Disease Mongering

Readers, I'd like to share a few striking quotes from the book: The Science of Fear by Daniel Gardner. What I'm about to share isn't just relevant to our health, it's also directly relevant to how we consumers react to our informational environment, and how we react to the various things that are sold to us. Read on:

"It is not in the economic interests of a corporation selling pills to unhealthy people for people to be healthy, or rather--to be more precise--for them to perceive themselves to be healthy. Their actual physical state is irrelevant. What matters is whether someone believes there is something wrong that can be cured with a pill. If so, the corporation has a potential customer. If not, no sale. It doesn't take an MBA to figure out what parmaceutical companies need to do to expand their markets and boost sales.

Critics call it 'disease mongering.' Australians Roy Moynihan and David Henry, a journalist and a pharmacologist, respectively, wrote in the April 2006 edition of the journal Public Library of Science Medicine that 'many of the so-called disease awareness campaigns that inform contemporary understanding of illness--whether as citizens, journalists, academics or policymakers--are underwritten by the marketing departments of large drug companies rather than by organizations with a primary interest in public health. And it is no secret that those same marketing departments contract advertising agencies with expertise in 'condition branding,' whose skills include 'fostering the creation' of new medical disorders and dysfunctions.'"

Of course, this process of disease mongering involves more than fostering new dysfunctions. It also involves influencing symptom thresholds for already existing diseases, or "widening the diagnostic boundaries" of illnesses. And then, it involves making sure that the public is well-informed about these various conditions. Casual Kitchen readers, all of whom are sophisticated media consumers, should see the irony in my use of the phrase "well-informed." In reality, this is anti-information.

Gardner continues:

"This is much bigger than advertising. It is about nothing less than shifting the line between healthy and diseased, both in consumers' perceptions and in medical practice itself... Erectile dysfunction, female sexual dysfunction, hair loss, osteoporosis, restless leg syndrome, shyness: These are just a few of the conditions whose seriousness and prevalence have been systematically inflated by drug companies seeking bigger markets.

Language is one of the most basic means of medicalizing a problem, the critical first step in getting people to ask their doctors for a pill. So 'impotence' becomes 'erectile dysfunction,' an impressively medical-y phrase that pushes away consideration of factors like stress and anxiety as causes of impotence that can be cured without a pill.

Numbers are also key. People with be more likely to conclude they have a condition if they think it's common, and so drug companies push statistics like 'more than half of all men over forty have difficulties getting or maintaining an erection'--a number that is grossly misleading because it comes from a study not taken seriously by experts in the field."

Remember the other week's post about authority figures in advertising? How, as much as we'd like to think it's not true for us, we respond to authority figures so autonomically, so instinctively, that even ads containing phony symbols of authority can dramatically impact sales of products and services?

Well, here are two forms of what should be actual authority--medical professionals and professional journalists--used to reshape our entire perception of medical conditions and disease. What makes this even more sneaky and subtle is that the authorities in question appear to have our interests at heart: "Hey, they're only trying to help! Maybe there really is a condition out there that we might actually have. We really ought to know about these things."

That's when, as a culture, we begin to pathologize what's actually normal:

"'The rhetoric surrounding disease mongering suggests that it will promote health,'" writes Iona Heath, a British physician, in the Public Library of Science Medicine, 'but the effect is in fact the opposite. Much disease mongering relies on the pathologizing of normal biological and social variation and on the portrayal of the presence of risk factors for disease as a disease state in itself. When pharmaceuticals are used to treat risk factors, the vicious circle is completed because anyone who takes medicine is by definition a patient.'"

At this point, the average person will begin shaking their fist at "Big Pharma" and presume, falsely, that consumers are too powerless to fight back against such large, powerful, and deeply misleading opposition.

Once again, however, Casual Kitchen readers know better. They know they have agency in this domain, just like they have agency in the domain of consumer products, the domain of food, and the domain of personal finance. And they know a central truth, a truth that should be far more obvious to far more people: No one can force you to take a pill or make you believe, contrary to reality, that you have a disease.

One final thought. Any numerate person who spends a few open-minded minutes looking at mortality data will see that we're safer and healthier than ever. Yet as a culture, we worry more than ever about our safety and health. Gee, maybe they should make up a new disease.

But it's not really in anyone's interest to convince us that we're safer and healthier then ever. There's no money in it! Instead, there is money--big, big money it turns out--in using our fears to convince us otherwise.

If we permit it.

Read Next: Why Can't I Find People Who Share My Values on Anti-Consumerism and Frugality?

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Melissa said...

Fantastic post, Dan.

chacha1 said...

There used to be a national conversation about the military-industrial complex. Now we need a national conversation about the pharmaceutical-insurance complex. Maybe you are starting that, Dan. :-)

Lauren said...

This: "Much disease mongering relies on ... the portrayal of the presence of risk factors for disease as a disease state in itself." Hello, statins; go home, you're drunk.