Disease mongering for fun and profit

disease_moungering.jpgOpen-access journal PLoS Medicine has a special on disease mongering – the practice of promoting medical conditions in an effort to boost drug sales.

Drugs are, of course, incredibly useful in treating suffering and disease, but their reality doesn’t always match the marketing of either the compound or the diagnosis.

For example, the definition of many psychiatric conditions is often based on fuzzy criteria on what constitutes a mental disorder and what constitutes normal human suffering or impairment.

The official acceptance of a diagnosis can involve intensely political decisions because if a group of experiences are defined as a mental disorder, the government or insurance companies can be called on to provide care for the affected people.

If a drug company can get their medication licensed as an ‘approved’ part of the care package, they can obviously make a huge amount of money.

This has led to drug companies funding pressure groups both to get a condition recognised with an ‘official’ diagnosis or to raise awareness of certain diagnoses (which has the effect of increasing the rates of diagnoses, and, of course, prescriptions).

This is not to deny that people may genuinely be suffering, but whether that suffering is best treated by a particular drug is another matter.

Here is where science is supposed to settle the matter, except for the fact that drug companies have been known to suppress drug trials that find no effect, and ghost-write scientific papers to which respected scientists add their names (and prestige).

Individual doctors are persuaded to prescribe certain drugs by free gifts, meals, air tickets to visit conferences, and large-scale sponsorship of academic meetings.

It’s all very murky and quite insidious. The PLoS Medicine collection has articles that point out some of the marketing practices that support this process.

Of particular interest to readers here might be the articles on female sexual dysfunction, bipolar disorder and ADHD, although the whole issue is quite thought-provoking.

The issue coincides with a conference currently being held on the same topic in Australia.

Link to PLoS Medicine collection on disease mongering (thanks Petra!)
Link to conference website.
Link to 2002 British Medical Journal special on disease mongering.
Link to coverage from BBC News.


  1. Posted April 13, 2006 at 12:56 am | Permalink

    The April issue of The Atlantic has a good article about pharmaceutical sales representatives and how they court doctors. It’s called The Drug Pushers.

  2. Posted April 13, 2006 at 12:58 am | Permalink

    Apparently html is stripped from comments. Here’s the url (full article is not free):

  3. gabe
    Posted April 13, 2006 at 5:51 pm | Permalink

    i’ve seen the drug pushers (reps) in action, and i know a few people from college that tried to suck me into that world w/ them (i didn’t budge). it’s amazing that it’s even legal, it would seem a doctor that’s in the pocket of some pharm company is having a conflict of interest when treating a patient.
    “if drug A has less side effects, but drug B’s manufacturer is paying for my new outdoor swimming pool, i’m not gonna bite the hand that feeds me!” wouldn’t it at least be fair to the patient to know what drugs a doctor is being paid to prescribe?
    on a slightly related note, i did work for a clinical research organization which was marketing an SSRI (anti-depressant), but with prozac and paxil and zoloft flooding the market treating all the existing emotional and psychological symptoms, diseases and syndromes, they couldn’t find a niche. so they literally scanned their case report forms for trends, and found “statistically significant” weight loss for many patients on the drug. VOILA! diet medication!
    cast a certain overweight oral sex champion of the last democratic presidential administration as the spokesperson and our old drug has new fancy clothes!
    i remember specifically asking my bosses about the drug’s mechanism of action – it apparently worked to “facilitate a nuclei in the hypothalamus known to cause feelings of satiation.” wow, what were the chances?!?

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