By Ray Moynihan, B.A. 2012
Source: Health Action International
Photo Source: Unsplash, James Yarema
Disease Mongering is a term to describe the process of widening the boundaries that define medical illness in order to expand markets for those who deliver and sell treatments. It can take many forms, including framing risk factors as diseases, portraying mild problems as severe pathology, widening existing definitions and constructing whole new categories of medical illness. While the analysis of disease-mongering has to date focussed largely on pharmaceutical marketing, and unhealthy industry-professional entanglement, the phenomenon is broader and deeper than a critique of drug company promotions. The concern is that by transforming more and more of the ups and downs of ordinary life into the signs and symptoms of treatable conditions, we may be producing much iatrogenic illness, wasting many resources and fundamentally shifting what it means to be human. After a brief history of the concept, some examples will be provided, before concluding with some challenges facing those interested in the problem.
…..by transforming more and more of the ups and downs of ordinary life into the signs and symptoms of treatable conditions, we may be producing much iatrogenic illness, wasting many resources and fundamentally shifting what it means to be human.
An important context for the current debate about disease-mongering is the work of Ivan Illich (1976), the maverick thinker who expressed concerns in the 1970s that an expanding medical establishment was ‘medicalising’ life itself. He argued in his landmark book
that the medical establishment was undermining the human capacity to cope with the reality of suffering and death and making too many people into patients. He criticised a medical system “that claims authority over people who are not yet ill, people who cannot reasonably expect to get well, and those for whom doctors have no more effective treatments than that which could be offered by their uncles or aunts.”
In 1992, American health writer Lynn Payer published Disease-Mongers: How doctors, drug companies and insurers are making you feel sick (Payer, 1992), a book which generated interest in the problem. The book outlined numerous examples where doctors and drug companies were involved in strategies to widen the actual and perceived boundaries of illnesses, in order in part to see more patients and sell more drugs. The roots of this disease-mongering critique of course go back beyond Illich and Payer, featuring in popular literature of the early 20th century via characters such as Jules Romain’s Dr. Knock, who famously builds a healthy medical business by transforming the people of his village into patients. More broadly the work of many social scientists has contributed to current understandings of the related phenomena of medicalization and disease-mongering.
Inspired in particular by Payer’s book, a decade later in 2002, I co-authored a feature in the British Medical Journal or BMJ, which introduced the concept of disease-mongering to wider academic audiences. (Moynihan, et al., 2002) It also documented how informal alliances of pharmaceutical manufacturers, doctors and patient advocacy groups often used the media to frame health conditions as being widespread, severe and treatable. As that paper demonstrated, questions, uncertainties and controversies surrounding the nature and prevalence of these conditions and the costs and harms of the promoted solutions are often not present in the corporate sponsored “awareness-raising” campaigns that inform media coverage and public debate.
Finally, it is worth noting that there are some key challenges in both understanding and addressing this relatively new and controversial phenomenon described as disease-mongering. Firstly, some thinkers have wanted to locate this concern within a wider social and historical context. Nikolas Rose for instance has observed that it is “too simple to see actual or potential patients as passive beings acted upon by the marketing devices of Big Pharma who invent medical conditions and manipulate individuals into identifying with them.” (Rose, 2006) Using a number of psychiatric disorders as examples, Rose has argued there are many processes that “lower the threshold at which individuals are defined, and define themselves, as suitable cases for treatment” which are turning non-patients into patients.
Thanks to Alan Cassels for his thoughtful comments on a draft of this piece.
References
Alonso-Coello, P., Garcia-Franco, A., Guyatt, G., Moynihan, R. (2008). Drugs for pre-osteoporosis: prevention or disease-mongering? BMJ, 326,126-129.
Cassels, A. (With editor Alisa Gordaneer and illustrator Jeremy Gordaneer). (2007) The ABCs of disease mongering: An epidemic in 26 letters. Victoria: EmDash Press.
Conrad, P., Mackie, T., Mehrotra, A. (2010). Estimating the costs of medicalization Social Science & Medicine, 70, 1943-1947.
Illich, I. (1976). Limits to medicine. London: Penguin.
Institute of Medicine (IOM). (2009). Conflict of interest in medical research, education, and practice. IOM. Available at: http://www.iom.edu/Reports/2009/Conflict-of-Interest-in-Medical-Research-Education-and-Practice.aspx
Lilly (2004). Advertisement for Strattera. US News & World Report, 26 April 2004, p.65.
Lexchin, J., Bero, L., Julbegovic, B., Clark, O. (2003). Pharmaceutical industry sponsorship and research outcome and quality: systematic review. BMJ, 326,1167–1170.
Moynihan, R., Heath, I., Henry, D. (2002). Selling sickness: the pharmaceutical industry and disease mongering. BMJ, 324, 886-890.
Moynihan, R. & Cassels, A. (2005). Selling Sickness: how the world’s biggest pharmaceutical companies are turning us all into patients. Vancouver: Greystone.
Moynihan, R., Doran, E., Henry, D. (2008). Disease mongering is now part of the global health debate. PLoS Medicine 5(5).
Moynihan, R., & Mintzes, B. (2010). Sex, lies and pharmaceuticals. Vancouver: Greystone.
Moynihan, R., Heath, I., Henry, D. (2002). Selling sickness: the pharmaceutical industry and disease mongering. BMJ, 324, 886-890.
Payer, Lynn., 1992. Disease-Mongers: How doctors, drug companies and insurers are making you feel sick. New York: John Wiley and Sons.
PLoS Medicine. (2006). Disease Mongering Collection of Articles. Available at: http://www.ploscollections.org/article/browseIssue.action?issue=info%3Adoi%2F10.1371%2Fissue.pcol.v07.i02
Rose, N. (2006). Disorders without borders? The expanding scope of psychiatric practice. Biosocieties, 1, 465-484.
Woloshin, S., Schwartz, L.M. (2006). Giving legs to restless legs: a case study of how the media helps make people sick. PLoS Medicine, 3(4).
Further reading:
Illich, I. (1976). Limits to medicine. London: Penguin.
Moynihan, R. (1998) Too much medicine?, Sydney: ABC Books.f
Moynihan, R. & Cassels, A. (2005). Selling Sickness: how the world’s biggest
pharmaceutical companies are turning us all into patients. Vancouver: Greystone
PLoS Medicine. (2006). Disease Mongering Collection of Articles. Available at: http://www.ploscollections.org/article/browseIssue.action?issue=info%3Adoi%2F10.1371%2Fissue.pcol.v07.i02
Rose, N. (2006).
How could disease mongering impact your health? Have any of the drugs you have take been recalled or pulled off the shelf? Why? Have you been switched from one drug to another for the same condition? Why? What are your religious beliefs?
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