Diseasemongering Selling sickness

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Disease-mongeringSelling sickness

• David Henry
• Faculty of Health
• University of Newcastle
• New South Wales

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Motivational Deficiency Disorder You are not lazy
you are sick
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Reaction

• Thousands of sites carried MoDeD some featuring
  it as serious news, others as April Fools Joke
• We gave many overseas interviews (CNN, BBC, NPR,
  Voice of America, Chicago Tribune, Business Week,
  PR Week)
• Complaints to the BMJ. The editor of the the
  Dominion Post thundered "Credibility is hard
  earned, you damaged yours and ours as a result."
  (http//bmj.bmjjournals.com/cgi/content/full/332/7
  546/0-f).

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Why did people believe it?

• Plausible disorder and pathogenesis
• Intuitive appeal
• Impressive scientific language
• Credible academic sources and journal
• Typical statistics (prevalence, cost of illness)
• Expectation of continual medical progress
• Blamelessness transfer of responsibility

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".....an expanding medical establishment, faced
with a healthier population of its own creation,
is driven to medicating normal life events (such
as the menopause), to converting risks into
diseases, and to treating trivial complaints with
fancy procedures.." Roy Porter 1996
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Disease-mongering

• Disease-mongering is a useful term to describe a
  form of medicalisation where the primary motive
  is to market products and services
• Treating the sick is not as profitable as
  treating the healthy members of society (they are
  more of them)
• Close relationships between industry, the medical
  profession, patient support groups and a
  compliant media lead to enormous pressure to
  fund new treatments

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Candidates for disease-mongering

• Obesity
• Ageing
• Sexual dysfunction (male and female)
• Social anxiety disorder
• Forgetfulness
• Mood swings
• Anger / intermittent explosive disorder
• Osteoporosis
• Hyperactivity/learning disabilities
• Bipolar Disorder
• Unhappiness (incl post-traumatic stress disorder)
  
• Menopause
• Irritable bowel
• Genetic testing
• Minor skin lesions

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Disease-mongering classification(Moynihan et
al. BMJ 2002 324 886-891 )

• Ordinary processes and life experiences treated
  as medical problems
• Mild symptoms as portents of serious disease
• Personal or social problems as medical ones
• Risks conceptualised as diseases
• Prevalence and outcomes exaggerated

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Irritable Bowel

• In Vivo Communications
• IBS must be established in the minds of doctors
  as a significant and discrete disease state
• Patients need to be convinced that IBS is a
  common and recognised medical disorder
• Need for an advisory board with one KOL from
  each state in Australia

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Mongering of social phobia

• "You may even need to reinforce the actual
  existence of a disease and/or the value of
  treating it. A classic example of this was the
  need to create recognition in Europe of social
  phobia as a distinct clinical entity and the
  potential of antidepressant agents such as
  moclobemide to treat it,"
• Pharmaceutical Marketing 2001

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The death rate in women with hip fractures is
greater than the incidence of all female cancers
combined
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Corporate relations

• Medical profession close associations, genuine
  conflicts of interest, in kind and financial
  support, advisory panels, opinion leaders,
  guidelines, increasing government and police
  interests
• Patient support groups single diseases, often
  financially strapped, naïve
• Media uncritical, hurried, naïve, obsequious,
  PR-driven, waiting for the next breakthrough,
  susceptible to framing effects

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Why is DM so successful?

• Plays on our deepest fears
• Need to conform to idealised notions of
  appearance and behaviour
• The alliances of corporations, PR companies,
  doctors and patient organisations are very
  powerful
• Highly motivated and effective companies
• We live in a world of marketing

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Disease-mongering campaign

• The aim was to make disease-mongering a meme
  (Dawkins 1976) "a unit of cultural transmission,
  or a unit of imitation."
• Created a disorder Motivational deficiency
  Disorder launched on April 1st 2006
• Commissioned a series of papers in a journal
  PLoS Medicine April 10th 2006
• Held a Conference April 11th to 13th 2006

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Conclusion

• With each condition featured here there are
  individuals in whom the distress caused by it
  justifies management
• But the art of medicine is to define for each
  condition and each individual where the line is
  drawn between the probability of benefit and harm