April 12, 2002

'A pill for every ill'
Drug firms are 'disease-mongering' with pills for shyness, baldness and more, doctors say

Helen Branswell
The Canadian Press, with files from The Daily Telegraph

TORONTO - Drug companies are "disease-mongering" in a bid to sell healthy consumers pills for a range of problems such as baldness and shyness, doctors say.

"There is a lot of money to be made from telling healthy people they are sick," say the authors of a series of articles in tomorrow's British Medical Journal. "What for many people is a mild functional disorder -- requiring little more than reassurance about its benign natural course -- is currently being reframed as a serious disease attracting a label and a drug, with all the associated harms and costs."

The authors call the process "disease-mongering" -- a bid by drug companies to extend the boundaries of treatable illness to expand the pool of consumers who might be persuaded to buy their drugs.

In the process, drug companies are conveying the myth that there are magic solutions to problems such as being overweight or having high blood-cholesterol counts -- problems for which a better and more long-term remedy would be losing weight and getting more exercise, some physicians suggest.

The companies' efforts are very much in evidence in the ubiquitous drug commercials seen on U.S. television, adds Barbara Mintzes, a health economist at the University of British Columbia who is an expert on the impact of direct-to-consumer drug advertising.

Those ads send the message that there is "a pill for every ill -- and increasingly an ill for every pill," Ms. Mintzes said in an editorial in the journal.

The BMJ also conducted a poll among doctors to draw attention to the increasing tendency to classify people's problems as diseases.

Ageing and work-related problems, followed by boredom, bags under the eyes, ignorance, baldness and freckles were the "non-diseases" most frequently cited by doctors.

Big ears, greying hair and ugliness completed the Top 10. Jet lag, cellulite and anxiety about penis size made the Top 20.

"We are not suggesting that the suffering of people with 'non-diseases' is not genuine," Richard Smith, the editor of the BMJ, said. "But everything is to be gained and nothing lost by raising consciousness about the slipperiness of the concept of disease.

"To have your condition labelled as a 'disease' may bring benefit, but the diagnosis may also create problems. You may be denied insurance, a mortgage and employment."

Drug companies argue that many diseases are under-diagnosed and under-treated, a circumstance that "leads to a considerable social burden of otherwise avoidable morbidity [disease] and mortality," write Silvia Bonaccorso and Jeffrey Sturchio, executives with the drug giant Merck.

They acknowledge that drug companies want to increase the market for their medications. But they argue consumer surveys and other studies show direct-to-consumer ads provide valuable information, spur people to talk to their doctors about problems and motivate them to adopt "behavioural changes that lead to better health."

"It is mischievous to suggest that reducing levels of diagnosis and treatment will somehow improve both the health and wealth of a society," they write in the BMJ.

Some of the ailments they list as being under-treated include high blood pressure, cholesterol problems, diabetes, osteoporosis, depression and childhood asthma.

Several of those are not diseases, but conditions or even risk factors for disease (high cholesterol, for instance).

But it is in the interest of drug companies to blur the line, to create concern and fear among potential drug consumers, says the lead article, by Australian journalist Ray Moynihan, British general practitioner Iona Heath and David Henry, professor of clinical pharmacology at the University of Newcastle, Australia.

One of the ways the companies accomplish this is by funding patient groups or foundations -- the International Hair Study Institute is one example -- that try to raise public awareness of a problem. They also try to get the mainstream media to write newspaper articles or broadcast items on the condition, the authors say.

For instance, when the drug Propecia -- which combats hair loss -- was first licensed for use in Australia, leading newspapers featured articles on "the emotional trauma associated with hair loss."

In another example, the drug firm Roche began promoting its antidepressant Aurorix as a treatment for "social phobia." A press release suggested more than one million Australians suffered from this "soul-destroying condition." Government figures suggested the number was closer to 370,000.

"All the media stories seemed to be part of a wider push to change the common perception of shyness from a personal difficulty to a psychiatric disorder," Mr. Moynihan and his co-authors argue.

The same is true in the area of sexual health, where the emergence of Viagra has changed expectations of what is normal, write two British professors, Graham Hart of the University of Glasgow and Kaye Wellings of the Centre for Sexual Health Research in London.

"Although many men with erectile dysfunction daily thank Pfizer" -- the maker of Viagra -- "for their efforts, others who once thought their low libido was 'normal' and acceptable now feel dissatisfied with their sexual lives," they said.

The BMJ admitted some critics thought the vote on non-diseases to be absurd, but said: "We wanted to prompt a debate on what is and what is not a disease and draw attention to the increasing tendency to classify people's problems as diseases.

"Worst of all, the diagnosis of a disease may lead you to regard yourself as forever flawed and incapable of 'rising above' your problem," the BMJ said, giving the modern attitude to alcoholism as an example.

The BMJ compiled a list of 174 conditions it suggested could be defined in non-medical terms. It then asked doctors, via its Web site, which ailments they wished to be re-classified.

"Non-disease" was defined as "a human process or problem that some have defined as a medical condition but where people may have better outcomes if the problem or process was not defined in that way."

Chronic fatigue syndrome (myalgic encephalomyelitis, or ME) and menopause were deemed non-diseases by 13% of doctors.

Brian Dow, of Action for ME, said he did not object to a mature discussion about what constituted a disease "but this poll has been done in a crude way and is not very helpful."

Diabetes and osteoporosis were named by 2%.

A spokesman for Diabetes U.K. said the organization already avoided using "disease" to describe diabetes. "We use the word 'condition.' One reason is that a 'disease' is communicable, and also, while diabetes can be treated, there is no cure."