September 2005: Selling Sickness

Drug companies profit hugely from creating “diseases,” then the “cures”
September 1, 2005

How the World’s Biggest Pharmaceutical Companies are Turning Us All into Patients

by Ray Moynihan and Alan Cassels (Greystone, 2005)

Review by Abby Lippman

“At the end of times the merchants of the world will deceive the nations through their Pharmacia” [sorcery]. -- Rev 18:23

We haven't yet reached the "end of time," but we are certainly living in an age when deception may be as much a trademark for the pharmaceutical industry as the drugs they sell. At least this is what one might conclude after reading Ray Moynihan’s and Alan Cassels’s recent book, Selling Sickness. In a series of 10 sharply drawn "case studies," these long-time drug company muckrakers expose how the industry and the regulatory agencies, physicians, patient groups, and celebrities that too-often collaborate or are used by it, are redefining illnesses, turning "risk factors" into diseases, jigging the threshold of "abnormality" to create new under-treated disease epidemics, and medicalizing conditions and traits whenever they can. Then they develop an array of drugs to "cure" what they have helped manufacture.

Most of us have generally assumed that the pills we take are necessary, that they work and are safe--and that celebrities are entertainers, not health educators. We expect physicians to prescribe what they know is good for us, and we rely on government regulators to safeguard our health. But, given all the recent news about drugs like Vioxx being pulled off the market, and warnings for users of drugs like SSRIs and DepoProvera, could these assumptions be wrong?

Selling Sickness throws light on these taken-for-granteds, revealing some hard truths about pharmaceuticals and those who make, sell, regulate, prescribe, and shill for them. Drawing on extensive interviews and documents, Moynihan and Cassels relate a troubling story of drug salesmen wining and dining physicians to encourage them to prescribe their newest, priciest product; of companies reporting only studies with favourable results to regulators; of “experts” heavily funded by drug companies writing clinical guidelines that change the threshold for “abnormality” and establish treatment standards; and of large sums of (hidden) money given to high-profile celebrities who help “brand” products.

The selling of sickness seems to follow a familiar pattern. A drug company identifies a wedge condition, set of symptoms or “risk factors”; hires a PR firm to come up with a “disease” name, ideally something catchy with a pronounceable acronym (e.g., SAD); develops a drug or adapts an existing one to tout as a “fix” for this new medical problem; and begins massive marketing to physicians and the public. The media pick up the story, suggesting that this “new” disease is greatly undiagnosed or undertreated. Drug sales soar. Voila! Another pharmaceutical blockbuster is born.

To read Selling Sickness is to realize that the operations of Big Pharma may be much more dangerous threats to the health of Canadians than the currently demonized waiting lists that delay joint or eye surgery. The health of women is particularly threatened, since the conditions discussed--and it’s hard to know what word to use here, since only one even approaches being a disease, while the others are either normal life experiences or everyday symptoms for many--include six that are of special interest to women. Each is used to illustrate some particular pharma approach to sell sickness: for example, using celebrities to push hormone treatment (menopause); selling diagnostic tests to convert risk factors into a disease (osteoporosis); advertising to create a disease or to get an extension on a patent for an old drug (“pre-menstrual dysphoric disorder”); turning a social problem into a disease (female sexual dysfunction); and altering public perceptions to craft new maladies (social anxiety disorder).

Moynihan and Cassels use their well-honed investigative skills to pull together a story that clarifies how well over half of all biomedical research is now in the hands of the pharmaceutical industry, and how drug companies not only control the questions asked, but also the way the results are interpreted, when and how they will be published, what regulators--and physicians--will know when they decide whether or not something will be safe and useful for us.

The authors provide solid evidence for their claims, but they don't give full credit to all the work done before them by women's groups in Canada and elsewhere who have been revealing the medicalization of women's bodies and conditions and the dangers of the drugs given us (hormone treatment; anti-depressants, depo provera; DES) for decades.

What we read in Selling Sickness is, unfortunately, an old story for women, but these authors’ telling of it serves as a powerful reminder that we must continue to re-claim our own experiences. We've always been judged as "crazy" for complaining about our lives, and we saw through this when physicians were the judges. It's now mainly the pharmaceutical companies that are doing much of the "judging," so that their shareholders can make huge profits, and we need to resist this newest "disease-mongering" collectively. A good start will be demanding independent, transparent, accountable regulatory procedures for drugs and devices, as well as being sure that society removes the oppressive situations that make us ill.

(Abby Lippman is a professor of epidemiology at McGill University. She is on the steering committee of Women and Health Protection and chairs the board of the Canadian Women’s Health Network.)