For Immediate Release
"Disease mongering" by pharmaceutical companies threatens to bankrupt
Canada's public health system
Authors of new book warn that drug company marketing techniques are turning
us all into patients
Daily media articles say that the Canadian public health system is in
jeopardy, and fingers are pointed at everything from doctor shortages to
government mismanagement and bureaucratic greed. But Ray Moynihan and Alan
Cassels, authors of the new book, Selling Sickness: How the world's biggest
pharmaceutical companies are turning us all into patients, point the finger at
another cause: drug company funded disease creation.
Using their dominating influence in the world of medical science, drug
companies are working to widen the very boundaries that define illness. Mild
problems are painted as serious disease, so shyness becomes a sign of social
anxiety disorder and pre-menstrual stress a mental illness redefined as
pre-menstrual dysphoric disorder. Everyday sexual difficulties are seen as
sexual dysfunctions, the natural change of life is a disease of hormone
deficiency called menopause, and distracted office workers now have adult ADD.
Just being 'at risk' by having an elevated blood pressure or cholesterol level
has become a 'disease' in its own right.
"Too often the aim is to lower the bar and turn healthy people into
patients," says Alan Cassels, co-author of Selling Sickness, and drug policy
researcher at the University of Victoria in British Columbia. "And lowering the
bar makes more and more of us candidates for the latest pills promoted by the
Selling Sickness reveals how expanding the boundaries of illness and lowering
the threshold for treatments is creating millions of new patients and billions
in new profits, in turn threatening to bankrupt national healthcare systems all
over the world. Canada's publicly funded healthcare system is not immune.
"From their domination of guideline committees, their involvement in
physician 'education' and their marketing of fear to consumers, the
pharmaceutical industry is using its immense power to drive more and more of us
towards another prescription," warns Cassels. And, he notes, "a health system
that allows drug companies to play a role in defining who is sick is
With many health problems, there are people at the severe end of the spectrum
suffering genuine illness, or at very high risk of it, who may benefit greatly
from a medical label and a powerful medication. But for the relatively healthy
people who are spread across the rest of the spectrum, a label and a drug may
bring great inconvenience, enormous costs, and the very real danger of rare but
deadly side effects.
As the authors of Selling Sickness note, with plenty of detail,
pharmaceutical company marketing executives don't sit down and actually write
the rules for how to diagnose illness, but they increasingly underwrite those
who do. The industry now routinely sponsors key medical meetings, in Canada and
around the world, where disease definitions are debated and updated. Eight of
the nine 'experts' who created the most recent cholesterol guidelines in the US
had undisclosed ties to the pharmaceutical industry. The new guidelines shifted
the definition of 'high' cholesterol so drastically that it meant another 40
million Americans should be taking cholesterol-lowering drugs. In Canada, recent
guideline changes to cholesterol treatment, if implemented, would put 500,000
more people on cholesterol-lowering drugs.
Added to this is the fact that the bulk of clinical trials on new medication
is funded directly by the drug manufactures rather than the public or
not-for-profit sources. And that this research is then disseminated at
scientific meetings, events and conferences sponsored by the pharmaceutical
industry, and often hosted by medical societies or patient groups that are
themselves partially underwritten by drug companies. "The reach and the scale of
the industry's influence is really quite breathtaking in its scope," notes
"Many Canadians would be horrified to know that drug company money is also
involved in funding much of the Continuing Medical Education of Canadian
physicians. Yet I feel that we are never going to achieve rational prescription
drug use in this country until we get the drug money out of our medical
education system," argues Cassels.
And then there is the barrage of drug advertisements that hit consumers every
time they turn on the TV. While direct-to-consumer advertising of prescription
drugs is illegal in Canada, drug manufacturers here mount 'disease awareness
campaigns,' which constantly urge you to 'see your doctor' for practically
everything. "There are many different promotional strategies used in the selling
of sickness, but the common factor amongst them all is the marketing of fear,"
Soaring sales have made drug companies the most profitable corporations on the planet during particular years of this past decade. But the flip side of healthy returns for shareholders is the unsustainable increase in costs for those funding the health system. Selling Sickness tells us that we need the pendulum to swing back towards a rational and appropriate use of pharmaceuticals for everyone who is sick. "Our health care system will collapse if we continue to allow for-profit enterprises to define who is sick and who needs treatment," says Cassels. "Now is the time to start having the conversation about whether we want to continue to allow pharmaceutical greed, not appropriate need, to be driving our health care expenditures."
For author interviews, contact:
Email: [email protected]
About the Authors:
Alan Cassels is a drug policy researcher at the University of Victoria, in British Columbia. He has spent most of the last ten years studying how clinical research about prescription drugs is communicated to policy makers, prescribers and consumers, and has produced several full-length documentaries for CBC Ideas, including "Manufacturing Patients," which deals with the subject of selling sickness.
Ray Moynihan has been covering the business of health care for almost a
decade as an award-winning broadcast journalist and more recently with the
British Medical Journal. He is a regular contributor to the New England Journal
of Medicine and the Lancet and was a Harkness Fellow in health care policy based
at Harvard University.
Selling Sickness: How the world's biggest pharmaceutical companies are
turning us all into patients by Ray Moynihan and Alan Cassels is published in
Canada by Greystone Books (2005) www.greystonebooks.ca and in the US by Avalon
Publishing Group, www.avalonpub.com
Barbara Bourrier-LaCroix, BSc, MLS
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