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Disease Mongering
I recognize that pharmaceutical companies do a lot of good through the development of treatments for various ailments. I also recognize that they have the difficult task of balancing business--they invest millions in research and development and they have to recover those costs. They should not be immune to scrutiny, however.
PLoS Medicine has published eleven essays on disease mongering--attempts to turn things within the natural range of human biology into diseases that need treatment. ED, ADHD, and Bipolar disorder are all discussed. I think they are worth looking through, if for no other reason, to be aware that you are a target of marketing forces--something to keep in mind as you manage your health.
(Note: All PloS journals are open access.)
7 comments:
One of the essays, "The Latest Mania: Selling Bipolar Disorder," caught my attention. Having read a great deal of literature about this disorder during the past 13 years, I'll just opine that the author of this essay is not bipolar himself and has not lived for any length of time with anyone who is — I say this because the article exhibits no sympathy for those who are or have.
Gary,
I don't know what it's like either. I didn't get the sense that you did, but I know less about the topic than you and I haven't walked in your shoes.
The advert can be read as a genuine attempt to alert people who may be suffering from one of the most debilitating and serious psychiatric diseases—manic-depressive illness. Alternatively, the advert can be read as an example of what has been termed disease mongering.
Based on the above exerpt, I don't agree that the author exhibits no sympathy for those who are bipolar. He is, however, noting that advertisements seem designed to convince people who are not bipolar (mainly those with depression) that they are bipolar so they will try different medications. I think it is a legitimate concern.
I'll just add that this is an academic publication we're talking about.
Where I come from, we talk about HIV, gonorrhea, smallpox, and other such things without batting an eyelash. It is easy to forget how these things shatter lives, but that level of the problem is not our focus.
But like I said, I haven't walked in Gary's shoes, so I may be missing something.
This is an unfortunate trend - people criticizing the very portrayal of limitations as limitations. There's a trend, for instance, among the deaf and those with other handicaps to not want their handicaps to be considered handicaps to such an extent that when their children could be cured of these things they refuse. Likewise there are behaviors that can be treated. Why shouldn't they be.
It's very unfortunate. I understand why, for reasons of feelings of self-worth, that people want to "normalize" conditions. But the very refusal of a kind of cost/benefit calculation is very troubling to me.
Now regarding ads, I think they should be off the air for different reasons. But the underlying phenomena from the other side is just very troubling to me.
Jared: I second your notion that scientists become removed from the human suffering that we study. The science itself can become so interesting that we forget that the people dealing with the problem do not share our same kind of excitement.
I would draw a distinction within the pharmaceutical companies between the basic scientists who study the problem, the clinicians who run the trials, and the marketers who sell the solution. While the basic scientists can forget that they are dealing with people, not just data, they still frequently come back to this important point. I can't think of a single seminar that I have attended where the speaker did not begin the talk with a few slides on the human impact of the disease.
The clinicians have cause to be more careful in their work, because they are dealing directly with human subjects, so the consequences of forgetting the "big picture" are more serious than for the basic scientist. I think that there is a troubling amount of abuse in this area.
Lastly, I think a lot of the negativity towards pharmaceutical companies is a result of the actions of its marketers. Clark points out the ubiquitous adds, and I think that is a good example.
I may be way too biased here and so I am putting an unfair amount of the blame on marketers, but I see the scientists' role as that of finding information and the marketers' role as that of deciding what to do with it. So a scientist says, "Drug X will lower cholesterol by 5% in 20% of the population," and then suddenly we see a commercial with dozens of happy people dancing in fields of wildflowers, with a tag-line that asks, "Shouldn't you ask your doctor about Drug X?" Why don't we also see a couple hundred people in that field who look totally frustrated because their cholesterol is still high but they are now nauseous, sleepless, and constipated?!
Jared,
The idea of disease mongering is very interesting to me. Just today I had a lecture given on obesity and how it is or should be considered a neuroendocrine disorder. Basically people become resistant to the actions of a hormone leptin which should turn down appetite. He compared it to diabetes where you become resistant to insulin. It is an interesting idea but I don't fully subscribe to it.
I feel like our understanding of disease continually needs to be expanding. It used to be a normal part of aging for women to get shorter/broken bones (osteoporosis) and for people to go crazy (Alzheimer's) when they got old. Now we can do things to at least alleviate some of the symptoms and postpone/prevent the disease. The fact is that drug companies wouldn't have worked towards improving these conditions if they were not considered "diseases".
I do, however, hate all of the drug ads and feel like they can play off of people's paranoia. There needs to be an awareness of what can be treated, but usually you (the patient) are aware if there is a real problem.
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