Disease Mongering: Good For Big Pharma, Bad For You

In "Should You Get Your Drug Information From an Actor?" I discussed the pharmaceutical industry's egregious practice of using celebrity-driven, prime time television commercials to promote drugs directly to consumers. Illegal in most of the world -- and legal in this country only since 1985 -- this kind of advertising does much more harm than good and should be banned.

But as bad as this practice is, at least the example that I cited, actor Sally Field's Boniva campaign, promotes a drug to treat a real disease: osteoporosis. Even worse is a growing trend to invert this process: to promote diseases to fit existing drugs. In a fascinating New York Review of Books piece, Marcia Angell, M.D., denounced the practice of "disease mongering." As she put it, "The strategy is to convince as many people as possible (along with their doctors, of course) that they have medical conditions that require long-term drug treatment."

A British Medical Journal article said it more succinctly, "A lot of money can be made from healthy people who believe they are sick."

A central disease-mongering tactic is to attach polysyllabic, clinical-sounding names to what used to be seen as trivial or transient conditions. In most cases, the new, formidable names come complete with acronyms, which add even more gravitas. Thus:

• Occasional heartburn becomes "gastro-esophageal reflux disease" or GERD.
  
• Impotence becomes "erectile dysfunction" or ED.
  
• Premenstrual tension becomes "premenstrual dysphoric disorder" or PMDD.
  
• Shyness becomes "social anxiety disorder" or SAD.
  
• Fidgeting legs becomes "restless leg syndrome" or RLS.

Clearly, extreme, intractable versions of these conditions may indeed require vigorous treatment, but the pharmaceutical industry does little to draw a distinction between serious and mild manifestations. Minor gastric upset following a spicy meal is labeled "GERD," and butterflies before giving a speech is "SAD." And the proffered solution? "Off-label" use of existing drugs to expand their market share, though there may be little or no research that justifies such use.

So what should be done? The nation is in the throes of a pitched debate about health care reform, and I'm a vigorous advocate for universal health care and many other political changes (as laid out in my book, Why Our Health Matters: A Vision of Medicine That Can Transform Our Future).

But as we push for a better medical system, we must also remember that not all of the changes we need can be left to politicians. As a culture, we should be suspicious whenever we hear of a new "disease," and ask whether it may just be a marketing ploy to exploit one of the minor discomforts that come with being a human being -- and a driver of the out-of-control costs of American health care.

If it is, the best "medicine" may be low-tech, inexpensive and safe measures such as small modifications in diet or exercise patterns, or some simple stress-reduction techniques. Or -- even more radical! -- the answer may simply be to wait, give the body's own healing mechanisms a chance to find equilibrium, and get on with our lives.

Andrew Weil, M.D., is the founder and director of the Arizona Center for Integrative Medicine and the editorial director of www.DrWeil.com. Become a fan on Facebook.

Follow Dr. Andrew Weil on Twitter: www.twitter.com/DrWeil

Comments

[gabby2]

Does anyone realize that the Supreme Court is ruling on campaign reform and part of it is to EASE THE AMOUNT OF MONEY UNIONS AND CORPORATIONS GIVE TO CAMPAIGNS! We need these two entities to be BANNED FROM GIVING MONEY to political campaigns. ( throw in lobbying groups) This will only enforce the culture in our political system that has developed of a GOVERNMENT FOR BUSINESS AND BY BUSINESS!!

What we need is to ADD an amendment to the constitution! YES, add one that says: If you can vote, have voted, or will be eligible to actually vote (better known as a human being)then you are eligible to donate to a political campaign or a PAC and this comes with monetary limits. Business, lobbying groups, and PACs with the EXCEPTION of the DNC, RNC and their house and senate groups should not be able to give one Penny to a political campaign. The exceptions just mentioned are also not allowed to take non-human being's money. This will solve the problem of getting the right system past. Our constitution reads government FOR THE PEOPLE AND BY THE PEOPLE not for and by corporatio­­ns/busine­s­s and their lobbying groups and PACS. Big Pharma let the healthcare system out of its box and put the Disease Care system in one.

[JAB20]

Have you noticed what happens to medical standards?

In 1997, the standard for diagnosing diabetes was two fasting readings in a row of 140. A couple of years ago it was lowered to 124. And now they say it is 99.

I'm not a physician, so I don't know how accurate these guidelines are. I just know that a lot of studies were paid for by drug companies.

Every time the numbers go down, I have to wonder how many millions more "need" medications.

The standards should be set through tests by independent groups with no vested interest in the billions made by big pharma.

[Star2000dancer]

I noticed in 1994 and have been fighting to stay alive and change our health system since then.

[vincealy]

Most standarts have little science behind them and the 'experts ' who write them tend to make huge speaking fees for thier efforts.

[confuseddemocrat]

I agree with you comments. Big Pharma has clearly launched a campaign to convince patients that they are sicker than they really are

One of the most egregious ad that I have seen of late is the one in which a pharma company is directly encouraging patients with depression to take an additional psych med on the grounds that their disease is inadequately managed....

this ad is clearly designed to encourage patients to pressure their docs to add an additional (expensive) drug to their regimen

I find it horrifying that a company would prey upon the mentally ill to peddle a drug which produces serious untoward effects including diabetes, cardiovascular failure, parkinsonism, immune dysfunction as well as possible fatal drug-drug interactions when mixed with other psych meds

This is one area where stricter FTC and FDA regulations are required

[StephanieStahl]

"this ad is clearly designed to encourage patients to pressure their docs to add an additional (expensive) drug to their regimen....a drug which produces serious untoward effects including diabetes, cardiovascular failure, parkinsonism, immune dysfunction as well as possible fatal drug-drug interactions when mixed with other psych meds"

So, why are doctors prescribing unecessary and expensive drugs with all these side effects (and much more)? Just because a patient has seen an ad on TV doesn't mean the doctor has to prescibe it. This is not a rhetorical question. Why are doctors prescribing drugs that aren't needed and are often dangerous to particular patients? The same is true for surgical procedures and not just in general medicine but also in specific areas like dentistry.

To say that the FDA and/or FTC need "stricter" regulations isn't really getting the job done. These watchdogs don't need more work/power; they need to be overhauled. Moreover, we need healthcare professionals who are more focused on health.

[confuseddemocrat]

you are right...an overhaul is required

Maybe health care reform can address the fraud and the under the table deals between big pharma and physicians

In addition you have a major point with dentistry....

the dental profession has become one in which dentists push expensive surgical procedures (which incidentally) always costs about the same as the maximum yearly limits that the insurance provides for dental care

[BunnyMama]

Who developed the protease inhibitors that transformed HIV from a death sentence to a manageable chronic disease?
Oh yeah - the pharmaceutical companies.
Don't drink ALL the Kool-Aid, people.

[confuseddemocrat]

No one is chastising the drug companies because of their products..­..American pharmaceutical companies are above par with regards to creating high quality medications

What should be criticized is the "direct to consumer marketing" strategy which seeks to convince patients that they should add additional meds to their regimen or request the newest medication within a specific medication class

Often times, these meds are only available as "brand" formulations (which means that they are extremely expensive) and offer very little improvement over the generic versions of the older (prototypical) drugs that are also members of that particular medication class

In addition, it is a well known practice that big pharma "create" new indications (uses) for existing meds simply to prolong the patent and thus prevent them from being manufactured as "generics".

Then the company takes the same drug(s)...change the color of the pill, maybe make some minor chemical modifications, give it a new name, advertise it as a new breakthrough and then sell it at an even more exorbitant price

It is absolutely scandalous

[Star2000dancer]

Please. Even the dyes can be deadly.

[Star2000dancer]

Generics are no where near the name brand.. None of them work anyway. My family grew old without taking an aspirin. Now everybody's on drugs? Even me.

[Star2000dancer]

The drug companies should be chastised!

[BunnyMama]

It's not a *real* fake disease until it has an acronym. Hence restless legs syndrome becomes RLS or chronic fatigue immunodeficiency syndrome becomes CFIDS.

[StephanieStahl]

Levaquin, Vioxx, Bextra, Crestor, Baycol, Fosamax®, Actonel®, Aredia®, or Zometa®, Prozac (fluoxetine), Chantix (Champix or varenicline), Zyban just to name a few. How do these unsafe drugs get through the FDA and onto the market?

The United States Supreme Court ruled that FDA approval does not prohibit liability lawsuits against pharmaceutical companies. (Wyeth v. Levine, 06-1249, October, 2008, http://www.supremecourtus.gov/opinions/08pdf/06-1249.pdf ) The FDA will "fast track" or "accelerate approval" or "priority review" drugs, http://www.fda.gov/ForConsumers/ByAudience/ForPatientAdvocates/SpeedingAccesstoImportantNewTherapies/ucm128291.htm , No comment is made as to whether or not drug companies pay for the fast tracking process; however, the legal fact remains that FDA approval does not immunize drug companies against liability.

Fortunately for lawyers, there are many options for milking the drug companies for more and more money. Type the following terms into your favorite online serach engine: pharmaceutical liability lawsuit. And PhRMA wins because every drug-injured person will need medical attention (and more drugs) to heal, right?

Step 1 on healthcare reform: Prohibit pharma funding of med schools. We don't need drug pushers writing our medical texts and journals.

[Star2000dancer]

They're in your drinking water everyday.

[Star2000dancer]

Open the phone book. Why are there more lawyers than doctors?

[StephanieStahl]

When I said "fortunately for the lawyers" I was being sarcastic. Sorry if that didn't come through. There have been a couple of times when I really needed a lawyer but couldn't get any one of them to take the case.

The point is that the FDA isn't doing its job of protecting people from unsafe drugs.

[dukeitout]

I read recently there are negative comments from the AMA coming out on the efficacy of aspirin. I've always thought it had was healthy to take them occasionally (not on an empty stomach!!! of course) and they were truly a miracle drug since their cost is so low. Isn't it a low point in medicine to demonize aspirin? What next-----avoid water since ingestion into the lungs can be fatal?

[maxfax]

Anyone been to their doctor lately? For me I have never seen so many drug reps standing in line to get in to see my doctor. In fact there are more reps than patients some days. Must mean something!

[timetorevolt]

Restless Leg Syndrome is my favorite...And now big pharma is hocking a pill to grow thicker eye lashes..The side effects will kill you but you're eye lashes will look fabulous when you're lying in a coffin.

[Ventoi]

'A few small repairs' -

O goody!!
This guy might let me write what I need to write!

I was thinking today, as I walked through the aisles of the grocery store, of all places...
just how GREAT our school systems would be if our tax dollars (someone was discussing tax dollar usage with a child) were better used...

ie/used to educate and uplift rather than fight diseases that 'can't be explained'

I have relatives who died of cancer...I may end up dying of it myself...
but it may be because I have been withheld from learning information about the spiritual occurence of my body that might keep me healthy...
I have lived through all the unexplained syndromes...
and have been taught spiritually to attribute them to dehydration, and friction of body tissue...one against another..when two or more bodies are joined at one body base...from the inside out...

"she didn't believe in transcending"

[chickenNgravy]

What? What? What?

[Star2000dancer]

Quick! Go buy "You Can Heal Your Life" by LouisaL. Hay.

[Carl Caroli]

Unfortunately, too many Americans want that magic pill that will cure what ails them without having to change their diet, life style or exercise and big Pharma knows it.

[artistinresidence]

Absolutely! My doctor told me he makes his living treating heart disease, clogged arteries, and diabetes.
JUST inside the door to his building is a soda machine and a candy machine!!!
That's insane.
Here, boys and girls, get your diabetes early!!

And by the way: people who take statin drugs for cholesterol.....if they're men, they usually then need viagra....(statin drugs interfere with erections).
Western medicine is really SICK..

AND: we are responsible for our diets and our behavior--this WILL keep health care costs down.
We need a public option for health care. (just couldn't resist adding that....)
I've just reread this and it's pretty disjointed, but I wanted to make about 37 points in one post....
sorry..

[MidnightRambler]

A drug that treats a twitchy leg? Yeah. The government lets it happen. The repugnacans cheer it on.

[Star2000dancer]

Twitches often come from muscle that have been torn and heal incorrectly. Thereby shrinking with liquid underneath. Since all muscles are connected it only takes one small incorrectly healed muscle to pull on all the others. Thereby causing muscle & joint pain all over & restless muscle syndrome. It's especially true in joints, like torn rotator cuffs. The pain gets more excruciating every year if not treated correctly. Eventually no amount of pain pills can help you. however they can sell you alot & keep you disabled, until it's so bad they can convince you that you no longer even want to live.. The iliopsoas, a tiny relatively unknown muscle can cripple you.
How would I know this? Why from experience of course. You see I was a fitness consultant & I healed others, I also lived in other countries where they healed you. In 1994 I experienced the American way of treating symptoms & surgery. I almost died many times, & sit here wishing they'd pass massage therapy, spa treatments, replace my pt heated shiatsu massage chair I used to repair myself from herniated discs to seized muscles. I was told was impossible.Things your doctor doesn't even know by me.

[Star2000dancer]

A few deep tissue massages will fix 'em better.

[StephanieStahl]

I also suggest applying heat in many cases. And--with both heat and massage--drinking plenty of water is essential. A deep massage with no enough water usually leads to very sore muscles the next day.

[kemahcw]

I'm one of the one's who believe Obama had some divine help in winning the election of the presidency. we have begun to see how racist America really is; the teabaggers, the birthers, the "just say no to everything" republicans, the pictures of our president with swastikas. the message is very clear, hate for President Obama is being elevated to internal race war proportions. Obama won only because God had His Hand in the mix. this all to my present thoughts and pleas to President Obama about this whole health care and public option debate.

When speaking of the public option President Obama said that "truth is on our side." I think it will be a crime for President Obama not to keep up the fight for a public option. the insurance companies are the "death squads, they ration health care.

We need the government option, we need you Mr President to stand up and fight the powers that be. my dad once said, "the power behind you is greater than the task in front of you." there are many of us who are praying for you, praying for God to give you strength, wisdom, perseverance, protection and continued passion to help those "other sheep." for you not to keep up the good fight tells me that you have lost faith in God and we in turn will lose faith in you.

we need for you to remember the audacity of hope...

[klmebane]

not to pick apart your post, but you really think God is the only reason obama won? it couldn't be because of a well run campaign? i don't know that i really buy that. how do you explain george bush winning? twice? does god hate us?

[Lechuguilla]

Yes indeed ... another "nauseating" example of unregulated capitalism.

Too bad we don't have a Democratic President and Democratic Congress to make needed changes.

[Star2000dancer]

I didn't realize how intertwined they had got. Sigh. I said I'd know when they fixed health care. Not going to happpen. At least not the right way.

[Rich DeWitt]

Thank you Dr Weil! I get irate when I see these television advertisements that "create the need" (a time honored advertising tactic). You know, the ones with the spooky music and dismal lighting, and the actor with the distressed demeanor. I don't believe that advertising is going away, so it is incumbent upon the individual to be aware, informed, and realistic so as to make wise health care choices. The AMA should be more forceful and judicious as to what it chooses to label as a disease or disorder, especially these transient type conditions.

[Star2000dancer]

AMA, FED, WHO, FDA, FCC ALL BOGUS, not for the people.