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Disease Mongering Debate: Creating Diseases to Sell Drugs?

Drug companies are convincing us we're sick and then selling us the cure.

Pretty bad, huh?  Well, critics say it's true.  And it all has to do with big pharma's marketing tactics—you know, the ads that put ADHD, irritable bowel syndrome and social phobia into your vocabulary?  The ones that declare that there's help for restless legs syndrome—that thing you never knew anyone needed help for?  Erectile dysfunction for older men … need we say more?

Critics call it disease mongering. Pharmaceutical companies call it disease awareness. And the debate begins.


If you believe the critics, drug companies sometimes invent, sometimes exaggerate—and always profit.  They may give small problems disease (and thus cure-worthy) status.  They may take existing disorders and water down the symptoms, convincing people who thought they were OK that they need medicine—and now!


But if you believe the drug companies, they're providing much-needed education and treatments.  They're spending billions of dollars each year to find helpful remedies.  And when they find them, they're letting people know the good news:  If they're suffering, there's help.

So what's really going on?  Here, we present both sides.

Which do you believe?  Share your opinions here.

It's disease mongering:  Drug companies make people who are well today believe instead that they have a disease.

Experts have commented that it is often more effective for a pharmaceutical firm to market the disease rather than to market the drug that treats the disease.  This business strategy has led to a wave of "disease mongering."

A public campaign to get people who today think they are well to believe instead that they have a disease and should see their physicians can be justified in two circumstances.  The first arises when an asymptomatic disease has a highly effective treatment that prevents a future dire outcome, and healthy people need to be urged to seek screening.  The second occurs when a disease has an effective treatment but is associated with embarrassment or stigma, and people need to be persuaded to tell their physician that they have the condition.

Sadly, defenders of the industry have used these legitimate cases to justify many advertising campaigns where the goal is surely profit rather than health. Sometimes disease mongering occurs when a basic problem of living is transformed into a disease, as when "shyness" turned into "social phobia" that required pharmacologic management.  Other times, disease mongering consists of lowering the threshold at which sufferers seek medical care.  Restless legs syndrome can be very debilitating in its most severe form, but recent advertising probably drove many with fairly mild symptoms to "ask their doctor" for a medicine.

Any public health benefits of disease mongering are far outweighed by its deleterious effects.  The American public has the least disease burden and longest lifespan in its history, yet average persons feel anxiety-ridden about health—in part due to our scaring them at every opportunity.  The physician-patient relationship has been turned from consulting a professional to get advice about one's problems, to going to a pill-dispensing machine to demand pharmaceuticals for all ills, and becoming angry when the prescription is not immediately forthcoming.

It's disease awareness: Claims otherwise aren't worthy of a response.

Editor's note: We invited Pharmaceutical Research and Manufacturers of America, the industry's large lobbying and advocacy group, to suggest an expert to participate in the debate. They declined and instead issued this statement to JHMFD from their senior vice president Ken Johnson.

Millions of patients in the United States and throughout the world benefit each year from the life-saving and life-enhancing medicines developed by America's pharmaceutical research companies.

More than 1,000 new medicines have been made available to patients over the past 15 years alone. These medicines have helped millions of people lead healthier, more productive lives, and have contributed to a longer life expectancy than ever before.

The concept of "disease mongering" is so ridiculous, it doesn't merit a response.

The statement also included a description of the companies they represent, which, it said, "are devoted to inventing medicines that allow patients to live longer, healthier, and more productive lives.  PhRMA companies are leading the way in the search for new cures.  PhRMA members alone invested an estimated $43 billion in 2006 in discovering and developing new medicines.  Industry-wide research and investment reached a record $55.2 billion in 2006."


Mr. Johnson's

PhRMA declined to submit a rebuttal.


Dr. Brody's

The pharmaceutical industry spends between $29 and $40 billion annually in the U.S. on marketing, allowing the industry to effectively convey almost any message it wishes to as many people as it wants to reach.  When you have that sort of money and power, you donot need to engage any of your critics; you can simply keep repeating your basic message over and over.

Anyone who does not believe that there is a problem with disease-mongering should read John Abramson's Overdosed America, Ray Moynihan and Alan Cassels's Selling Sickness, Greg Critser's Generation Rx, and Shannon Brownlee's Overtreated, for starters.  The evidence that this is a substantial and serious problem cannot be dismissed by any fair-minded commentator.


Click here for more debates!


Last updated and/or approved: August 2009. Bios accurate as of September 2007.
Original article appeared in September/October 2007 print issue.

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