Drug Firms Accused of Turning Healthy People Into Patients

New studies accuse the pharmaceutical industry of "disease mongering." Healthy people are being turned into patients by drug firms which publicize mental and sexual problems and promote little-known conditions only then to reveal the medicines they say will treat them.




By Ian Sample
The Guardian
Tuesday, April 11, 2006


You are lying on the sofa after a hard day at work and should be relaxing. But you are overcome by an insatiable urge to kick your legs about. As you struggle to control yourself, your kids run riot in the room. And to cap it all, your sex life is rubbish.

Just an everyday scene in many people's ordinary lives, or the combination of three newly identified medical conditions that can be treated at the pop of a pill?

The latter, according to some of the world's biggest, most profitable pharmaceutical companies, which have come up with a range of new drugs to treat "restless legs syndrome", attention deficit hyperactivity disorder in children, and female sexual dysfunction. But according to reports published today, the truth is more complicated. Healthy people are being turned into patients by drug firms which publicise mental and sexual problems and promote little-known conditions only then to reveal the medicines they say will treat them.

The studies, published in a respected medical journal, accuse the pharmaceutical industry of "disease mongering" -- a practice in which the market for a drug is inflated by convincing people they are sick and in need of medical treatment.

The "corporate-sponsored creation of disease" wastes resources and may even harm people because of the medication they turn to, the researchers add.

In 11 papers in the journal Public Library of Science Medicine, experts from Britain, the US and elsewhere argue that new diseases are being defined by specialists who are often funded by the drug industry.

According to the researchers, the campaigns boost drug sales by medicalising aspects of normal life such as sexuality, portray mild problems such as irritability in children as serious illnesses and suggest that rare health conditions, such as the urge to move ones' legs, are common.

"Disease mongering exploits the deepest atavistic fears of suffering and death," said Iona Heath, a general practitioner at the Caversham Practice in London who contributed to the journal. She added: "It is in the interests of pharmaceutical companies to extend the range of the abnormal so that the market for treatments is proportionately enlarged."

In the journal's editorial, guest editors Ray Moynihan and David Henry write: "Informal alliances of pharmaceutical corporations, public relations firms, doctors' groups and patient advocates promote these ideas to the public and policy makers, often using mass media to push a certain view of a particular health problem."

In one of the reports, Dr Joel Lexchin, a drug safety expert at York University in Toronto, alleges that Pfizer, the maker of Viagra, devised ways to "ensure that the drug was seen as a legitimate therapy for almost any man", and "took steps to make sure Viagra was not relegated to a niche role of just treating men with [erectile dysfunction] due to organic causes, such as diabetes or prostate surgery".

The message from adverts and Pfizer's website, "is that everyone, whatever their age, at one time or another, can use a little enhancement," he claims.

In a statement, Pfizer said it "only promotes prescription medicines to healthcare professionals and only in line with its licensed indications. Pfizer does not promote any of its prescription medicines to the general public and does not recommend, or promote the use of Viagra, outside of its licensed indications."

It added: "Viagra has been available in the UK for over seven years and is an important treatment for erectile dysfunction. All promotion of Viagra is aimed at educating health professionals on this serious condition, to enable them to effectively treat patients with this condition."

According to Leonore Tiefer, clinical professor of psychiatry at New York University, a textbook case of disease mongering is the creation and promotion of "female sexual dysfunction". The campaign by a number of drug companies has been especially successful in the US, he notes, where there has been a heavily contested attempt to convince the public that 43% of women live with the condition.

In another paper, David Healy, director of the North Wales sub-department of psychological medicine at Cardiff University, describes how a TV advertisement from Lilly Pharmaceuticals encouraged people to find out about mood disorders via a website sponsored by the company. "This advert markets bipolar disorder," he writes in the journal.

Dr Graham Archard, vice-chair of the Royal College of General Practitioners, said it was inevitable that drug companies benefited from such campaigns.

"If a company produces a product, they are going to want to market it in the best way they can and if they can increase public awareness of a condition that may or may not exist, then a person may well believe they have that condition and look for treatment," he said. "There's a limited amount of cash in the NHS and if people are spending limited resources on areas that aren't terribly important, that will detract from areas of greater importance. Potentially we could all be losers."

Lilly Pharmaceuticals said: "Bipolar disorder is one of the most debilitating and serious psychiatric illnesses there is. Appropriate treatment should be decided after the treating clinician has fully evaluated the person's condition and discussed the full range of treatment options. The advertisement that Dr Healy refers to was not designed for and was not shown to the general public in the UK. Olanzapine (Zyprexa) is not approved for use in children. Lilly does not market it for use in children."

GlaxoSmithKline said: "It's estimated that 10-15% of adults suffer from restless legs syndrome, yet it is a very underdiagnosed medical condition, which even when diagnosed, often leaves people without effective treatment. About 3% of adults experience moderate to severely distressing RLS symptoms at least two to three times a week and are likely to benefit from treatment."




Pfizer asserts that more than half of all men over 40 have difficulties getting or maintaining an erection, a figure contested by many studies.


Prescriptions for ADHD drugs escalated during the 1990s following the organised penetration of the education system by the pharmaceutical industry. Teachers may be most likely to report signs of behavioural disorders.


Publicised as the female equivalent of erectile dysfunction, FSD has been plagued by vague definition. In the British Medical Journal, John Bancroft, director of the prestigious Kinsey Institute, called it "preconceived" and "non-evidence based".


Selling bipolar disorder has become "the latest mania" according to David Healy at Bangor University in Wales. Awareness campaigns have encouraged people to "mood watch".


A campaign launched by GlaxoSmithKline in 2003 raised RLS as a "common yet unrecognised disorder". In 2005, the company was granted approval to use its drug, Ropinirole, to treat the condition.

Informant: NHNE


Drug firms accused of turning healthy people into patients

Informant: Sianette Kwee


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