Creating diseases for profit

 

Some years ago, my mother remarked that the number of diseases had exploded exponentially since the time of her childhood, young adulthood and even until the 1970s and 1980s.

“When I was younger, you had cough and cold, tuberculosis, chicken pox, smallpox, cholera, malaria, pneumonia, leprosy and a few other diseases. Today, it’s impossible to list the number of ailments.

“And you can’t pronounce many of them, either. When you can’t pronounce the name of a disease, or it has more than two words, it is time to be suspicious,” she had declared then.

Today, of course, there are even more diseases. And some of them are indeed a mouthful – schistosomiasis, leishmaniasis, polymyalgia rheumatica, granulomatosis with polyangiitis, hypercholesterolaemia – as my mother remarked more than a decade ago.

But not all diseases are natural. Pharmaceutical firms, it appears, have not only been manufacturing medicine but also some of the myriad ailments that afflict us.

Some people even believe the Covid-19 virus pummelling us is not natural and was created in a lab in Wuhan, China. There is a fierce exchange of views on this even among the scientific community.

Apart from influencing research via funding and in other subtle ways, which I will write about next, they also indulge in what is referred to as “disease mongering”.

Georgetown University Medical Center’s PharmedOut project fact sheet on “disease mongering” says: “By expanding the definitions of diseases and marketing everyday symptoms as new disease states, pharmaceutical companies increase the number of eligible patients for their treatments.

“Disease mongering benefits pharmaceutical companies without benefiting health outcomes. Disease mongering involves persuading essentially well people that they are ill.”

Common disease mongering tactics include:

• Implying that normal bodily functions indicate that there’s something wrong that should be treated;
• Portraying mild symptoms as indications of a serious disease;
• Defining as large a proportion of the population as possible to be suffering from the “disease”;
• Conceptualising risks as diseases; and
• Promoting self-diagnosis of the condition.

According to the fact sheet, disease mongering often takes place years before the treatment is expected to be approved.

“Continuing medical education (similar to our continuing professional development or CPD) is often used in campaigns to promote disease states to prescribers prior to drug approval. CME is used as a promotional tool by increasing clinician receptivity to new products, expanding existing markets, positioning products against competitors, mitigating concerns about adverse effects, and promoting unproven off-label uses of marketed drugs.”

PharmedOut gives erectile dysfunction as a high-profile example of disease mongering.

“Viagra was originally used for men with diabetes or spinal cord damage-induced erectile dysfunction. It was later marketed as a lifestyle drug for normal men with any degree of erectile dysfunction, or even as a sexual performance enhancer. Both the prevalence and psychological effects of erectile dysfunction were exaggerated in order to sell Viagra.”

It also notes that Female Sexual Dysfunction (FSD), “a vaguely defined condition of low sexual activity or desire in women”, was promoted seven years before regulatory consideration of a treatment.

It says US$100 million was spent on promoting FSD prior to the US Food and Drug Administration consideration of a testosterone patch in 2004. The patch was not approved.

“The advance marketing campaign also overstated the benefits of testosterone while potential risks of cardiovascular disease and breast cancer were ignored or minimised. Following the failure of FSD drugs to receive FDA approval, industry then invented Hypoactive Sexual Desire Disorder.

“A campaign that accused the FDA of sexism for not approving sexual treatments for women was successful, and flibanserin, a treatment for HSDD, was approved in 2015,” according to the PharmedOut fact sheet.

Writing on “‘Medicalization’ of diseases: A crisis in the domain of social health” in the Nov-Dec 2020 issue of Science and Culture, Amrita Bagchi says pharmaceutical companies are actively involved in sponsoring the definition of diseases and promoting them to doctors and consumers.

“The routine human condition – unhappiness, bone thinning, stomach aches and boredom – is increasingly being re-defined as disease: depression in its milder forms, osteoporosis, irritable bowel syndrome and attention deficit disorder all are clubbed as diseases.

“Likewise, risks factors, such as high cholesterol and high blood pressure, are declared diseases in their own right – hypercholesterolaemia and hypertension – with falling thresholds resulting in more people considered to be sick.

“In other cases, drugs approved for devastating illness, such as clinical depression, are indicated for milder conditions, such as shyness, which is now dubbed ‘social phobia’”.

Talking about obesity, she says what used to be seen as someone simply being overweight, has spawned an entire industry of health products, weight loss medications and surgeries, and referral services and centres.

Writing in The Baltimore Sun of July 16, 2021, PharmedOut director Adriane Fugh-Berman, who is a professor in the department of pharmacology and physiology and also in the department of family medicine at Georgetown University Medical Center, and Patricia Bencivenga, a graduate student at the same university, discuss how drug makers may want to make you think you have Alzheimer’s disease.

Referring to a “purported educational” website on Mild Cognitive Impairment (MCI) by a US drugmaker and a Japanese drugmaker and which promotes the drug aducanumab, they say it was launched in early May, about a month before the drug was approved.

“This website states that one in 12 Americans aged 50 years and older have noticeable symptoms of MCI and that MCI is most commonly due to Alzheimer’s disease.”

“A review of medical literature suggests neither statement is true, and Biogen (the drugmaker) failed to provide any supporting information when we asked for it. In fact, there is no standardisation in diagnosing MCI, and estimates of prevalence among people over 65 range from 3% to 22%.

“MCI is a risk factor for Alzheimer’s, but it is not necessarily Alzheimer’s, and it does not usually lead to Alzheimer’s. It has many causes, including: medications, fatigue, depression, hypothyroidism, vitamin B12 deficiency and sleep apnea. Besides, MCI often remains stable or disappears.”

I can give you more examples, but I’m sure you get the picture.

Could this be one reason why revenues of pharmaceutical firms keep rising? For instance, in 2000, worldwide drug sales was US$365 billion; in 2020, revenue was estimated to have reached US$1.27 trillion.

We can be certain that the figures for 2021 and 2022 will be much higher, given the Covid-19 pandemic.

But we can’t just blame the pharmaceutical industry or what is known as big pharma.

As Ray Moynihan and David Henry wrote in the PLOS Medicine Academic Journal of April 2006:

“Through the work of investigative journalists, we have learned how informal alliances of pharmaceutical corporations, public relations companies, doctors’ groups, and patient advocates promote these ideas to the public and policymakers – often using mass media to push a certain view of a particular health problem.

“While these different stakeholders may come to these alliances with different motives, there is often a confluence of interests – resulting in health problems routinely being framed as widespread, severe, and treatable with pills, as has happened recently with social anxiety disorder.

“Currently, these alliances are working with the media to popularise little-known conditions, such as restless legs syndrome and female sexual dysfunction, in each case lending credence to inflated prevalence estimates.”

Adding to this, Amrita notes in her 2020 paper on the medicialisation of diseases, that these alliances, ostensibly engaged in raising public awareness about underdiagnosed and undertreated problems, tend to promote a view of their particular condition as widespread, serious, and treatable.

“Because these ‘disease awareness’ campaigns are commonly linked to companies’ marketing strategies, they operate to expand markets for new pharmaceutical products.

“Alternative approaches – emphasising the self-limiting or relatively benign natural history of a problem, or the importance of personal coping strategies – are played down or ignored.”

Profit is today placed above ethics, and even the health of human beings. Now you know why my mother has always been suspicious of the prevalence of so many new diseases.

My mother also said: “In the past we depended on food, work and play to keep ourselves healthy but these days people depend on medicine.” She said this decades ago, but it is applicable even more so in 2022.

So, it appears that my mother may be right about the need for caution when we have difficulty pronouncing the name of a disease and if it has more than two words. And she’s certainly right about our overdependence on medicine and not on ourselves. - FMT

The views expressed are those of the writer and do not necessarily reflect those of MMKtT.