Disease MongeringThat ADHD article that I pointed you towards the other day is actually part of a set of articles in the latest Public Library of Science: Medicine Journal concerning Disease Mongering, which is, according to editors Ray Moynihan, David Henry: "...the selling of sickness that widens the boundaries of illness and grows the markets for those who sell and deliver treatments. It is exemplified most explicitly by many pharmaceutical industry–funded disease-awareness campaigns—more often designed to sell drugs than to illuminate or to inform or educate about the prevention of illness or the maintenance of health." This stuff is very worthwhile reading. In a set of articles covering ADHD, Bipolar Illness, Female Sexual Dysfunction and Male Erectile Dysfunction, the various authors contributing to this edition have chronicled the increasing medicalization of aspects of life that were formerly just normal aspects of life. There is a strong anti-pharmaceutical industry bent to these articles. Pharmaceutical marketing is seen as a force of corruption, foisting an essentially profit driven agenda onto various conditions real (bipolar disorder) and imagined (Premenstrual Disorder?). In the bipolar article, the author laments how an entirely new class of medicine "mood stabilizers" has been created out of other pre-existing drugs and seen as a treatment of choice for bipolar conditions that aren't even all that severe. The risks associated with these (anti-psychotic, anti-epileptic) medications over time add up to increased risk of early death, according to the author. While not pooh-poohing the very real utility of established medications like lithium for serious bipolar conditions, the author expresses upset at the explosion of new forms of bipolar disease, especially childhood forms of the illness. I'm of two minds regarding the idea of a pharmaceutical industry plot against society. It is undoubtedly true that the pharma industry is trying as hard as they can to get us all to believe that we have legitimate conditions that require their products as treatments. It is also true that they are not above advocating for diseases that don't (yet) exist or looking for new angles and conditions for selling their existing products. At the same time, this is the free market at work (I hope); desire of profits makes the industry creative and they produce medications and treatments that are of real benefit to suffering people. While the boundaries of acceptable diagnosis for conditions like bipolar disorder are being pushed perhaps towards inappropriate directions, the core condition is undoubtedly real. While there is no better medicine for bipolar disorder than the good old standby lithium, I'm told, there are also a very real group of patients who either won't take that medication, or can't. This group benefits from an increasingly diverse set of "mood stabilizing" medications, assuming they are safe when used as directed (which may not always be the case). I take it as a given that the pharmaceutical companies are incented to exaggerate the efficacy of their products; everyone involved in treatment should know that. The group that really needs to tighten up here are the medical doctors, who have allowed themselves as a profession to become very dependent on the largess of the pharmaceutical companies. Doctors have their continuing education paid by drug companies, in some cases, and most annual conferences are sponsored by or receive massive funding infusions from the pharmas. Not a month goes by without drug representatives from the pharmas visiting doctors' offices and offering samples, pens and prescription pads. It would be nice to see the doctors dissociate themselves better from the pharmas. Were that to occur, the situation might become a little bit more balanced then it currently is.