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Selling Sickness

Posted by medconsumers on January 1, 2006

BOOKS WE LIKE

Selling Sickness: How the World’s Biggest Pharmaceutical Companies Are Turning Us All Into Patients (New York: Nation Books, 2005)

We are being manipulated by the pharmaceutical industry. The we in this case includes the general public, doctors, researchers, consumer advocacy groups, federal health officials, and politicians. The pharmaceutical industry exerts its influence over virtually all aspects of the medical care system. It sets a lion’s share of the research agenda; has a strong say in the ever-changing definitions of normal; controls most of the average doctor’s postgraduate pharmacological education; and is changing the way we think about illness in order to sell more drugs. Just to name a few.

With predictable regularity, one “silent epidemic” after another—high blood pressure, high cholesterol, bone loss, depression—is promoted either directly with “educational” advertising or indirectly through media stories inspired by the press releases of multi-national pharmaceutical giants that stand to profit from our fears. And the industry isn’t above creating a few diseases of its own. Shyness is now a social anxiety disorder; whereas menopause has long been a hormone-deficiency disease. Both, of course, have prolonged drug therapy as the solution.

More often the pharmaceutical industry has a hand in broadening the definition of illness so that more and more people can be funneled into long-term drug therapy. In the not-so-distant past, for example, one did not have osteoporosis until a fracture had occurred; now the diagnosis can be applied to anyone who shows more bone loss than the average 35-year-old (on a bone density test). How this particular diagnostic change occurred can be traced to a World Health Organization meeting funded by producers of drugs that stop bone loss.

In “Selling Sickness,” Ray Moynihan, a journalist, and Alan Cassels, a pharmaceutical policy researcher at the University of Victoria, British Columbia, carefully document pharmaceutical industry tactics in hyping awareness of and selling drugs for ten common conditions. Moynihan and Cassels do not dispute the fact that conditions like hypertension and osteoporosis can in fact lead to heart attacks and hip fractures, respectively, in some people. And others like depression and irritable bowel syndrome cause undeniable suffering.

Moynihan and Cassels object to industry-influenced expanding definitions of illness that turn millions of healthy people into lifelong patients. Too often thresholds for normal blood pressure and cholesterol are lowered, resulting in the same effect. Too often the normal travails of life or afflictions of aging are “medicalized.” Moynihan and Cassels found that 90% of the experts who sit on committees that set disease definitions and treatment guidelines for their peers have a conflict of interest because of financial ties to the drug industry.

For many doctors, the bulk of their information about new drugs comes from the materials supplied by the ubiquitous drug salespeople who regularly visit doctors at their offices armed with gifts and detailed information about their prescribing practices. (The Wall Street Journal once reported that there are 7,000 salespeople in the U.S. solely selling the cholesterol-lowering drug, Lipitor.) Moynihan and Cassels report how two Canadian health professionals are working to counter industry tactics by bringing unbiased information directly to doctors as well as the general public.

Bob Rangno, a physician, and James McCormick, a doctor of pharmacy—both members of Therapeutics Initiative at the University of British Columbia—travel the province delivering the same lecture. As recounted in “Selling Sickness,” they explain to a group of retirees that high blood pressure is not a disease in itself. Rather, it is one factor that can raise their risk of a future heart attack or stroke. Then Rangno and McCormick go on to demonstrate how easy it is to mislead with statistics, a common drug industry tactic. Their powerpoint slide shows the following questions based on study results:

Would you take a drug every day for five years if it…

A) lowered your chance of having a heart attack by 33%?

B) lowered your chances of having a heart attack from 3% down to 2%, a difference of 1%?

C) saved one person in a hundred from having a heart attack but there is no way to know in advance who that one person will be?

Rangno and McCormick ask the audience how many would take the drug based on question A, and about 80-90% raised their hands. Only about 20% indicated that they would take the drug based on questions B and C.

Then Rangno and McCormick reveal that all three questions are based on exactly the same study results. They explain that if a person’s risk of having a heart attack is 3% to start with, taking an antihypertensive drug to reduce that by 33% would bring that risk down to 2%. The 1% difference explains the one in a hundred who will benefit from the drug. “Advertisements to doctors and patients will claim, for example, that a drug offers a 33% reduction in the risk of heart attack without explaining that in actual fact you may have to take the medicine for five years in order to lower risks from 3% to 2%.” The surprised reactions they elicited from this audience of senior citizens, say Rangno and McCormick who have given this lecture numerous times, is no different from those expressed by an audience of physicians.

Industry’s marketing strategies are illustrated aptly in the chapter on female sexual dysfunction. To show how “new disease markets” are created, Moynihan and Cassels cite a business report, intended only for drug company marketing executives and potential investors, that “outlines how companies are ‘expanding the patient pool’ by using marketing campaigns to change public perceptions about what used to be considered normal life.”

Companies that make erectile dysfunction drugs are expanding their market to include women. But activists are fighting back. Chief among them is psychologist Dr. Leonore Tiefer, New York University School of Medicine, who is said to have documented the fact that for almost every key meeting where this new condition was being defined, the funding came directly from the pharmaceutical companies. She attends many of these meetings objecting to the narrow focus on genitalia and voicing another view of women’s sexual difficulties, which she acknowledges are widespread. “Women’s sexual problems and satisfactions have far more to do with relationship difficulties, life stress, and cultural expectations than with clitoral blood flow or testosterone levels.”

Tiefer’s five-year campaign of activism, which has had a strong impact on public debate via the media, merits imitation, say Moynihan and Cassel, “Her colorful campaign could well become a guide for others looking to expose and combat corporate attempts to inappropriately widen the boundaries of human illness.”±

Maryann Napoli, Center for Medical Consumers © January 2006

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