Legal Drug-Pushing: How Disease Mongers Keep Us All Doped Up

By manipulating our fear of suffering and death, big pharmaceutical companies are able to keep us coming back for expensive medications.

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Pharmaceutical giants, like small-town pizza parlors, have two options for making more money: convince regulars to buy more of what they obviously like, or find ways to persuade more people that they will be happier with this drug or that thin crust with extra cheese.

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 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. "120/80 was considered normal blood pressure; now it's considered 'pre-hypertension.'"

Entirely new diseases can be, and have been, invented to extend a manufacturer's patent on a highly profitable drug. Fugh-Berman said Eli Lilly stood to lose a lot of profits once the patent expired on its hugely popular antidepressant Prozac. "So they positioned this new condition, PMDD (Pre-Menstrual Dysphoric Disorder), and then went to physicians and the FDA with their highly paid experts who said PMDD is a tragic disease, and they got approved for Sarafem, the same drug. It's an on-label use for a repackaged drug; they created the disease and then got a drug re-approved that was going off patent."

You may not need chemical enhancement for the E.D. or the baldness. The best remedy for both may be to reexamine your beliefs about why hair or hardness are so important.

Just how sly a move was it? "If I as a physician write a prescription for Prozac 20 mg," Fugh-Berman said, "the pharmacist can substitute fluoxetine, the generic. If I write a prescription for Serafem, they can't substitute another drug."


Dr. Leonore Tiefer, a noted sexologist and associate clinical professor of psychiatry at New York University School of Medicine, said the 1998 approval of Viagra for "erectile dysfunction" -- formerly known as impotence -- created a "sea change" in the field of urology. "It was like being sucked into a very medical model and treatment orientation," she told me.

People immediately started asking about Viagra for women. As it was doing for men, Tiefer said that, as a feminist, writing about women, "I knew what would happen if there was a Viagra for women -- the isolation of the function from the person, the isolation of the genitalia from the rest of the body."

The only way to redefine "what a woman wants" -- and build a case for a drug to "treat" it -- was to turn "it" into a medical condition. Without widespread agreement on its definition, pathophysiology, or clinical manifestations, Female Sexual Dysfunction (FSD) was created. Tiefer called the development of FSD "a textbook case of disease mongering by the pharmaceutical industry and by other agents of medicalization."

With Pfizer's 2011 U.S. Viagra sales pushing $2 billion, and Eli Lilly's Cialis catching up, the booming "enhancement" market suggests that either there has been an extraordinary uptick in male impotence -- or that Pharma has convinced multitudes of men that erectile dysfunction, "E.D." for short, has reached epidemic proportions (40 percent of men are allegedly "at risk"), and drugs are the only solution.

It pains to think of the men who aren't ready when the moment is right as a result of taking Propecia to "treat" another natural effect of aging nearly as widespread among men as occasionally uncooperative equipment: male pattern baldness, or, in medicalese, alopecia.

The fact is you may not need chemical enhancement for the E.D. or the baldness. The best remedy for both may be to reexamine your beliefs about why hair or hardness are so important. A shot of redefined meanings can do wonders to restore normal functioning.


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.

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The author of Victory Deferred, John-Manuel Andriote has specialized in HIV/AIDS reporting since 1986. His research materials, correspondence, and recorded interviews are part of a special collection curated by the Smithsonian.

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