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Editor: Katharine Van Tassel
Akron Univ. School of Law

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Wednesday, June 4, 2008

Disease Mongering

PLoS Medicine published an interesting article on the popularity of "disease mongering" and the harms that it causes.  Ray Moynihan , Evan Doran, and David Henry write,

Disease mongering is the selling of sickness that widens the boundaries of illness in order to grow markets for those who sell and deliver treatments. It is a process that turns healthy people into patients, causes iatrogenic harm, and wastes precious resources [1]. Disease mongering is the contemporary form of “medicalisation.” It is a process now driven by both corporate and professional interests, and it has become part of the global debate about health care. International consumer groups now target drug company–backed disease mongering as a wasteful threat to public health [2], while the global pharmaceutical industry has been forced to defend its promotion of “lifestyle” medicines for problems like slimming and sexual difficulties [3]. . . .    Disease mongering increasingly appears in media analyses of medical conditions and new treatments. It has a page devoted to it on Wikipedia [7], and was recently the subject of a much publicised award-winning work of art [8]. . . .

Two years ago, we helped organise the world's first international conference on disease mongering in Newcastle, Australia, which coincided with a special theme issue of PLoS Medicine on the same subject [4]. . . . New York University academic psychiatrist Leonore Tiefer spoke about the involvement of drug companies in helping to foster the creation of a new condition called female sexual dysfunction [9]. Cardiff University psychiatrist David Healy charted the growing promotion of bipolar disorder and drugs to treat it [10]. Dartmouth University researchers Lisa Schwartz and Steven Woloshin revealed how the prevalence of restless legs syndrome was being exaggerated to broaden markets for new drugs [11]. One of the most popular sessions of the conference was the opening plenary, which featured the fictional Professor Leth Argos discussing a satirical “new” disease called motivational deficiency disorder, said to affect up to one in five people worldwide [12]. Part of his presentation is available on YouTube [13]. . . .

In the United States, which is responsible for roughly half of all global spending on prescription medicines, a leading media watch organisation now routinely analyses health news stories for any signs of disease mongering [14]. Created in 2006 in the US, and inspired by similar organisations in Australia and Canada, HealthNewsReview.org (http://HealthNewsReview.org/) tries to encourage journalists writing about health not to contribute to the process of medicalising ordinary life [15]. The emergence of high-profile articles on the subject also suggests scepticism is building within the mainstream media. In covering a new drug called Requip—for “restless legs syndrome”—The Wall Street Journal headlined the story “How Glaxo Marketed a Malady to Sell a Drug” [16]. Similarly, The New York Times recently ran a story about a new medicine called Lyrica—for “fibromyalgia”—under the headline “Drug Approved. Is Disease Real?” [17]. . . . .

As public interest in the corporate-sponsored creation of disease grows, the need for a central database or resource library is becoming clearer. A credible Web site attached to an academic or advocacy group featuring case studies and other information on disease mongering could prove very valuable. Already some groups, including Healthy Skepticism (http://healthyskepticism.org/), have devoted space to this debate, and others are likely to follow.

While we have noted some signs of media, consumer, and academic debate and action about the problem of disease mongering, we are not aware of a similar increase in policy interest or action. In fact, to the contrary, there is some evidence of complacency about disease mongering on the part of regulators. The US Food and Drug Administration's recent proposal to relax restrictions on off-label marketing risked setting the conditions for disease mongering to flourish [23]. Unnecessary medicalisation and medication may be wasting many precious health resources, with obvious opportunity costs for private and public health insurers alike. Producing credible estimates of the magnitude of those costs is a future direction that should be urgently pursued.

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