You used to think your shyness was nothing to be ashamed of. Then one day you read a magazine article about the horrors of social phobia and how it can be treated, and soon after that someone suggested that you take anti-depressants to help you ease up in those tense social situations.
According to the New England Journal of Medicine, so-called "medicalisation" occurs when conditions that were not previously construed as illnesses are defined and treated as medical problems. "Accordingly, these problems are newly deemed to require treatment by physicians or some other form of medical intervention such as therapy, medication, or surgery."
Such shifts in what we consider to be medical problems are nothing new. So, for example, homosexuality has made the journey from medical problem to normal, and epilepsy, which was once explained from a spiritual perspective, is now clearly a medical problem.
But whereas these shifts have in the past been influenced by things such as cultural changes and scientific advances, critics argue that they are today largely driven by financial concerns.
"There's a lot of money to be made from telling healthy people they're sick," writes Ray Moynihan and Professor David Henry in a commentary appearing in the British Medical Journal (BMJ). "Some forms of medicalising ordinary life may now be better described as disease-mongering: widening the boundaries of treatable illness in order to expand markets for those who sell and deliver treatments."
They write that pharmaceutical companies are actively involved in sponsoring the definition of diseases and promoting them to both prescribers and consumers. "The social construction of illness is being replaced by the corporate construction of disease."
Just how bad is IBS?
One example outlined in the BMJ article is that of the re-framing of irritable bowel syndrome (IBS). They write that, while for many people IBS is only a mild functional disorder requiring little more than reassurance about its benign natural course, pharmaceutical companies are trying to reframe it as as a serious disease attracting a label and a drug, with all the associated harms and costs.
In this regard they quote from a confidential draft document leaked from a medical communications company describing a three-year "medical education programme" to create a new perception of irritable bowel syndrome as a "credible, common and concrete disease."
The programme formed part of the marketing push for an IBS drug that has since been withdrawn.
The BMJ article continues to quote from the leaked documents: "IBS must be established in the minds of doctors as a significant and discrete disease state." Patients also "need to be convinced that IBS is a common and recognised medical disorder."
Apart from promoting a new IBS drug, the document also recommended establishing an advisory board on how opinion can be shaped, developing best-practice guidelines for diagnosing and managing IBS, and producing a newsletter in the period before the drug is launched.
A wider problem
Apart from IBS, the BMJ article also outlines a number of similar examples of "disease-mongering" relating to baldness, social phobia, osteoporosis and erectile dysfunction.
Common techniques include things such as dramatically overstating disease severity or prevalence, and even sponsoring journalism prizes for writing about certain conditions – thus cementing the notion that these conditions are severe enough to warrant special attention.
Driven by alliances
According to the BMJ article, networks are increasingly emerging comprising drug company staff, doctors, and consumer groups. "Ostensibly engaged in raising public awareness about underdiagnosed and undertreated problems, these alliances 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."
Even though everyone involved may have honourable motives, the authors point out that such alliances are usually orchestrated, funded, and facilitated by corporate interests – which usually comes down to selling pills.
Our vulnerable minds
One of the areas most vulnerable to such marketing efforts is psychological health.
Earlier this year, an article published in the Journal of Clinical Psychiatry concluded that bipolar disorder is being overdiagnosed and that in some cases medication for the illness is being over-prescribed.
Commenting on the study, Professor Michael Simpson, Health24's CyberShrink, said that just from experience on the CyberShrink Forum it "appears as though almost everyone is being diagnosed with bipolar disorder".
"If they don't get diagnosed with the disorder by the doctor, they self-diagnose. I have also noticed that many of these people seem to be on more medication than may be necessary – and it's usually of the newest and most expensive variety too," he said.
- (Marcus Low, Health24, June 2008)
Selling sickness: The pharmaceutical industry and disease mongering. British Medical Journal.
Bipolar disorder overdiagnosed?
Drug benefits all in the mind?