Today, more than ever, we live in a disease-ridden society. But that’s not because we lack sanitation, hygiene, abundant foods or opportunities for exercise.
We live in a disease-ridden society because we are creating diseases. Or, more accurately, we are having diseases created for us, and through careful manipulation of our fears, we have come to accept these manufactured diseases as real.
Anyone who watches television or reads a magazine has seen (albeit largely unconsciously) how cleverly marketing first creates a disease, ensures that lots of people come down with it, and then offers a “cure” to get rid of it.
As an example: Until Viagra came along, impotence was either an occasional mishap resulting from emotional causes or secondary to other disorders, such as circulatory problems, nutritional deficiencies, and diseases or trauma interfering with nerve function.
Then Pfizer came along, developed a drug that increases blood flow to the male penis, and needed a market to sell it to. Nevermind that Viagra’s ability to improve function is limited to a single mechanism that really only works for a few men (those that are producing insufficient amounts of nitric oxide). That market was too small. What Pfizer needed to do was to create a larger market.
First, they created the need, and that was easy: What man doesn’t want to be better in bed? Second, they created the disease, i.e., the reason you’re not better in bed. They took the old name — impotence — and scotched it, because of its negative connotations. The word “impotence” conjures up images of a skinny-armed teen getting sand kicked in his face by the guy with the rock-hard biceps and bosomy blonde in tow. Or the cuckolded husband coming home from his 9-to-5 only to discover his randy wife in bed with the next door neighbor.
No, those are not images with which any man would associate himself. So Pfizer created a new disease — Erectile Dysfunction — with an entirely neutral connotation — and craftily expanded the boundaries of this created disease. The really, really important thing to note here is that Pfizer took a symptom of several diseases and made it into a disease by itself so that they could sell a drug to “treat” the disease.
It still hasn’t reached the point where a man is going to sit down on the bar stool, look over at his neighbor and say, “Damn, dude, I just got diagnosed with ED. Pass the peanuts, wouldya?”
But the reformation of impotence (the symptom), into ED (the value-neutral disease), mainstreamed the concept to the point where healthy young men are now taking the drug for a perceived extra performance edge.
And Pfizer is putting lots of money in the bank.
Another excellent example of a manufactured disease is osteopenia.
There was a time when osteopenia was an incidental finding on an x-ray, a way you would describe a bone which had gotten more transparent than others. It was an indicator of the loss of mineral in that bone, and a sign that, as a doctor, you might want to be on the lookout for osteoporosis further on down the line.
Or maybe not. Plenty of people experience temporary osteopenia, which reverses on its own. A number of pharmaceuticals cause osteopenia as a side effect, and as soon as the drug is no longer taken, normal bone is restored. People living sedentary lifestyles, either due to other health problems or simple neglect, often develop osteopenia which disappears with a return to activity.
But for several years, I had many a middle-aged woman come to my office with the “diagnosis” of osteopenia, for which they had been prescribed Fosamax or one of the other bisphosphonates.
Again, here we have a symptom, or exam finding, that has been carefully recrafted into a disease.
The rebranding of osteopenia came with the development by Merck of a new drug that could increase the mineralization of bone. But this new drug — Fosamax — like, Viagra, had a very limited audience. People with osteoporosis, a true weakening of the bone.
But in 1997, Merck hooked up with the developer of a cheap and easy x-ray machine which purported to measure bone density in a way that would predict risk of fracture. The DEXA scan immediately multiplied Merck’s market by creating a new class of disease sufferers, this time people who had the new disease of “osteopenia.”
And the market took off. With the addition of standards manufactured by the drug companies themselves, medical doctors started prescribing Fosamax to a huge number of middle-aged women.
The wheels have since come off that cart, at least a little bit. No so much because subsequent research shows that Fosamax does not create healthier bone, nor because Fosamax has also been shown to actually cause bone death and increase fracture risk in certain bones (true). Nor has the fad decreased because research has also shown that the DEXA scan does not adequately — or even remotely — predict bone fracture (true).
No, the fad has passed because the patent on Fosamax ended in 2008, and the horde of no-name drugs has reduced the value of Fosamax considerably. With competition, Fosamax is no longer the money maker that it once was.
But the lesson that Merck learned was a valuable one. No, not the lesson about the consequences of releasing a dangerous and poorly-tested drug onto the market.
The real lesson here was that coupling tests which purport to objectively demonstrate the presence of a “disease” with a drug that cures that “disease” is an extremely potent form of marketing.
Today, consultants of pharmaceutical companies are offering week-long seminars on how to couple drug development with tests that will increase the demand for that drug, and then market them to medical doctors and consumers alike.
This development has gone largely unnoticed, and unreported, and the vast (and unwarranted) trust that Americans have in their medical physicians makes such sales easy to make.
Medical doctors, on their side, are seeing pharmaceutical company payouts, in the form of “consulting fees,” as a lucrative sideline to offset the continuing pressure on their income. Medical doctors are also paid ludicrous sums for enrolling patients into research programs, to the extent that some practices have hired specialists to sift through the studies available and determine which will be the most profitable to participate in.
And patients, on their side, are manipulated by the fear spread by pharmaceutical companies that previously unheard-of diseases will dramatically affect their quality of life.
But you know what? Most people aren’t sick, and most people don’t need prescription drugs — although 50% of the U.S. population are taking them.
In fact, most of the people taking drugs today are not the victims of disease, they are victims of a lucrative marketing scam no more ethical than an email from a banker in Kenya.