Archive for the ‘inventing disease’ Category

Re-Defining or Inventing Disease:The Medicalization of America

Sunday, January 27th, 2008

In 1978 in a remarkably candid Fortune article Henry Gadsden, CEO of Merck announced he would like to see his pharmaceutical giant “be more like chewing gum maker Wrigleys” since it had long been his dream to make drugs for healthy people, so Merck would then be able to “sell to everyone.” Ten years later, Lynn Payer would write on Disease-Mongering: “…widening the boundaries of illness: the selling of sickness, and growing the markets for those who sell and deliver treatments.”

Mistaking medical treatment for health care, we are deluged with redefinitions of such universal life experiences as personality quirks, now “social anxiety disorder,” and minor gastrointestinal complaints, re-defined and expanded into GI reflux and irritable bowel syndrome. Moreover, normal muscle aches and pains become “fibromyalgia” and even risk factors such as high cholesterol, are being defined as disease. The very concepts of health and illness are being reframed, resulting in a spectrum of normal complaints and behavior routinely being advertised as widespread, severe, and treatable with medication.

We are learning how informal alliances of pharmaceutical corporations, public relations companies, doctors’ groups, policy makers, and patient advocates promote these ideas to the public.* Along with the media these alliances popularize previously little-known conditions, such as “restless leg syndrome.” In some cases large diagnostic categories have been defined, for example, “female sexual dysfunction” where there has been a serious attempt to convince the American public that 43% of women live with this condition.

The case for bigger and better erections resulted in a $2 billion a year sales of Viagra when Pfizer redefined erectile dysfunction to include men of virtually any age going out on a date. Then there is the Eli Lilly–sponsored promotion of “premenstrual dysphoric disorder,” regarded by many as a nonexistent condition, to help sell their renamed version of the antidepressant Prozac© (rebranded as Serafem©)

More on disease mongering and other redefined or expanded conditions can be seen at the Public Library of Science (PLOS) website.

*This is not to deny there exists large numbers of Patients who can be helped by the publicity and marketing devoted to their disorder and its treatment. I admit the issue resolves finally into a circular argument: the definition of a patient depends on how or who defines his disease or condition.

Creating Diseases

Friday, January 25th, 2008

An archipelago of unexplained symptoms is the reason for over 100 million doctor visits a year. A vast medical literature indicates that certain complaints, often described as “unexplained” are exceedingly common in the general population. The word “somatization”, more accurate and less stigmatizing than hypochondriais, describes patients whose emotional problems seem to be translated into bodily (somatic) complaints. Large studies have shown that 80% or more of all healthy people experience at one time or another a virtual mixed salad of bodily symptoms. Among the most common ingredients are: joint and muscle aches and pains,fatigue, weakness, irritability, faintness or dizziness, headaches, insomnia, sleepiness, nausea, constipation, diarrhea, sweating, etc. What most of these complaints have in common is their unexplained occurrence, their lack of abnormal physical or laboratory findings, and most important of all, their usually benign clinical course.

Some of these complaints, once they receive a name from the medical establishment form a new church called “diagnosis,” and overnight millions of new converts appear out of the previously healthy population. These co-religionists, now termed “patients” flock to doctors, buy new drugs fashioned for their disease, form support and advocacy groups, and metastasize into web sites. On balance this may not turn out to be a bad thing. After all, millions of sufferers now have a Name for their complaint, physicians and drug companies to nurture them, and, above all social respectability.

On the other hand, for those who question whether certain complaints are indeed a new disease, the issue often comes down to economics. Do doubters have the right to deny fellow citizens the wellness ritual: drugs, diets, and doctors, even if the cost threatens to bankrupt the healthcare system?

For my part, I am anxiously awaiting breakthrough medical articles on “Age-Related Stress Envelopment” or ARSE, previously known as midlife crisis. Then I can finally obtain health insurance coverage for this disabling condition.