We should treat diseases not create diseases to treat

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Category : Medical Rants

This article speaks loudly to me – Legal Drug-Pushing: How Disease Mongers Keep Us All Doped Up

Readers know how mad direct to consumer advertising makes me.  I love the advances that the pharmaceutical industry has given us.  I hate their marketing departments.

Primum non nocere

Why not apply our motto to the pharmaceutical industry?  Why do we let them manipulate both physicians and patients into spending money when the indications are shaky and weak?

Why do we let them create conditions that we then need to treat?

Please read the article.  Here are some quotes that I particularly like:

In the case of the drug companies, it's not our taste buds they're appealing to. Instead, they market prescription drugs directly to consumers — a practice legal only in the United States and New Zealand — by, basically, manipulating our fear of suffering and death.

These "disease mongers" — as science writer Lynne Payer in her 1992 book of that name called the drug industry and the doctors, insurers, and others who comprise its unofficial sales force — spin and toil "to convince essentially well people that they are sick, or slightly sick people that they are very ill."

Changing the metrics for diagnosing a disease is one reliable technique. Dr. Adriane Fugh-Berman, associate professor of pharmacology and director of the industry watchdog group PharmedOut.org at Georgetown University School of Medicine, pointed to how the numbers used to diagnose diabetes and high cholesterol have been lowered over time. "The very numbers we use have been reduced to the point of absurdity," she said. "120/70 was considered normal blood pressure; now it's considered 'pre-hypertension.'"

and

Australia-based journalist and disease-mongering researcher Ray Moynihan, author of Selling Sickness, said in an email, "We seem to be living through the most extraordinary paradox: We have never been healthier, yet we seem to consider ourselves sicker and sicker than ever. Mild symptoms, inconvenience, being at low-risk, aging, human life, and death, are rapidly being medicalized."

No other medical specialty has turned more aspects of human life into diagnoses than psychiatry. Not coincidentally, no other medical specialty shares a cozier relationship with the pharmaceutical industry — its resources flowing lavishly through conference and continuing medical education (CME) funding, medical research support, and generous contributions to patient advocacy groups happy for the donations and glad to endorse a drug if it will help others.

Dr. Marcia Angell, the editor of the New England Journal of Medicine for more than 20 years, in a two-part 2011 essay in the New York Review of Books singled out psychiatry for its "subjective and expandable" diagnostic categories. She noted that in the fifth edition of the American Psychiatric Association's Diagnostic and Statistical Manual (DSM-V), to be published in 2013, "diagnostic boundaries will be broadened to include even precursors of disorders, such as 'psychosis risk syndrome' and 'mild cognitive impairment' (possibly early Alzheimer's disease)."

As Angell said, "It looks as though it will be harder and harder to be normal."

To repeat:

Primum non nocere

Let us please remember that at all times!

Comments (4)

Amen!  My own experience is that my doctor insists on following the latest guidelines and insists on prescribing drugs.  I never ask about tests or medications based on TV ads because I don't trust the drug companies but he has a different mindset!
Keep preaching… 

I don't disagree with the criticism leveled specifically at psychiatry and pharma, but I would like to respectfully submit that new diagnoses, even if just re-alignment of previously understood syndromes or better understanding of longstanding conditions, can represent legitimate advancement in medical science. Some conditions that come to mind include RLS (leaving aside DTC advertising of drug treatments for it; I prescribe iron and quinine first line), and insulin resistance syndromes (thinking of PCOS). No one's going to get rich from generic metformin prescriptions, but I've seen it result in some successful pregnancies. 

Amen, brother db.

I agree wholeheartedly.  My personal bent is that this fallout was nearly inevitable when the pharmaceutical industry changed its tune from a public good style modest growth and profit motive to wanting a blockbuster each and every day of the year to pad the bottom line.  
This type of loss of the long view is dramatically harmful to society.  And, not just with regard to what is considered a disease.  We have lost the long view on funding medicine as well as funding medical education.  I predict we shall have difficulties of exactly this type until the long view is successfully brought to bear again.
Thank you for continuing to shine light on these situations.

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