Disease Mongering - there's good money in that

The British Medical Journal is not known as a publication that normally pushes boundaries. Indeed, by allowing the publication of Brian Deer’s series of articles vilifying and slandering Dr Andrew Wakefield by calling his work on links between MMR vaccines and autism fraudulent without also informing readers of their own very strong links with the manufacturers of those very vaccines, they set the bar for transparency and ethical reporting very low indeed.

To their credit however, they do have some very good writers who cover real topics in health. One of these is Ray Moynihan - an Australian journalist and health researcher and a long-time vocal critic of ‘disease mongering’.

For those who are unfamiliar with the term, disease mongering is basically defined as the creation of new diseases with the sole purpose of increasing the market share for drugs that are already on the market but for which there are too few buyers as well as drumming up demand for the introduction of new ‘blockbuster’ medications which won’t be able to fulfill their sales potential until a market has been created for them.

Disease mongering doesn’t just benefit the pharmaceutical industry however. Doctors, psychiatrists and other therapists can also reap the rich rewards available when those who were previously defined as healthy are now told they are ill and will require treatment - many times for the rest of their lives - due to the expansion of disease definitions by a profession that is so intertwined with pharmaceutical interests, it’s almost impossible to tell where one begins and the other leaves off.

If you would like more information on this subject, I highly recommend you read Ray Moynihan’s excellent book, Selling Sickness: How the Pharmaceutical Companies are Turning us All Into Patients.

International Conference Thanks to the support of our wonderful AVN members, in April 2006, I was lucky enough be able to attend the Inaugural Conference on Disease Mongering which Ray Moynihan and Professor David Henry of the University of Newcastle had organised on this subject. You can find an excellent collection of articles on the conference at the PLOS Medicine site which would be well worth checking out - they are free to download.

In preparation for the conference, the organisers had orchestrated a true-to-life demonstration of how disease mongering works and how easy it is to trick a credulous medical community and media into believing that a large segment of the population who would normally have been considered healthy are actually quite sick and require drug-based treatments.

Several weeks before the conference, Moynihan, with the cooperation of the BMJ, placed a short article in the Journal describing a new condition that had been just discovered - Motivational Deficiency Disorder (MODeD). Luckily and coincidentally, there was also a new drug that just happened to have come onto the market to treat it - Indolebant.

MODed was defined as an unwillingness or inability to get up and go to work. An uncontrollable laziness and desire to do things like surfing, resting and being on the dole.

Using the BMJ article as the ‘hook’ on which to base a marketing campaign, Moynihan then issued press releases on the letterhead of the fictitious pharmaceutical company that produced Indolebant, and sent it to media outlets around the world. The release introduced Professor Leth Argos (a play on words that none of the media picked up), a respected neuroscientist from the University of Newcastle who didn’t actually exist though not one journalist investigated Prof Argos’ qualifications nor did anyone even contact the University to check that he actually worked there.

Make the drug and they will come The response to the press release was immediate and overwhelming!

Not only did the disease and drug get front page news coverage in major newspapers, magazines and on television news shows, but national Australian broadcasters went to the beaches of Byron Bay to film and interview those who ‘suffered’ from this disease about the new treatment available. There were scholarly discussions in the press about whether the people who were sitting on the beach instead of out working demonstrated the widespread nature of this ‘disease’. There were reports which talked about how great it was that a new drug had finally been released and approved to deal with this scourge blighting the lives of millions around the world.

Within hours of the media picking up this story, doctors and clinics began to call the contact number on the press release. They wanted to know how they could get their hands on these drugs because they had patients who were suffering from MODeD and they urgently required treatment.

Even when the person on the other end of the phone told them that this was a fake disease - a hoax condition for which there was no treatment available because it simply didn’t exist, some of these medicos insisted that their patients were crying out for this drug and they wanted to order it.

So, it is easy to see that creating diseases is a quick and easy way to drum up new markets for products that might otherwise languish on the pharmacy shelves, eating holes in the considerable profit base of Big Pharma.

Disease mongering sells drugs It is with this background in mind, that I wanted to tell you about a new article by the indomitable Mr Moynihan in a recent edition of the British Medical Journal.

Entitled, Who Should Define Disease?, it is a critique of how new diseases are being introduced and the definition of existing conditions is being expanded so as to increase the number of people requiring drug treatment.

Moynihan discusses in detail the way in which government committees that approve and fund drug policies are seriously conflicted by their close ties to drug companies. These same committees allow - through not so benign neglect - for the expansion of how we both define and treat illness and pseudo-illnesses, meaning that nearly 100% of the adult population in developed countries may now be diagnosed as suffering from at least one chronic condition.

“...a growing scrutiny of the seemingly well meaning march of medicalisation suggests we may sometimes be pushing boundaries too wide, and setting treatment thresholds so low, that people with mild problems or modest risks are exposed to the harms and costs of treatment with little or no benefit. It has also become clear that many of the people on the panels that are widening the patient pool have direct financial ties to the companies benefiting from that expansion. Concerns are mounting that doctors are collectively overdiagnosing millions of what were until very recently considered healthy people, and leading voices are asking whether it is time society at large took a more direct role in deciding who really warrants a medical label. Some are now calling for a major renovation of the way in which we define disease.”

Moynihan talks about gestational diabetes - the sort that some women get during pregnancy and which, if untreated, may lead to health problems for both mother and child. Last year, the blood sugar level for diagnosing gestational diabetes was lowered by such a large amount, it may lead to a 20% increase in the number of women diagnosed with this disorder during pregnancy and treated.

Not part of this article but no doubt related to the above-mentioned change, is a recent media news story about a new trial which is just beginning in the UK. This trial will give 100 women who are obese and suffering from gestational diabetes (according to the new definition) powerful drugs whilst pregnant so that their babies will not be obese at birth - something which leads to an increased risk of caesarean birth. (Babies Given Anti-Obesity Drugs in the Womb) These drugs have never been tested for their safety during pregnancy, yet this trial will expose unborn children to a dangerous drug for the purposes of expanding its market in an environment where a large number of people are ignorant of the importance of good nutrition but are totally trusting in and unquestioning of their doctors’ knowledge of health and the safety of the drugs they prescribe.

Psychiatry and medicine - a match made at the bank

Nowhere is this conflict of interest more blatant then in the area of psychiatry - a ‘science’ whose sole purpose seems to be the prescription of medical drugs for the treatment of people who psychiatrists themselves - without any independent oversight - have defined as being not within the ever more narrow standards of ‘normal’.

“One of the best known examples of conflicted panels widening disease definitions comes from the Diagnostic and Statistical Manual of Mental Disorders. An examination of those who produced its fourth edition found 56% of panel members had financial ties to drug companies, although for some panels, including that for mood disorders, the figure was 100%. Despite a new American Psychiatric Association policy aimed at reducing conflicts, an analysis of the forthcoming fifth edition [of the Diagnostic and Statistical Manual of Mental Disorders] found that of those panel members who’d made disclosure statements, exactly 56% had financial relationships with pharmaceutical companies.”

These same conflicted panels have seen children as young as 6 months of age being prescribed powerful and dangerous psychotropic medications for conditions such as ADD and ADHD, bipolar disorder (formerly called manic-depression) and depression.

These drugs have not been tested in children so the dosages are simply guesses and their use in this population is considered off-label, yet this sort of treatment is meted out to millions every day. In the United States, many children have died as a result of these drugs with some of them being prescribed as many as 9 different pharmaceutical products at one time. In one high-profile case, the parents were sent to prison for causing the death of their daughter because whilst taking a large number of these drugs, the child became ill with a cold and was given an over-the-counter cold medication which interacted with her prescribed medications, leading to her death. The psychiatrist who prescribed the drugs was held harmless in the matter but the parents were imprisoned and their other child placed in care.

It’s time for independence and transparency

It is obvious that our health policies are not based on the best available science. Instead, they are constructed with an eye to benefitting the drug companies and those government regulators who in most cases, are owned lock stock and barrel by those they are meant to be overseeing.

In this article, Moynihan goes on to say that this situation needs to change. The excuse usually given for why we must use conflicted experts on these panels is that it is hard to find anyone with the necessary expertise who is not associated with drug companies. This is not true however and the US FDA has taken its first tentative steps to correcting this situation.

But the conflicts continue to escalate - for both the licensing of medical products including vaccines and the definition of diseases and indications for who needs to be treated and when.

“Perhaps one of the most contentious questions is whether the process of disease definition is deemed so important that it warrants more regulatory oversight, rather than the loose self regulating system that currently exists. While the US National Institutes of Health consensus panels may have a strict model, many of the groups around the world deciding who is normal and who is not are simply self interested professional societies, whose panels are riddled with conflicts. “New diagnoses are as dangerous as new drugs,” said Allen Frances. “We have remarkably casual procedures for defining the nature of conditions, yet they can lead to tens of millions being treated with drugs they may not need, and that may harm them.” Frances wonders whether regulatory agencies should play more of a role in overseeing new panels, and is developing proposals as part of a forthcoming book.”

The public needs to be aware of these conflicts and of the risk to their own health and the health of those they love from these sorts of dirty dealings that are profit-driven but which can potentially place at risk the lives of tens of millions of people both here in Australia and around the world. It is time and past time for real changes and for those who have let money be their God to be held accountable in the courts for the harm their policies have caused.