Farmaceutische maffia verzint ziektes

[Steffie]

"Farmaceutische sector verzint ziektes"


Farmaceutische bedrijven verzinnen ziektes en overdrijven de ernst van relatief kleine gezondheidsproblemen om meer winst te maken. Ze zorgen ervoor dat gezonde mensen zich patiënt voelen en meer medicijnen gebruiken. Dat constateren onderzoekers van de Newcastle-universiteit in de Australische stad Callaghan.

De geneesmiddelenindustrie produceert zware medicijnen tegen onder meer de hyperactiviteitsstoornis ADHD en het Restless legs syndroom (onrustige benen). Verder 'medicaliseren' farmaceutische bedrijven reguliere gezondheidsproblemen zoals de overgang.

De resultaten van het onderzoek zijn dinsdag gepubliceerd in het Amerikaanse tijdschrift Public Library of Science Medicine.

Het Laatste Nieuws

U vertrouwt toch ook die lieve dokter of specialsit met zijn gratis monstertjes die het beste met u voor heeft... </STRONG></EM></U></I></B>

[Pieke]

Oorspronkelijk geplaatst door Steffie

U vertrouwt toch ook die lieve dokter of specialsit met zijn gratis monstertjes die het beste met u voor heeft... </STRONG></EM></U></I></B>

u schiet hier op de verkeerden hoor. De overgrote meerderheid der huisdokters of specialisten hebben echt wel het beste met u voor.

[Turkje]

Sinds wanneer is ADHD een "denkbeeldige ziekte"?

(ik ontken niet dat er ouders rondlopen die te onpas strooien met dat begrip als het om hunne kleine gaat, maar dat is een andere zaak)

[Heftruck]

Oorspronkelijk geplaatst door Steffie

"Farmaceutische sector verzint ziektes"


Farmaceutische bedrijven verzinnen ziektes en overdrijven de ernst van relatief kleine gezondheidsproblemen om meer winst te maken. Ze zorgen ervoor dat gezonde mensen zich patiënt voelen en meer medicijnen gebruiken. Dat constateren onderzoekers van de Newcastle-universiteit in de Australische stad Callaghan.

De geneesmiddelenindustrie produceert zware medicijnen tegen onder meer de hyperactiviteitsstoornis ADHD en het Restless legs syndroom (onrustige benen). Verder 'medicaliseren' farmaceutische bedrijven reguliere gezondheidsproblemen zoals de overgang.

De resultaten van het onderzoek zijn dinsdag gepubliceerd in het Amerikaanse tijdschrift Public Library of Science Medicine.

Het Laatste Nieuws

U vertrouwt toch ook die lieve dokter of specialsit met zijn gratis monstertjes die het beste met u voor heeft... </STRONG></EM></U></I></B>

1 woord: idioot.

Dit "nieuwsbericht" is weer volledig in lijn met de antipharmaceutische gezindheid gestart door staatskrapuul Demotte om de sector kapot te maken. Geweldige bron trouwens...

[Black Cat]

Oorspronkelijk geplaatst door Heftruck

1 woord: idioot.

Dit "nieuwsbericht" is weer volledig in lijn met de antipharmaceutische gezindheid gestart door staatskrapuul Demotte om de sector kapot te maken. Geweldige bron trouwens...

Publiceert Demotte in Amerikaanse tijdschriften? (Ik kan de vent ook niet hebben, dat is het niet)

[Heftruck]

Oorspronkelijk geplaatst door Black Cat

Publiceert Demotte in Amerikaanse tijdschriften? (Ik kan de vent ook niet hebben, dat is het niet)

Oorspronkelijk geplaatst door Steffie

Het Laatste Nieuws

[Flippend Rund]

De farmaciesector is uw vriend. Ze zijn helemaal niet geïnteresseerd in super-winsten, enkel in uw welzijn en geluk!

En neem intussen nog een pilletje

[Heftruck]

Oorspronkelijk geplaatst door Steffie

U vertrouwt toch ook die lieve dokter of specialsit met zijn gratis monstertjes die het beste met u voor heeft...

Ja, ik vertrouw mijn dokter. Die man heeft langer gestudeerd dan de meesten onder ons ooit zullen doen. Ja, ik vertrouw de specialist. Die man heeft langer gestudeerd dan de meesten onder ons ooit zullen doen.

In tegenstelling tot zovelen hier weet ik wel hoe de gezondheidszorg in België werkt. In tegenstelling tot zovelen weet ik wel hoe de gezondheidszorg in België kapotgemaakt wordt.

[Heftruck]

Oorspronkelijk geplaatst door Flippend Rund

De farmaciesector is uw vriend.

Klopt. Ik heb veel aan ze danken. Maar dat zijn u zaken niet.

Oorspronkelijk geplaatst door Flippend Rund

Ze zijn helemaal niet geïnteresseerd in super-winsten

Klopt. Maar ook zij hebben lonen, productie, onderzoek, aandeelhouders, enz... te betalen. Waar haal jij die superwinsten vandaan? De propagandamolen?

Oorspronkelijk geplaatst door Flippend Rund

enkel in uw welzijn en geluk!

En dat heb ik al kunnen ondervinden hoor.

Oorspronkelijk geplaatst door Flippend Rund

En neem intussen nog een pilletje

Bedankt. Vanmorgen eentje tegen keelpijn, vorige week eentje tegen hoofdpijn. Ik zou niet weten wat gedaan te hebben zonder.

[carlgustaaf]

Oorspronkelijk geplaatst door Heftruck

Ja, ik vertrouw mijn dokter. Die man heeft langer gestudeerd dan de meesten onder ons ooit zullen doen. Ja, ik vertrouw de specialist. Die man heeft langer gestudeerd dan de meesten onder ons ooit zullen doen.

In tegenstelling tot zovelen hier weet ik wel hoe de gezondheidszorg in België werkt. In tegenstelling tot zovelen weet ik wel hoe de gezondheidszorg in België kapotgemaakt wordt.

in één zin: Gij hebt de wijsheid in pacht.Bravo...

[/\|cazar]

Oorspronkelijk geplaatst door carlgustaaf

in één zin: Gij hebt de wijsheid in pacht.Bravo...

Niet mee beginnen, laat het flutvolkje in zijn geloof.

Pillen zijn goed voor U,


Langs de andere kant is de moderne geneeskunde de grootste killer in de Westerse Wereld.

Santé.

[carlgustaaf]

met vaccinatie moet je goed opletten!Ik denk aan de reklame die gemaakt is voor het vaccineren tegen hepatitis B.Daarna kwam het uit dat talrijke mensen door deze inenting zwaar ziek geworden waren.
Volgens sommigen is ook Aids ontstaan door vaccinaties die uit de hand gelopen zijn, maar daar kan ik geen bewijzen voor aanvoeren.

[/\|cazar]

http://medicine.plosjournals.org/per...l.pmed.0020124

http://collections.plos.org/diseasemongering-2006.php

The Fight against Disease Mongering: Generating Knowledge for Action

Ray Moynihan, David Henry*
Ray Moynihan and David Henry are the guest editors of the April 2006 theme issue of PLoS Medicine on disease mongering. Ray Moynihan is a journalist, documentary maker, author, and conjoint lecturer at the University of Newcastle, Newcastle, New South Wales, Australia, and recently co-authored Selling Sickness: How the World's Biggest Pharmaceutical Companies Are Turning Us All into Patients (Nation Books, New York, 2005). David Henry is a professor of clinical pharmacology at the University of Newcastle, Newcastle, New South Wales, Australia, and co-founder of Media Doctor (http://www.mediadoctor.org.au), a Web site that monitors media coverage of medicine.
Funding: RM received a commissioning fee from PLoS to write this article, and to serve as a guest editor, but RM and DH received no other specific funding for this piece.
Competing Interests: The authors declare that they have no competing interests.
Published: April 11, 2006
DOI: 10.1371/journal.pmed.0030191
Copyright: © 2006 Moynihan and Henry. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Citation: Moynihan R, Henry D (2006) The Fight against Disease Mongering: Generating Knowledge for Action. PLoS Med 3(4): e191
* To whom correspondence should be addressed. E-mail: [email protected]
Disease mongering turns healthy people into patients, wastes precious resources, and causes iatrogenic harm. Like the marketing strategies that drive it, disease mongering poses a global challenge to those interested in public health, demanding in turn a global response. This theme issue of PLoS Medicine is explicitly designed to help provoke and inform that response.
What Is Disease Mongering?

The problem of disease mongering is attracting increasing attention [1–3], though an adequate working definition remains elusive. In our view, disease mongering is the selling of sickness that widens the boundaries of illness and grows the markets for those who sell and deliver treatments. It is exemplified most explicitly by many pharmaceutical industry–funded disease-awareness campaigns—more often designed to sell drugs than to illuminate or to inform or educate about the prevention of illness or the maintenance of health. In this theme issue and elsewhere, observers have described different forms of disease mongering: aspects of ordinary life, such as menopause, being medicalised; mild problems portrayed as serious illnesses, as has occurred in the drug-company-sponsored promotion of irritable bowel syndrome (see pp. 156–174 in [2]; [4]) and risk factors, such as high cholesterol and osteoporosis, being framed as diseases.
Drug companies are by no means the only players in this drama. Through the work of investigative journalists, we have learned how informal alliances of pharmaceutical corporations, public relations companies, doctors' groups, and patient advocates promote these ideas to the public and policymakers—often using mass media to push a certain view of a particular health problem. While these different stakeholders may come to these alliances with different motives, there is often a confluence of interests—resulting in health problems routinely being framed as widespread, severe, and treatable with pills, as has happened recently with social anxiety disorder [5]. Currently, these alliances are working with the media to popularize little-known conditions, such as restless legs syndrome [6] and female sexual dysfunction [7], in each case lending credence to inflated prevalence estimates. In the case of female sexual dysfunction, there has been a serious, though heavily contested, attempt to convince the public in the United States that 43% of women live with this condition (see pp. 175–195 in [2]). This is happening at a time when pharmaceutical companies perceive a need to build and maintain markets for their big-selling products and when pipelines for new and genuinely innovative medicines are perceived as being weak.
“The coming years will bear greater witness to the corporate sponsored creation of disease.”

A Context for Disease Mongering

Three decades ago, Ivan Illich argued polemically that the medical establishment was “medicalising” life itself [8], and in the 1990s Lynn Payer described widening the boundaries of illness as “disease mongering” [3], highlighting the role of pharmaceutical companies. Today's debate about this phenomenon, while still maturing, both acknowledges the axiomatic interest of corporations and professionals in maximizing turnover and appreciates that well-informed citizens may choose to embrace the medicalisation of health problems previously regarded as troublesome inconveniences.
It can also be argued that disease mongering is the opportunistic exploitation of both a widespread anxiety about frailty and a faith in scientific advance and “innovation”—a powerful economic, scientific, and social norm. In many nations, government policy priority is to secure market-based economic development, while more equitable social policies, such as public health strategies, can become subordinate or redundant. Disease mongering can thrive in such a normative environment. The practical consequences are that many of the so-called disease-awareness campaigns that inform our contemporary understanding of illness—whether as citizens, journalists, health professionals, industry leaders, academics, or policymakers—are now underwritten by the marketing departments of large drug companies rather than by organizations with a primary interest in public health. And it is no secret that those same marketing departments contract advertising agencies with expertise in “condition branding,” whose skills include “fostering the creation” of new medical disorders and dysfunctions [9]. As a recent Reuters Business Insight report on so-called lifestyle drugs— designed to be read by pharmaceutical industry leaders—pointed out, “The coming years will bear greater witness to the corporate sponsored creation of disease” [10]. We hope the coming years will also bear witness to a much more vigorous effort from within civil society to understand and to challenge that corporate process.
Problems Defining Disease Mongering

While the term “disease mongering” is now commonly used as shorthand to describe campaigns that inappropriately widen the boundaries of treatable illness, there is uncertainty about how to operationally define the concept. With most disorders or conditions, there will be a number of individuals who suffer severe forms of the problem, who will benefit greatly from treatment and may be helped enormously by the publicity and marketing given to both the treatment and the disorder. For example, industry-funded awareness raising about the treatment and prevention of HIV/AIDS has surely been valuable. But in other cases, the same marketing/awareness-raising campaign will be viewed very differently depending on the perspective of the observer: what an industry-linked professional group may consider to be legitimate public education about an underdiagnosed disease, an activist group free from industry sponsorship may regard as a crude attempt to build markets for potentially dangerous drugs.
The Eli Lilly–sponsored promotion of premenstrual dysphoric disorder to help sell a re-branded version of fluoxetine (rebranded from Prozac to Sarafem) is a case in point (see pp. 99–118 in [2]). Considered by some as a serious psychiatric illness, premenstrual dysphoric disorder is regarded by others as a condition that does not exist.
These discordant views of the same activity reinforce the fact that there are often different motives for the different individuals who get caught up in disease-mongering campaigns. In the pharmaceutical industry and in the public relations companies that serve them, the marketers often now dominate. But these corporations are not heterogeneous, and staff working in research or medical departments may express the same doubts as many working outside industry. For their part, the motives of health professionals and health advocacy groups may well be the welfare of patients, rather than any direct self-interested financial benefit, but we believe that too often marketers are able to crudely manipulate those motivations. Disentangling the different motivations of the different actors in disease mongering will be a key step towards a better understanding of this phenomenon.
Generating Better Knowledge

The views in this article are based on observations and interpretation informed by interviews with stakeholders and other more journalistic research methods, rather than a deeper academic investigation that employs qualitative and quantitative research techniques. Before embarking on research agendas to investigate disease mongering and its impacts, a broader conception of the phenomenon is warranted—requiring researchers to explore the uncertainty surrounding the definition of the problem, how and why different stakeholders understand it differently, and the deeper social and economic contexts. For example, the broad shift away from government-run programs and towards the marketplace within social democracies worldwide, and the consequent commercialisation and commodification of health services, may be a useful framework for a more profound explanation of this problem. In a climate where governments are encouraging corporations to vigorously pursue for-profit activities within the health-care sector, it is hardly surprising that pharmaceutical companies will use a range of promotional activities to widen the definitions of disease in order to grow the potential markets for their products.
Most people in Western countries take medication to treat or prevent illness or enhance well-being

(Illustration: Anthony Flores)

Along with deeper reflection, we suggest researchers start to develop strategies for generating data on the impact of disease mongering. More conventional health-science methodologies may prove to be valuable ways of investigating the potential influences of a disease-marketing campaign on outcomes such as public perceptions of a particular disease, prevalence/incidence rates for that disease, prescription patterns for the drugs linked to that disease, and even health status of those diagnosed with and/or treated for that disease. Multisite controlled studies of drug company–funded disease-awareness campaigns would be the ideal. However, defining appropriate control groups and devising indices to measure outcomes such as inappropriate medicalisation will prove extremely challenging since almost everyone is exposed to disease mongering in some form. Similarly, rigorous studies of publicly funded “counter-detailing”—where noncommercially oriented information about disease is promoted to physicians and citizens—may be warranted, though, again, it is very difficult methodologically.
A challenge to the excesses of disease mongering may come from within the industry.

Apart from these more challenging approaches, we believe there is a range of research projects that are both achievable and urgently needed. First, academic investigation of the prevalence of this problem would be highly desirable. Researchers could, for example, take a group of the most common (high-burden) diseases/conditions, and investigate how and why the definitions of those diseases/conditions have changed over time in different nations. Such retrospective investigations could include analysis of the decisions and recommendations of the panels that define and redefine illness, the evidence informing those decisions, the conflicts of interest of panel members and their respective professional bodies, and the sponsorship of these processes. Early versions of this investigation are happening in a random, ad hoc way [11], but a coordinated systematic effort by a multinational group of respected researchers or research institutes is obviously preferable. As part of such an examination, a series of case studies would inevitably emerge, warranting deeper study and research and serving as a way to popularize awareness of the process of disease mongering.
Another potentially rich research method might involve a prospective study of the launch of a new or recently expanded disease or condition. A global collaboration could, for example, study the way female sexual dysfunction is being constructed and then promoted. “Creating the need” is now an established and integral part of the promotion of any new blockbuster drug, and sometimes that involves introducing a whole new condition to the wider public [12]. The success of sildenafil depended on corporate-funded disease-awareness campaigns promoting erectile dysfunction [13], and similarly the commercial success of any pharmaceutical treatments for female sexual dysfunction will hang in part on similar campaigns. While activists and scholars have begun the process of observing these activities, it is our view that the magnitude of public and private resources spent on these products, the potential harm that can flow from inappropriate medicalisation, and the opportunity cost in terms of treating and preventing genuine pathology demands more rigorous scientific investigation.
Time for Action?

Around the world, there are tentative steps to identify, understand, and combat the threat to human health from the corporate-sponsored selling of sickness. These small steps are being taken by several players within the health field, and we trust this theme issue may support and augment these developments.
At a consumer level, Health Action International (http://www.haiweb.org)—the activist group working for a more rational use of medicines globally—has for a long time been concerned about what it has described as the blurring of boundaries between ordinary life and medical illness in order to expand markets for drugs and other technologies [14]. Unlike many patient advocacy groups, Health Action International does not accept pharmaceutical company sponsorship, and actively warns others about the threats to independence from doing so [15]. By way of contrast, many consumer/advocacy groups around the world now rely on such funding [16], raising questions about their credibility, particularly as they are often used as the human face of disease-awareness campaigns sponsored by their funders. An open debate within the health consumer movement about its close engagement with industry, and its involvement in disease mongering, would be welcome.
Likewise, amongst journalist circles, there are nascent debates about the media's propensity to exaggerate disease prevalence and severity, and how to deal with this problem. In this issue of PLoS Medicine, two high-profile scholars with an interest in the area of medicine and the media, Lisa Schwartz and Steven Woloshin, present a timely and relevant case study on the “selling” of restless legs syndrome [6]. In Australia and Canada, a new media watch group called Media Doctor is also investigating the extent to which media stories on medicine either report appropriately on the nature and extent of illness or tend to simply regurgitate the promotional messages of disease-mongering campaigns (http://www.mediadoctor.org.au).
While many professional organizations remain reliant on industry support, some are actively debating the problem of disease mongering. In a submission to the recent House of Commons inquiry into the influence of the pharmaceutical industry in Britain, the Royal College of General Practitioners outlined serious concerns about the process [17]. The subsequent report recommended that industry-funded disease-awareness campaigns should no longer be “veiled advertising” of branded drugs [18].
Shareholders in the world's large pharmaceutical companies have the strongest financial interest in widening the boundaries of treatable illness in order to widen markets for their products. Yet in the debate about research and development for treatments for neglected diseases in the developing world, there are strong signs that shareholders can support policies driven by motivations other than profit [19]. It may be that as key shareholders and company executives alike understand more of the implications of what their marketing departments do, a challenge to the excesses of disease mongering may come from within industry, just as other parts of the health sector challenge excesses of disease mongering from within.
Conclusion

Genuine sustainable change, however, will not come until policymakers better understand the phenomenon of disease mongering and the potential benefits of responding against it. In Australia, for example, it has been estimated that winding back the public subsidy for inappropriate prescriptions of several high-profile drugs to people with milder health problems could save hundreds of millions of dollars per year [20]. Those responsible for managing Australia's publicly funded national formulary, the Pharmaceutical Benefits Scheme, have become increasingly concerned about what is described as “leakage”—the process where subsidised drugs are prescribed by physicians to people for whom use of the drug has been deemed not cost-effective because of a poor cost–benefit ratio. We suspect that the estimated hundreds of millions of dollars of public money wasted on leakage in Australia annually is in part a result of drug companies promoting their products, through physicians, to people with mild problems for whom a powerful prescription may be unnecessary or even do more harm than good. In summary, combating disease mongering may improve the personal health of individuals, as well as the financial health of public (and private) insurers.
As an initial step toward combating disease mongering at a health policy level, we would urge decision makers to promote a renovation in the way diseases are defined. Continuing to leave these definitions to panels of self-interested specialists riddled with professional and commercial conflicts of interest is no longer viable. As a priority, new panels should be assembled, free of commercial conflicts of interest, involving a much wider, and less self-interested, group of players, who would ultimately generate more credible information.
Until a rigorous research agenda is initiated, and the social renovations and policy reforms that research might inform are enacted and evaluated, our beliefs, like those who argue for the benefits of corporate-sponsored disease-awareness campaigns, will remain based more on opinion than evidence. We hope this theme issue can start to change that.
References

1. Moynihan R, Heath I, Henry D (2002) Selling sickness: The pharmaceutical industry and disease-mongering. BMJ 324: 886–891. Find this article online
2. Moynihan R, Cassels A (2005) Selling sickness: How the worlds biggest pharmaceutical companies are turning us all into patients. New York: Nation Books. 254 p.
3. Payer L (1992) Disease-mongers: How doctors, drug companies, and insurers are making you feel sick. New York: Wiley and Sons. 292 p.
4. Moynihan R (2002) Alosteron: A case study in regulatory capture or a victory for patients rights? BMJ 325: 592–595. Find this article online
5. Koerner B (2002) Disorders made to order. Mother Jones 27: 58–63. Find this article online
6. Woloshin S, Schwartz LM (2006) Giving legs to restless legs: A case study of how the media helps make people sick. PLoS Med 3: e170 DOI: 10.1371/journal.pmed.0030170. Find this article online
7. Tiefer L (2006) Female sexual dysfunction: A case study of disease mongering and activist resistance. PLoS Med 3(4): e178 DOI: 10.1371/journal.pmed.0030178. Find this article online
8. Illich I (1976) Limits to medicine. London: Penguin. 294 p.
9. Parry V (2003) The art of branding a condition. Med Mark Media 38: 43–49. Find this article online
10. Coe J (2003) Healthcare: The lifestyle drugs outlook to 2008, unlocking new value in well-being. London: Reuters Business Insight. 243 p.
11. Moynihan R (2004) The intangible magic of celebrity marketing. PLoS Med 1: e42 DOI: 10.1371/journal.pmed.0010042. Find this article online
12. Moynihan R (1998) Too much medicine. Sydney: ABC Books. 308 p.
13. Lexchin J (2006) Bigger and better: How Pfizer redefined erectile dysfunction. PLoS Med 3: e132 DOI: 10.1371/journal.pmed.0030132. Find this article online
14. Mintzes B (1998) Blurring the boundaries. Amsterdam: Health Action Internatonal. Available: http://haiweb.org/pubs/blurring/blurring.intro.html. Accessed 7 March 2006.
15. Health Action International (1999) The ties that bind: Weighing the risks and benefits of pharmaceutical industry sponsorship. Amsterdam: Health Action International. Available: http://www.haiweb.org/campaign/spon/toc.html. Accessed 7 March 2006.
16. Health and Social Campaigners News International (2004 April) Health campaigners, fundraising and the growth of industry involvement. Knighton (Wales): Patient View. 57 p.
17. Royal College of General Practitioners [RCGP] (2004 August 17) RCGP warns against unhealthy pharmaceutical industry. London: RCGP. Available: http://www.rcgp.org.uk/default.aspx?page=1609. Accessed 7 March 2006.
18. House of Commons Health Committee (2005) The influence of the pharmaceutical industry: Fourth report of session 2004–2005. London: House of Commons. Available: http://www.lindalliance.org/pdfs/HofCHealthCommittee.pdf. Accessed 7 March 2006.
19. Moran M (2005) A breakthrough in R&D for neglected diseases: A new way to get the drugs we need. PLoS Medicine 2: e302 DOI: 10.1371/journal.pmed.0020302. Find this article online
20. Moynihan R, Murphy K (2002 March 18) Doctors causing a drug costs blowout. Australian Financial Review: 1.

[Flippend Rund]

Oorspronkelijk geplaatst door Heftruck

Klopt. Ik heb veel aan ze danken. Maar dat zijn u zaken niet.

Klopt. Maar ook zij hebben lonen, productie, onderzoek, aandeelhouders, enz... te betalen. Waar haal jij die superwinsten vandaan? De propagandamolen?

ik beweer ook niet dat de farma-sector in dit opzicht slechter is dan gelijk welke andere economische sector. Maar we moeten ons ook geen illusies maken dat ze een haar beter zijn. Winstmaximalisatie en eeuwige vergroting van de afzetmarkt is wat hen drijft. Cash rules and money talks.

De autosector wil graag aanpraten dat we allemaal 2 auto's nodig hebben. De farma-sector wil ons graag aanpraten dat we niet zonder pillen door het leven kunnen. Ik ben zeker niet tegen de farmacie, ik zeg enkel dat we ons bewust moeten zijn van die dingen.

Bedankt. Vanmorgen eentje tegen keelpijn, vorige week eentje tegen hoofdpijn. Ik zou niet weten wat gedaan te hebben zonder.

[duveltje382]

Oorspronkelijk geplaatst door /\|cazar

http://medicine.plosjournals.org/per...l.pmed.0020124

http://collections.plos.org/diseasemongering-2006.php

The Fight against Disease Mongering: Generating Knowledge for Action

Ray Moynihan, David Henry*
Ray Moynihan and David Henry are the guest editors of the April 2006 theme issue of PLoS Medicine on disease mongering. Ray Moynihan is a journalist, documentary maker, author, and conjoint lecturer at the University of Newcastle, Newcastle, New South Wales, Australia, and recently co-authored Selling Sickness: How the World's Biggest Pharmaceutical Companies Are Turning Us All into Patients (Nation Books, New York, 2005). David Henry is a professor of clinical pharmacology at the University of Newcastle, Newcastle, New South Wales, Australia, and co-founder of Media Doctor (http://www.mediadoctor.org.au), a Web site that monitors media coverage of medicine.
Funding: RM received a commissioning fee from PLoS to write this article, and to serve as a guest editor, but RM and DH received no other specific funding for this piece.
Competing Interests: The authors declare that they have no competing interests.
Published: April 11, 2006
DOI: 10.1371/journal.pmed.0030191
Copyright: © 2006 Moynihan and Henry. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Citation: Moynihan R, Henry D (2006) The Fight against Disease Mongering: Generating Knowledge for Action. PLoS Med 3(4): e191
* To whom correspondence should be addressed. E-mail: [email protected]
Disease mongering turns healthy people into patients, wastes precious resources, and causes iatrogenic harm. Like the marketing strategies that drive it, disease mongering poses a global challenge to those interested in public health, demanding in turn a global response. This theme issue of PLoS Medicine is explicitly designed to help provoke and inform that response.
What Is Disease Mongering?

The problem of disease mongering is attracting increasing attention [1–3], though an adequate working definition remains elusive. In our view, disease mongering is the selling of sickness that widens the boundaries of illness and grows the markets for those who sell and deliver treatments. It is exemplified most explicitly by many pharmaceutical industry–funded disease-awareness campaigns—more often designed to sell drugs than to illuminate or to inform or educate about the prevention of illness or the maintenance of health. In this theme issue and elsewhere, observers have described different forms of disease mongering: aspects of ordinary life, such as menopause, being medicalised; mild problems portrayed as serious illnesses, as has occurred in the drug-company-sponsored promotion of irritable bowel syndrome (see pp. 156–174 in [2]; [4]) and risk factors, such as high cholesterol and osteoporosis, being framed as diseases.
Drug companies are by no means the only players in this drama. Through the work of investigative journalists, we have learned how informal alliances of pharmaceutical corporations, public relations companies, doctors' groups, and patient advocates promote these ideas to the public and policymakers—often using mass media to push a certain view of a particular health problem. While these different stakeholders may come to these alliances with different motives, there is often a confluence of interests—resulting in health problems routinely being framed as widespread, severe, and treatable with pills, as has happened recently with social anxiety disorder [5]. Currently, these alliances are working with the media to popularize little-known conditions, such as restless legs syndrome [6] and female sexual dysfunction [7], in each case lending credence to inflated prevalence estimates. In the case of female sexual dysfunction, there has been a serious, though heavily contested, attempt to convince the public in the United States that 43% of women live with this condition (see pp. 175–195 in [2]). This is happening at a time when pharmaceutical companies perceive a need to build and maintain markets for their big-selling products and when pipelines for new and genuinely innovative medicines are perceived as being weak.
“The coming years will bear greater witness to the corporate sponsored creation of disease.”

A Context for Disease Mongering

Three decades ago, Ivan Illich argued polemically that the medical establishment was “medicalising” life itself [8], and in the 1990s Lynn Payer described widening the boundaries of illness as “disease mongering” [3], highlighting the role of pharmaceutical companies. Today's debate about this phenomenon, while still maturing, both acknowledges the axiomatic interest of corporations and professionals in maximizing turnover and appreciates that well-informed citizens may choose to embrace the medicalisation of health problems previously regarded as troublesome inconveniences.
It can also be argued that disease mongering is the opportunistic exploitation of both a widespread anxiety about frailty and a faith in scientific advance and “innovation”—a powerful economic, scientific, and social norm. In many nations, government policy priority is to secure market-based economic development, while more equitable social policies, such as public health strategies, can become subordinate or redundant. Disease mongering can thrive in such a normative environment. The practical consequences are that many of the so-called disease-awareness campaigns that inform our contemporary understanding of illness—whether as citizens, journalists, health professionals, industry leaders, academics, or policymakers—are now underwritten by the marketing departments of large drug companies rather than by organizations with a primary interest in public health. And it is no secret that those same marketing departments contract advertising agencies with expertise in “condition branding,” whose skills include “fostering the creation” of new medical disorders and dysfunctions [9]. As a recent Reuters Business Insight report on so-called lifestyle drugs— designed to be read by pharmaceutical industry leaders—pointed out, “The coming years will bear greater witness to the corporate sponsored creation of disease” [10]. We hope the coming years will also bear witness to a much more vigorous effort from within civil society to understand and to challenge that corporate process.
Problems Defining Disease Mongering

While the term “disease mongering” is now commonly used as shorthand to describe campaigns that inappropriately widen the boundaries of treatable illness, there is uncertainty about how to operationally define the concept. With most disorders or conditions, there will be a number of individuals who suffer severe forms of the problem, who will benefit greatly from treatment and may be helped enormously by the publicity and marketing given to both the treatment and the disorder. For example, industry-funded awareness raising about the treatment and prevention of HIV/AIDS has surely been valuable. But in other cases, the same marketing/awareness-raising campaign will be viewed very differently depending on the perspective of the observer: what an industry-linked professional group may consider to be legitimate public education about an underdiagnosed disease, an activist group free from industry sponsorship may regard as a crude attempt to build markets for potentially dangerous drugs.
The Eli Lilly–sponsored promotion of premenstrual dysphoric disorder to help sell a re-branded version of fluoxetine (rebranded from Prozac to Sarafem) is a case in point (see pp. 99–118 in [2]). Considered by some as a serious psychiatric illness, premenstrual dysphoric disorder is regarded by others as a condition that does not exist.
These discordant views of the same activity reinforce the fact that there are often different motives for the different individuals who get caught up in disease-mongering campaigns. In the pharmaceutical industry and in the public relations companies that serve them, the marketers often now dominate. But these corporations are not heterogeneous, and staff working in research or medical departments may express the same doubts as many working outside industry. For their part, the motives of health professionals and health advocacy groups may well be the welfare of patients, rather than any direct self-interested financial benefit, but we believe that too often marketers are able to crudely manipulate those motivations. Disentangling the different motivations of the different actors in disease mongering will be a key step towards a better understanding of this phenomenon.
Generating Better Knowledge

The views in this article are based on observations and interpretation informed by interviews with stakeholders and other more journalistic research methods, rather than a deeper academic investigation that employs qualitative and quantitative research techniques. Before embarking on research agendas to investigate disease mongering and its impacts, a broader conception of the phenomenon is warranted—requiring researchers to explore the uncertainty surrounding the definition of the problem, how and why different stakeholders understand it differently, and the deeper social and economic contexts. For example, the broad shift away from government-run programs and towards the marketplace within social democracies worldwide, and the consequent commercialisation and commodification of health services, may be a useful framework for a more profound explanation of this problem. In a climate where governments are encouraging corporations to vigorously pursue for-profit activities within the health-care sector, it is hardly surprising that pharmaceutical companies will use a range of promotional activities to widen the definitions of disease in order to grow the potential markets for their products.
Most people in Western countries take medication to treat or prevent illness or enhance well-being

(Illustration: Anthony Flores)

Along with deeper reflection, we suggest researchers start to develop strategies for generating data on the impact of disease mongering. More conventional health-science methodologies may prove to be valuable ways of investigating the potential influences of a disease-marketing campaign on outcomes such as public perceptions of a particular disease, prevalence/incidence rates for that disease, prescription patterns for the drugs linked to that disease, and even health status of those diagnosed with and/or treated for that disease. Multisite controlled studies of drug company–funded disease-awareness campaigns would be the ideal. However, defining appropriate control groups and devising indices to measure outcomes such as inappropriate medicalisation will prove extremely challenging since almost everyone is exposed to disease mongering in some form. Similarly, rigorous studies of publicly funded “counter-detailing”—where noncommercially oriented information about disease is promoted to physicians and citizens—may be warranted, though, again, it is very difficult methodologically.
A challenge to the excesses of disease mongering may come from within the industry.

Apart from these more challenging approaches, we believe there is a range of research projects that are both achievable and urgently needed. First, academic investigation of the prevalence of this problem would be highly desirable. Researchers could, for example, take a group of the most common (high-burden) diseases/conditions, and investigate how and why the definitions of those diseases/conditions have changed over time in different nations. Such retrospective investigations could include analysis of the decisions and recommendations of the panels that define and redefine illness, the evidence informing those decisions, the conflicts of interest of panel members and their respective professional bodies, and the sponsorship of these processes. Early versions of this investigation are happening in a random, ad hoc way [11], but a coordinated systematic effort by a multinational group of respected researchers or research institutes is obviously preferable. As part of such an examination, a series of case studies would inevitably emerge, warranting deeper study and research and serving as a way to popularize awareness of the process of disease mongering.
Another potentially rich research method might involve a prospective study of the launch of a new or recently expanded disease or condition. A global collaboration could, for example, study the way female sexual dysfunction is being constructed and then promoted. “Creating the need” is now an established and integral part of the promotion of any new blockbuster drug, and sometimes that involves introducing a whole new condition to the wider public [12]. The success of sildenafil depended on corporate-funded disease-awareness campaigns promoting erectile dysfunction [13], and similarly the commercial success of any pharmaceutical treatments for female sexual dysfunction will hang in part on similar campaigns. While activists and scholars have begun the process of observing these activities, it is our view that the magnitude of public and private resources spent on these products, the potential harm that can flow from inappropriate medicalisation, and the opportunity cost in terms of treating and preventing genuine pathology demands more rigorous scientific investigation.
Time for Action?

Around the world, there are tentative steps to identify, understand, and combat the threat to human health from the corporate-sponsored selling of sickness. These small steps are being taken by several players within the health field, and we trust this theme issue may support and augment these developments.
At a consumer level, Health Action International (http://www.haiweb.org)—the activist group working for a more rational use of medicines globally—has for a long time been concerned about what it has described as the blurring of boundaries between ordinary life and medical illness in order to expand markets for drugs and other technologies [14]. Unlike many patient advocacy groups, Health Action International does not accept pharmaceutical company sponsorship, and actively warns others about the threats to independence from doing so [15]. By way of contrast, many consumer/advocacy groups around the world now rely on such funding [16], raising questions about their credibility, particularly as they are often used as the human face of disease-awareness campaigns sponsored by their funders. An open debate within the health consumer movement about its close engagement with industry, and its involvement in disease mongering, would be welcome.
Likewise, amongst journalist circles, there are nascent debates about the media's propensity to exaggerate disease prevalence and severity, and how to deal with this problem. In this issue of PLoS Medicine, two high-profile scholars with an interest in the area of medicine and the media, Lisa Schwartz and Steven Woloshin, present a timely and relevant case study on the “selling” of restless legs syndrome [6]. In Australia and Canada, a new media watch group called Media Doctor is also investigating the extent to which media stories on medicine either report appropriately on the nature and extent of illness or tend to simply regurgitate the promotional messages of disease-mongering campaigns (http://www.mediadoctor.org.au).
While many professional organizations remain reliant on industry support, some are actively debating the problem of disease mongering. In a submission to the recent House of Commons inquiry into the influence of the pharmaceutical industry in Britain, the Royal College of General Practitioners outlined serious concerns about the process [17]. The subsequent report recommended that industry-funded disease-awareness campaigns should no longer be “veiled advertising” of branded drugs [18].
Shareholders in the world's large pharmaceutical companies have the strongest financial interest in widening the boundaries of treatable illness in order to widen markets for their products. Yet in the debate about research and development for treatments for neglected diseases in the developing world, there are strong signs that shareholders can support policies driven by motivations other than profit [19]. It may be that as key shareholders and company executives alike understand more of the implications of what their marketing departments do, a challenge to the excesses of disease mongering may come from within industry, just as other parts of the health sector challenge excesses of disease mongering from within.
Conclusion

Genuine sustainable change, however, will not come until policymakers better understand the phenomenon of disease mongering and the potential benefits of responding against it. In Australia, for example, it has been estimated that winding back the public subsidy for inappropriate prescriptions of several high-profile drugs to people with milder health problems could save hundreds of millions of dollars per year [20]. Those responsible for managing Australia's publicly funded national formulary, the Pharmaceutical Benefits Scheme, have become increasingly concerned about what is described as “leakage”—the process where subsidised drugs are prescribed by physicians to people for whom use of the drug has been deemed not cost-effective because of a poor cost–benefit ratio. We suspect that the estimated hundreds of millions of dollars of public money wasted on leakage in Australia annually is in part a result of drug companies promoting their products, through physicians, to people with mild problems for whom a powerful prescription may be unnecessary or even do more harm than good. In summary, combating disease mongering may improve the personal health of individuals, as well as the financial health of public (and private) insurers.
As an initial step toward combating disease mongering at a health policy level, we would urge decision makers to promote a renovation in the way diseases are defined. Continuing to leave these definitions to panels of self-interested specialists riddled with professional and commercial conflicts of interest is no longer viable. As a priority, new panels should be assembled, free of commercial conflicts of interest, involving a much wider, and less self-interested, group of players, who would ultimately generate more credible information.
Until a rigorous research agenda is initiated, and the social renovations and policy reforms that research might inform are enacted and evaluated, our beliefs, like those who argue for the benefits of corporate-sponsored disease-awareness campaigns, will remain based more on opinion than evidence. We hope this theme issue can start to change that.
References

1. Moynihan R, Heath I, Henry D (2002) Selling sickness: The pharmaceutical industry and disease-mongering. BMJ 324: 886–891. Find this article online
2. Moynihan R, Cassels A (2005) Selling sickness: How the worlds biggest pharmaceutical companies are turning us all into patients. New York: Nation Books. 254 p.
3. Payer L (1992) Disease-mongers: How doctors, drug companies, and insurers are making you feel sick. New York: Wiley and Sons. 292 p.
4. Moynihan R (2002) Alosteron: A case study in regulatory capture or a victory for patients rights? BMJ 325: 592–595. Find this article online
5. Koerner B (2002) Disorders made to order. Mother Jones 27: 58–63. Find this article online
6. Woloshin S, Schwartz LM (2006) Giving legs to restless legs: A case study of how the media helps make people sick. PLoS Med 3: e170 DOI: 10.1371/journal.pmed.0030170. Find this article online
7. Tiefer L (2006) Female sexual dysfunction: A case study of disease mongering and activist resistance. PLoS Med 3(4): e178 DOI: 10.1371/journal.pmed.0030178. Find this article online
8. Illich I (1976) Limits to medicine. London: Penguin. 294 p.
9. Parry V (2003) The art of branding a condition. Med Mark Media 38: 43–49. Find this article online
10. Coe J (2003) Healthcare: The lifestyle drugs outlook to 2008, unlocking new value in well-being. London: Reuters Business Insight. 243 p.
11. Moynihan R (2004) The intangible magic of celebrity marketing. PLoS Med 1: e42 DOI: 10.1371/journal.pmed.0010042. Find this article online
12. Moynihan R (1998) Too much medicine. Sydney: ABC Books. 308 p.
13. Lexchin J (2006) Bigger and better: How Pfizer redefined erectile dysfunction. PLoS Med 3: e132 DOI: 10.1371/journal.pmed.0030132. Find this article online
14. Mintzes B (1998) Blurring the boundaries. Amsterdam: Health Action Internatonal. Available: http://haiweb.org/pubs/blurring/blurring.intro.html. Accessed 7 March 2006.
15. Health Action International (1999) The ties that bind: Weighing the risks and benefits of pharmaceutical industry sponsorship. Amsterdam: Health Action International. Available: http://www.haiweb.org/campaign/spon/toc.html. Accessed 7 March 2006.
16. Health and Social Campaigners News International (2004 April) Health campaigners, fundraising and the growth of industry involvement. Knighton (Wales): Patient View. 57 p.
17. Royal College of General Practitioners [RCGP] (2004 August 17) RCGP warns against unhealthy pharmaceutical industry. London: RCGP. Available: http://www.rcgp.org.uk/default.aspx?page=1609. Accessed 7 March 2006.
18. House of Commons Health Committee (2005) The influence of the pharmaceutical industry: Fourth report of session 2004–2005. London: House of Commons. Available: http://www.lindalliance.org/pdfs/HofCHealthCommittee.pdf. Accessed 7 March 2006.
19. Moran M (2005) A breakthrough in R&D for neglected diseases: A new way to get the drugs we need. PLoS Medicine 2: e302 DOI: 10.1371/journal.pmed.0020302. Find this article online
20. Moynihan R, Murphy K (2002 March 18) Doctors causing a drug costs blowout. Australian Financial Review: 1.

Daar heb ik nu dat ballen van verstaan,heb je niet wat Nederlandstalige lectuur om te lezen

[King of beggars and fleas]

men moet in de eerste plaats altijd zijn eigen docter zijn. Dat begint met een gezond dieet ( =preventie ) . Ga voor een valling of een griepje naar een homeophaat of andere alternatieve genezer. En laat je niet door je winstgever onder druk zetten om je lichaam niet gewoon de tijd te geven om te genezen. Als je echt ziek bent ( kanker of zo bvb ) ga dan wel naar de docter en gebruik de geneeskundige mogelijkheden die er zijn.

[Heftruck]

Oorspronkelijk geplaatst door King of beggars and fleas

men moet in de eerste plaats altijd zijn eigen docter zijn. Dat begint met een gezond dieet ( =preventie ) . Ga voor een valling of een griepje naar een homeophaat of andere alternatieve genezer. En laat je niet door je winstgever onder druk zetten om je lichaam niet gewoon de tijd te geven om te genezen. Als je echt ziek bent ( kanker of zo bvb ) ga dan wel naar de docter en gebruik de geneeskundige mogelijkheden die er zijn.

Zolang een dokter een betere diagnose kan stellen dan ikzelf, blijf ik naar een dokter gaan. Verder is er over homeopathie en alternatieve genezing nog veel discussie en persoonlijk geloof ik er ook niet in. Ik blijf dus naar een dokter gaan zolang er geen rationele argumenten zijn die mij van iets anders kunnen overtuigen.

[Heftruck]

Oorspronkelijk geplaatst door /\|cazar

Langs de andere kant is de moderne geneeskunde de grootste killer in de Westerse Wereld.

Bron? Bewijs? Statistische gegevens?

[Heftruck]

Oorspronkelijk geplaatst door Flippend Rund

ik beweer ook niet dat de farma-sector in dit opzicht slechter is dan gelijk welke andere economische sector. Maar we moeten ons ook geen illusies maken dat ze een haar beter zijn. Winstmaximalisatie en eeuwige vergroting van de afzetmarkt is wat hen drijft. Cash rules and money talks.

Zie mijn vorig argument i.v.m. lonen, productie, enz. Bijkomend argument is dat een onderneming die geen rekening houdt met winstmaximalisatie en vergroting van de afzetmarkt (met andere woorden; de concurrentie) inefficiënt werkt en zichzelf zal kapotmaken.

Oorspronkelijk geplaatst door Flippend Rund

De farma-sector wil ons graag aanpraten dat we niet zonder pillen door het leven kunnen.

Mensen kunnen zonder pillen, dat is ontegensprekelijk. Daartegenover staat dat een leven met geneeskundige en juist gedoseerde pillen bijna altijd comfortabeler is.

Oorspronkelijk geplaatst door Flippend Rund

Ik ben zeker niet tegen de farmacie, ik zeg enkel dat we ons bewust moeten zijn van die dingen.

Je probeert anderzijds wel dokters en producenten van geneesmiddelen op een sarcastische manier af te breken.

[King of beggars and fleas]

Oorspronkelijk geplaatst door Heftruck

Zolang een dokter een betere diagnose kan stellen dan ikzelf, blijf ik naar een dokter gaan. Verder is er over homeopathie en alternatieve genezing nog veel discussie en persoonlijk geloof ik er ook niet in. Ik blijf dus naar een dokter gaan zolang er geen rationele argumenten zijn die mij van iets anders kunnen overtuigen.

een deftige klassiek geschoolde docter zal u ook wijzen op het belang van preventie ( een goed dieet ) en zal u ook niet voor het minste pillen voorschrijven. Dat ze geschoold zijn is jammer genoeg helemaal geen garantie dat het geen kwakzalvers zijn. Waarom moet de regering ze anders oproepen om minder antibiotica voor te schrijven ? Een docter die te rap voorschrijft is per definitie verdacht. Dikwijls krijgen ze zelfs nog een percent op wat ze voorschrijven. Weet niet meer precies maar daar is eens iets rond te doen geweest. Ik denk dat van duppen daar iets mee te maken had.