Disease-mongeringSelling sickness

David HenryFaculty of Health

University of NewcastleNew South Wales

Motivational Deficiency DisorderYou are not lazy you are sick

Reaction

• Thousands of sites carried MoDeD – some featuring it as serious news, others as April Fool’s 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/332/7546/0-f).

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

".....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

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

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

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

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”

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

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

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

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

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

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