Are Drug Companies Making Us Sick?
Human Experiences Become (Treatable) Medical Conditions By Daniel DeNoon
WebMD Medical News
April 12, 2002 -- When is a human condition a disease? Is it when somebody gets sick? Or is it when a drug company comes up with a treatment?
We're becoming a society of sick people, suggest articles in the April 13 issue of the British Medical Journal. The authors point to balding, shyness, and normal aging as examples of normal human conditions now seen as medical problems.
This isn't new. Throughout history, societies have defined many normal human behaviors as sick -- masturbation, for example. And societies have also defined as sick people who don't fit current ideas of what is normal.
What's different? Now corporations and not society are doing the defining, the articles argue. They do this partly through advertising. Even more effective are media campaigns -- often involving prominent and well-meaning doctors -- that "educate" people to see themselves as patients. And as patients they will demand the drugs that the companies sell. Australian journalist Ray Moynihan is lead author of one of the articles.
"I think it is patently absurd and unhealthy that companies with vested interests in maximizing the size or severity of a disease are involved in generating the [educational] materials about that disease -- either directly or indirectly through sponsorship," Moynihan tells WebMD. "Truly independent sources of information should replace these skewed sources. With such closeness between the medical profession and the industry, this will be very difficult."
The drug industry sees it differently. In a BMJ editorial, Merck executives Silvia Bonaccorso, MD, and Jeffrey Sturchio, MD, argue that drug companies -- and the researchers they fund -- have a lot of information. Sharing this information, they say, helps people make informed choices about their health.
"There is medicalization of our society, but I'm not sure it is driven by the pharmaceutical industry," David B. Nash, MD, MBA, tells WebMD. Nash is director of health policy and clinical outcomes at Philadelphia's Thomas Jefferson University Hospital.
"There are social forces at work: aging baby boomers who grew up with all this technology and want to be active into their 80s; the invention of effective drugs for all kinds of conditions," Nash says. "We live in a society with more access to information than ever before -- and no particular group has a monopoly on that information."
But is it helpful for shy people to be told they have something called social phobia? Or for normally aging people to be told they are sick because they are less robust than young people?
"A little of this has to be 'let the buyer beware,'" Nash says. "Healthcare is a commodity like everything else. People have to be on the lookout themselves. If people participated more in their healthcare it would be better for everyone. I am a real advocate of more information to more people more of the time."
Seeing normal experience as disease has an effect on our society, says Eric T. Juengst, PhD, former chief of the Ethical, Legal, and Social Implications Branch of the National Human Genome Research Institute and professor of biomedical ethics at Case Western Reserve University.
"Sociologists have described the sick role, a cultural role we play when we see ourselves as being sick," Juengst says. "It involves some freedom from responsibilities -- you don't have to go to work if you're sick. And there is also an obligation to do something about your sickness. Otherwise you are a malingerer. If that applies to aging, we all have to do everything we can -- whether through lifestyle or exercise or growth hormones -- to stay as young as we can as long as we can. If all old people are sick with a disease, that makes them less appealing than if they are just people reaching their golden years."
Moynihan calls for a public debate on this issue. Nash and Juengst agree.
"I think it would be a good idea to have an enlightened public discussion, like the one we have had over Viagra," Nash says. "Erectile dysfunction is a major and interesting medical issue. The public discussion has led to the topic coming out of the closet and as a result we have many happier couples. Does this mean we should pay for every single Viagra pill? No."
Juengst says that the discussion already is underway in the medical profession.
"I think a public debate is needed and would be welcome," Juengst says. "One does see the beginnings of it. The debate over whether aging is a disease is quite hot in gerontological sciences and is creeping out into the public through organizations like AARP, which doesn't necessarily want to see its members as diseased."
By Charlotte Grayson, MD