Widespread, Severe, and Treatable with Pills

If you’ve flipped through a daily newspaper recently, you may have seen the ad for the cholesterol-lowering drug Lipitor. Next to a stark image of the tagged toe of a corpse is this question: “What would you rather have, a cholesterol test or a final exam?”

Quick! Get to your doctor for a screening–and likely a prescription–or risk dying prematurely of a heart attack, the ad suggests.

Never mind that scientific research has found no difference in death rates between people using Lipitor and placebos. A classic example of disease mongering, the ad is intended to scare people.

Healthy to Hypochondriac

Health experts agree that promotion of the fear of illness is escalating, a phenomenon that not only expands markets for the billion-dollar pharmaceutical industry but also turns
otherwise healthy individuals into hypochondriacs.

Making matters worse, once people become convinced they need to talk to their physician–about, for example, female sexual dysfunction or social anxiety disorder, two diagnoses to appear lately–they could end up undergoing unnecessary diagnostic tests. From there, they could start popping pills or taking other forms of treatment whose potential harm outweighs their supposed benefit.

“Disease mongering turns healthy people into patients,” writes Ray Moynihan and David Henry in the April 2006 journal for the Public Library of Science Medicine, which focused exclusively on the subject. (The edition coincided with the inaugural conference on disease mongering held in Australia.)

In their article, Moynihan, author of Selling Sickness: How the World’s Biggest Pharmaceutical Companies Are Turning Us All Into Patients (Greystone, 2005), and Henry, a clinical pharmacology professor at Australia’s University of Newcastle, say there are different forms of disease mongering: the medicalization of aspects of ordinary life, such as menopause; mild problems being portrayed as serious illnesses (such as irritable bowel syndrome); and risk factors for illnesses being framed as diseases themselves, such as high cholesterol. Often, the conditions are touted as “widespread, severe, and treatable with pills.”

Although most people assume that drugs are developed in response to disease, critics such as Moynihan argue that medical conditions are frequently created by pharmaceutical giants to match currently available products. Make people afraid of getting sick and the drugs will fly off the shelves.

Fear Sells

Barbara Mintzes, member of the University of British Columbia’s Therapeutics Initiative, which provides doctors with evidence-based information on “rational drug therapy,” believes the ad for Lipitor–manufactured by Pfizer?promotes the fear of death to sell a product.”
Another Lipitor advertisement, featuring a man lounging in a pool while a shark swims beneath him, reads: “Living with high cholesterol? You could be surprised at what’s lurking beneath.”

Mintzes’ response to this ad: “The major message is the same: You’d better watch out or you could die at any minute.”

“Disease-awareness advertising is often the face of commercial influences,” she adds. Severe shyness only became known as social anxiety disorder after GlaxoSmithKline’s Paxil was approved to treat it. Estimated prevalence rates rose following the company’s awareness campaigns.

Cultivating Concern

Dr. Peter Laurie is the deputy director of Public Citizen’s health research group, a Washington, DC-based public interest organization. He says a common strategy to sell products is to foster widespread worry.

“The whole purpose of disease mongering is two-pronged,” Laurie says. “First, it’s to get doctors to consider new entities as real diseases, and secondly…to play up areas in which some group is likely to feel aggrieved, for people to say that their doctors were not taking them seriously. Female sexual dysfunction, for instance, plays upon the notion that sexual concerns were being ignored by doctors. And the route to greater sensitivity is to be prescribed a drug by them.”

Duty to Educate?

Some might argue that increased awareness of any potential illness is a good thing and that screening is beneficial if it leads to early diagnosis. Concurrently, drug companies maintain they have a duty to educate the public.

“We realize that not every medicine is for every person,” a spokes-woman for GlaxoSmithKline tells BusinessWeek magazine in May 2006. “We’re confident that doctors consulting with patients will assess their health care issues...and make an appropriate decision.”

Diagnostics can be Dangerous

California doctor Julian Whitaker argues that screening can be more dangerous than the disease itself. As he states in the July 2006 issue of his Health & Healing newsletter, nearly 784,000 Americans die every year from adverse effects of drugs, medical procedures, and hospitalizations. “Screening tests are the first step on the slippery slope of medical intervention,” he writes.

According to a 2002 issue of the Medical Journal of Australia, if a healthy individual is subjected to 10 unnecessary tests, there is a 40 percent chance of at least one false-positive result.

“Every diagnostic test has a certain false-negative and a false-positive rate,” UBC’s Mintzes says. “You have to look at how likely that test is going to be to give you an accurate result.” 

Besides causing significant stress, false-positives lead to further procedures, which strain heavily burdened public health care systems. In an era when people view themselves as consumers who want to have a say in their treatment, the demand for medical tests is easily met in private settings.

Ethics in Testing

People can pay for genetic tests, for example, to look for disease. An Asheville, North Carolina, company called Great Smokies Diagnostic Laboratory offers a “Genovations” test, which, according to its website, “empowers physicians and patients to realize earlier, more effective preventive interventions–years before disease develops” and for doctors to arrange “precise, customized therapies that truly address each individual’s needs.”

GeneWatch UK, a public interest group that monitors genetic technology, calls the company’s claims unethical. “Selling supplements, medicines, and follow-up tests to people based on their genetic makeup means treating them for illnesses they do not have but are worried they will get,” its website states. “At best, this is exploiting people’s fears in order to make a profit.”

“Disease mongering,” Mintzes says, “is easier to spot in the States, which, unlike Canada, allows direct-to-consumer advertising.” But fear tactics can be far more subtle than in-your-face commercials.

It’s no wonder so many awareness campaigns are springing up. Take the National Cervical Cancer Public Education Campaign, which sponsors January’s Cervical Cancer Screening Month. The campaign’s website explains that the disease, which can be caused by the human papillomavirus (HPV), “robs some women of the ability to bear children and threatens the lives of young mothers.” It adds: “Most women will be exposed to HPV during their lifetime.”

What’s the good news, according to the site? There’s a vaccine that prevents certain types of HPV. The campaign recommends routine vaccination for all 11- and 12-year-old girls. One line on the web page notes that the campaign’s patient education programs are funded in part by GlaxoSmithKline and Merck & Co., Inc.–which both make the vaccine.

Media’s Role

Among the studies in last year’s PLoS Medicine journal was “Giving Legs to Restless Legs: A Case Study of How the Media Helps Make People Sick,” by Steven Woloshin and Lisa M. Schwartz from Hanover, New Hampshire’s Center for the Evaluative Clinical Sciences.

Symptoms of restless legs include an urge to move the legs due to an unpleasant feeling in them–primarily occurring at night, it often causes sleep disruption. Treatment includes benzodiazepines and dopamine agonists. In 2003 Glaxo launched an awareness campaign about the condition.

Woloshin and Schwartz say many journalists exaggerated the disease’s prevalence and overstated the benefits of treatment while minimizing the harms. Several directed readers to the “nonprofit” Restless Legs Syndrome Foundation for further information without mentioning that the organization is subsidized by GlaxoSmithKline.

“The media seemed to have been co-opted into the disease-mongering process,” the authors say. “It is easy to understand why the media would be attracted to disease promotion stories and why they would be covered uncritically. The stories are full of drama: a huge but unrecognized public health crisis, compelling personal anecdotes, uncaring or ignorant doctors, and miracle cures.”

Separating Fact from Disease Mongering

How can people distinguish between quality information and disease mongering?

Mintzes advises skepticism. “When looking for reliable information, make sure the source does not have a financial incentive to sell you a particular product,” she says. “Beware of very inflated claims regarding the number of people affected by a particular disease.”

Dr. Whitaker suggests avoiding free health screenings sponsored by hospitals or clinics, since they’re simply marketing ploys. Plus, if you’ve been told to take a drug following a screening test, get a second opinion.

Instead of getting taken in by fear-inducing ads, consider that you might be healthier than you’ve been led to believe.