hEALTH

DISEASE OR NOT?

“Disease Mongering”

Turning healthy people into patients?

Have you ever asked how limits for high blood pressure or cholesterol levels are defined? Of course there are scientifc data that show correlations between higher levels and elevated risks of e.g. stroke. However, in many cases there are no clear thresholds which indicate that below them everything is alright and above them you are nearly dead, i.e. it is not always obvious where the border should be defined between a mild symptom and a disorder that needs medical attention. Instead, it is a smooth transition from low to medium to high risk, influenced by individual risk factors, and therefore, you have to define limits that are acceptable: setting a limit too high means that some patients could have a higher risk of damages due to improper medication. On the other hand, a very low limit turns healthy people into patients.
If you were a product manager of a pharmaceutical company selling drugs, which limit would you prefer for an effective drug marketing?

The Inaugural Conference on Disease Mongering (2006) has compiled a collection of articles dealing with this subject.
A collection of articles on disease mongering.
PLoS Medicine (2006).

More info about disease mongering:
Disease mongering -- a challenge for everyone involved in healthcare.
Dear JW, Webb DJ.
Br J Clin Pharmacol. 64:122-4 (2007).

“...it is not only companies who are to blame, but also physicians who diagnose a disorder and prescribe a drug, as well as patients who feel that they have a serious disease that needs treatment”
Disease mongering and drug marketing. Does the pharmaceutical industry manufacture diseases as well as drugs?
Wolinsky H.
EMBO Rep. 6:612-4 (2007).

Or how about a novel disease? Maybe you suffer from a depressive entity called the “Sisi syndrome”?
The “Sisi syndrome”: a new form of depression?
Burgmer M, Driesch G, Heuft G.
Nervenarzt 74:440-4 (2003).

Another suspect is the “Metabolic Syndrome”. Unknown until 2004, experts controversially discuss if it has a clinical value or not:
Should we dump the metabolic syndrome?: Yes.
Gale EAM.
BMJ 336:640 (2008).

Should we dump the metabolic syndrome?: No.
Alberti KGMM, Zimmet PZ.
BMJ 336:641 (2008).

More information about the business of reframing mild symptoms as portents of serious disease exemplified by baldness, irritable bowel syndrome, social phobia (shyness), osteoporosis and erectile dysfunction. “A lot of money can be made from healthy people who believe they are sick.”
Selling sickness: the pharmaceutical industry and disease mongering.
Moynihan R, Henry D.
BMJ 324: 886-891 (2002).