there is very little understanding of the mechanisms of the diseases, it seems that psychiatry treats symptoms rather than diseases. So a boisterous child who likes to climb trees is diagnosed (because of this apparently deviant behaviour) with ADHD. We know, due to our data mining research, that if we drug this child by giving him (oops, or her) methylphenidate, then he’ll turn into a good little teacher’s pet. These drugs treat the symptoms rather than the disease and we don’t even understand or have a model to explain the disease.

This type of quackery doesn’t happen in other areas. How many times has a doctor told you: hm your eyes seem to be yellow today, perhaps you need a liver transplant.

(Having two boisterous boys who like climbing trees more than reading and whose idea of fun is running laps around a football field in below zero weather, we have had to regularly fend off helpful suggestions of drug-based behaviour treatment.)

hc said...

Defining a disease in terms of a 'state of mind' offers flexible possibilities for expanding a market. The difficulties with bipolar disorder are that originally diagnosis was related to objective signs of distress - days admitted to hospital etc - now 'mood stabilising' drugs are being given to 2 year old kids because parents 'perceive' symptoms. We are becoming an over-medicalised society.

And, yes, your kids are experiencing an acute disorder, its called 'normality'. I'd be deeply troubled that they aren't more interested in Jesus or general equilibrium theory.