For most women, increased appetite, moodiness, and fatigue are normal occurrences during “that time of the month.” But to a pharmaceutical company, those biological happenings are ailments, symptoms of a disorder that can be identified, labeled, and treated with a pill—their pill.
In fact, aches, pains, nervousness, not being in the mood, excessive shopping, chocolate cravings, the desire to move one’s legs, sadness, and other parts of daily life are the new bread and butter for drug companies, who are ever seeking to expand their clientele. No longer in business just to treat the sick, pharmaceutical companies are looking to sell pills to a larger part of the population—the healthy.
Tired, Sleepy, Hungry? There’s a Cure
Disease mongering, which Ray Moynihan and David Henry, authors of Selling Sick, define as “the selling of sickness that widens the boundaries of illness and grows the markets for those who sell and deliver treatments” is pervasive on our society. One textbook example is the controversial disease Fibromyalgia. Last year, two drug makers spent hundreds of millions of dollars to raise awareness about the disease, even though scientists disagree whether the disease is real or not.
Fibromyalgia patients experience pain and fatigue. Although researchers don’t doubt they are in pain, they don’t know what causes the symptoms, which also overlap with other diseases. Because the cause is unknown, definitive treatment is allusive, yet Pfizer and Lilly have heavily marketed their drugs, Lyrica (an anticonvulsant) and Cymbalta (an antidepressant), for the condition, helping to boost sales by hundred of millions over the past two years.
The drug makers argue that they’re trying to educate the medical community and the public about a little known disease. But critics say companies do this to suggest that a large part of the population suffers from the disease when it may only be a small proportion. Marketing for Social Anxiety Disorder (SAD) makes it seem as if anyone who’s ever blushed or stammered in public might be a candidate for treatment.
Similarly, critics of disease mongering hold that many of these drug industry-sponsored campaigns take normal functions of life and imply that they’re disease states, suggesting suffering where there really isn’t any. Emotions like anxiety are labeled as General Anxiety Disorder, fatigue is Chronic Fatigue Syndrome, feeling overwhelmed warrants an anti-depressant.
Other diseases heavily marketed by the drug companies are so obscure or common that they’re easily spoofable: restless leg syndrome, shopaholic, and attention deficit disorder.
The process by which a disease is created or redefined isn’t difficult to grasp. A company wants to create a new market for a pre-existing drug, likely because a drug patent is about to expire. Instead of letting this happen, they extend the life of the patent by finding a new use, or indication, for the drug. Without a defined disease already out there, they go looking for something that will fit—oftentimes a hazily-defined psychological disorder or “lifestyle” ailment (something superficial or not life threatening). They hire a PR company to begin raising public awareness about the “disease.” Industry-sponsored patient advocacy groups are formed, press releases are sent to newspapers (who interview patients from the advocacy groups), companies fund studies to back their claims, and TV commercials are made. Medical conferences and grants are given to research and discuss the disease. Doctors, who have been given grant money from the companies, back up the disease and its need for a cure; celebrities who’ve signed contracts with the industry go on TV and do the same. Consumers wonder if they’re going undiagnosed.
This was the case in 1998, when Lilly was about to lose its patent on fluoxetine, otherwise known as Prozac. Instead of letting this happen, they turned their attention to a condition called “premenstrual dysphoric disorder (PMDD).” Many scientists questioned the validity of this as an actual disease. Although the PMDD is in the Diagnostic and Statistical Manual of Mental Disorders—the go-to guide for psychiatric disorders—it’s listed as “under evaluation,” meaning it is not yet accepted in the medical community.
Lilly repacked fluoxetine as a purple pill, gave it a new name—Sarafem—and began running ads warning women that their PMS might be something more sinister and something that needs to be treated. Informational Web sites that don’t seem directly tied to drug companies, like factsforhealth.org, give symptoms of the disease, such as moodiness, irritability, food cravings, fatigue, and bloating. Digging down a little shows that this Web site is run by the Madison Institute of Medicine, which is a private company run by doctors who receive funding and do consulting for the pharmaceutical industry.
Research indicates that the “symptoms” of PMDD are so universal and generic that anyone can suffer from them. One study performed found that a checklist of symptoms by women who identified themselves as having severe PMDD was no different than one by women who identified as asymptomatic, and also no different from a symptoms checklist filled out by men! The authors conclude that PMDD is not a mental disorder, but an unfounded social and cultural invention.
However, after Lilly successfully marketed and branded the disease and pill, Pfizer and GlaxoSmithKline were also were able to approve their anti-depressants for treating PMDD.
The drug companies have also taken a keen interest in medicalizing sex. Female Sexual Dysfunction (FSD) was another malady that the pharmaceutical companies, helped by media outlets and eager-to-treat doctors, pushed forth. Hoping to have its blockbuster drug Viagra approved for FSD, Pfizer was the main champion behind promoting the disease, despite Viagra’s poor performance in clinical trials. The criteria used to diagnose FSD was obscure and purposefully broad; at one point, it was estimated that 43 percent of the female population suffered from it. However, there is no agreement on the definition of FSD, no agreed upon clinical manifestations, and thus no cause for treatment. The reductionist view of female sexuality doesn’t seem to work.
Treatment Worse Than Disease
The danger in overprescribing drugs and creating conditions goes beyond the pocketbook. For instance, although menopause is a very real condition, with very real symptoms, the heavily marketed “treatment”—hormone replacement therapy—has been found to lead to an increase in heart disease, cancer, and strokes. And since it’s a normal part of aging, not all doctors believe it needs to be thought of as something that warrants treatment with pharmaceuticals.
Other conditions, such as high cholesterol and osteoporosis, are also treated as diseases, when in fact they are risk factors for diseases. Rarely discussed are the lifestyle changes that can be used to prevent the progression of these conditions into disease. In fact, many heavily marketed drugs for conditions such as anxiety, sleeplessness, and fatigue might be best treated with lifestyle changes, not drugs.
Yet a 2007 report in Business Week Healthcare, a trade journal for the pharmaceutical industry, notes that lifestyle drugs, not changes, are where the financial potential lies: “The market for lifestyle drugs has become one of the most dynamic and commercially attractive sectors in the pharmaceutical industry. With … aging demographics as well as increases in health awareness, disposable incomes, and pharmaceutical branding activity, conditions appear highly favorable for further growth.”
Some might wonder why the pharmaceutical companies need to spend so much time branding new diseases—there are plenty of real ones out there already. But given how long it takes to create new drugs, patent expirations, and the difficulty in finding novel treatments for complex diseases, it’s easier to find new indications for already approved drugs.
For instance, two major drug companies spent more on raising the awareness of Fibromyalgia than they did on the well-established diseases of diabetes and Alzheimer’s, mainly because there are effective drugs already on the market for diabetes and Alzheimer’s has alluded most forms of treatment. With no new blockbuster drugs in the pipeline, drug companies spend about 2.5 times the amount on marketing and promotion than they do on research, prompting consumers to buy more of their product, sick or not.