Disease Mongering (i.e., Medicalization) by Pharmaceutical Companies

The etymology for the word monger is quite interesting -- it was not originally used in a pejorative sense, as it is today, but referred neutrally to a trader or middleman. Mongering today is used to refer to an activity such as the peddling of cheap or illicit goods. A recent article discussed the medicalization of newly recognized and previously untreated problems and referred to the process as disease mongering (see: Disease Mongering or Medicalization). Below is an excerpt from it with boldface emphasis mine:

The overlap between business ethics and medical ethics represent a moral minefield. Nowhere more so than in the domain of newly recognised and previously untreated disorders, syndromes and diseases, among them social anxiety disorder, non-physiological erectile dysfunction, aging, fibromyalgia, adult attention deficit hyperactivity disorder (ADHD), restless leg syndrome and female sexual dysfunction....Diagnoses can be very real and finding effective treatments certainly worthwhile, but it is the interests of patients that should be served and not purely those of pharma industry shareholders when a condition is medicalized. Some observers have suggested that the process of medicalization, in which issues and problems have migrated into the scientific realm coincides with the demise of traditional values....It’s worth repeating, pharma companies enjoy increased profits because of medicalization, but that does not mean that we should not be treating previously latent disorders. Quality of life might be improved for countless individuals with new treatments....After all, your particular take on the human condition may one day be recognised as a disorder by the medical profession, but it remains your choice as to whether take the medicine.

One of the least desirable aspects of the web is that it often makes it difficult for some readers to distinguish between good advice and bad advice in the medical domain. This is in contrast to, say, a printed book where the author and the publisher are known and will stand behind the content. Some medical web sites such as MayoClinic.com do provide such a guarantee.

Broadcast media such as television can also fool naive viewers about medical matters. Unfortunately, advertisers have been refining their powers of persuasion with this communication channel for more than 50 years. I cringe every time I see direct-to-consumer advertisements from pharmaceutical companies on television. My discomfort is particularly acute for diseases where the etiology of the disease is not established like fibromyalgia but drug cures are being offered. I frequently ask myself the following question: how can a disease be treated when its etiology has not been established?

Although the web can also be a minefield of misinformation, this bothers me less than television which operates in a one-to-many broadcast mode and does not allow for interactivity or search to sort out valid information from misinformation. For example, a search using Google for "fibromyalgia" and "cause" or "etiology" yielded 1,870,000 hits. I am sure that there is a pony somewhere in this mass of information. The key to this problem of accurately searching on the the web is the need for a trusted source for medical information such as Mayo Clinic. There are many of them but also a lot of noise in the system.

Comments

[David Bradley]

I wasn't sure with all your bold and italics whether you were actually agreeing with what I said in my blog post or whether you thought my words were not credible simply because they were not published by Mayo or in a book.

In summary, I was not attempting to be derogatory towards either side: healthcare industry or patient advocates, simply to show that there are health problems and then there are health problems.

[Brian Jackson]

One more angle you didn't mention -- article placement in mainstream media by device companies. Typical scenario is that a device company is trying to push a new, technologically sexy product. They partner with a hospital/clinic/surgeon who sees an opportunity to promote themselves as cutting edge by offering this new device/procedure. They jointly pitch a story to a local science/medical writer, who doesn't have the background to critically assess the details, but who appreciates the material which is easy to package up into a news story.

I saw this recently with a spinal fusion device being promoted by orthopedists at Intermountain Healthcare together with the device manufacturer. The story implied, for example, that spinal fusion is beneficial in most people with chronic back pain.

[Ajit Alles]

This is a losing battle unless we are willing to ban direct-to-consumer advertising, which I personally believe we should do. The web is unregulated and democratic. You can't really blame the web by saying "it often makes it difficult for some readers to distinguish between good advice and bad advice in the medical domain." Websites that have the highest profile with slick graphics and easy maneuvering draw the biggest audiences. People watch TV without filtering the content, so why would they not do the same thing with websites? If it's out there it's true - an extension of "seeing is believing". Being a Sri Lankan, I see first hand examples of this with regard to reporting on the Sri Lankan conflict. The best way for reliable websites to attract more attention is to be ranked higher on Google.