Ask any woman over 45—your mother, sister, friend, or relative—if she’s worried about osteoporosis and chances are the answer will be yes. What many people don’t realize, according to Australian health researcher and writer Ray Moynihan, is that osteoporosis isn’t a disease itself and that the condition’s notoriety is a classic example of “disease mongering”.
“Being at risk of future illness is now being portrayed as being sick,” Moynihan said at an October 16 workshop on disease mongering hosted by UBC’s Therapeutics Initiative and held on campus. “High blood pressure, high cholesterol, low bone density: these are not technically diseases but rather risk factors of future conditions. But three decades of very powerful marketing have made us perceive them as diseases.”
Moynihan, a coauthor of Selling Sickness: How the World’s Biggest Pharmaceutical Companies Are Turning Us All Into Patients (Nation Books, 2005) with Victoria-based health writer Alan Cassels, defines disease mongering as the expansion of the boundaries of illness as a means to broaden markets for companies selling tests and treatments. He says that along with doctors and other health professionals, patient groups, and the media, pharmaceutical firms exaggerate the impact of a health problem as well as the benefits of the “solution” while minimizing the potential harm associated with a particular treatment.
“To my knowledge there is no organized, trusted voice which routinely evaluates the claims made about the nature and extent of medical conditions,” Moynihan said. “Perhaps there should be.”
There are countless examples of mild health problems that have become widely accepted as diseases, he noted. Take “pre-Alzheimer’s”, “prediabetes”, overactive bladder, and restless leg syndrome.
But osteoporosis remains one of the most compelling cases in light of its history, Moynihan explained.
In 1994, he said, the World Health Organization held drug company–funded deliberations in which experts were to come up with a definition for the condition, which is marked by a loss of calcium in the bones that results in an increased risk of fractures.
Those experts determined that a woman with a bone-mineral density of less than 2.5 standard deviations below mean qualified as having osteoporosis. Those same experts later admitted that their decision had been arbitrary, Moynihan said.
Yet the following year, a new class of drugs to treat osteoporosis hit the market.
Not only has Merck gone on to make billions with a bisphosphonate drug called Fosamax (alendronate), it also now manufactures diagnostic machines so that family doctors can test bone-mineral density in their own offices.
“This is not a conspiracy,” Moynihan noted. “The company wasn’t hiding its strategy.
“If you go to any website about osteoporosis, it will be labelled a disease,” he added. “This model has influenced the lives of tens of millions of people. The fear about it is extraordinary. I would say there’s been overstatement of fear to build markets.”
In fact, some researchers from the B.C. Office of Health Technology Assessment once described the promotion of testing for osteoporosis as the “marketing of fear”.
“Research evidence does not support either whole population or selective bone mineral density testing of well women at or near menopause as a means to predict future fractures,” the office stated in a 1997 report.
Attention deficit hyperactivity disorder and female sexual dysfunction are two other examples of disease mongering, according to Moynihan.
He was quick to acknowledge that some of the conditions he had mentioned are indeed real and severe. And he said that drugs can improve quality of life, extend life span, and clearly benefit many around the globe.
More and more, however, the line between ordinary life and illness is being deliberately and explicitly blurred, he said. Call it the “medicalization of life”.
It’s not just the fear factor that riles Moynihan. It’s also the way in which potential adverse effects of medications are minimized.
“One of the most tragic stories in modern medicine is the harms of drugs being played down,” he said at the workshop, which drew doctors, medical students, and health researchers, among others. Cassels and UBC pharmacology and therapeutics assistant professor Barbara Mintzes also spoke at the daylong forum.
At least 1.5 million preventable adverse drug events occur in the United States each year, Moynihan noted.
For a dramatic example, consider the use of Lotronex (alosetron) for irritable bowel syndrome. The drug can have sometimes fatal intestinal side effects. The condition itself, Moynihan pointed out, has never caused death.
Besides being a threat to human health—many people are getting tests and taking treatments they don’t need—disease mongering is now part of the global health debate, Moynihan added. In 2006, he helped organize the world’s first conference on disease mongering, which was held in Australia. In his view, doctors must increasingly protect their patients from the overuse of drugs.
Ultimately, Moynihan said, more research into disease mongering is urgently needed, as are policies preventing it. And the public needs to be made more aware of its hallmarks. That way, people can make educated decisions about their health rather than being driven to their doctor’s office out of fear.