Dr. Ben Goldacre, a British doctor writing in his weekly Bad Science column in The Guardian last fall, told this disturbing cautionary tale:
“In 2007, the British Medical Journal published a large, well-conducted, randomised controlled trial, performed at lots of different locations, run by publicly-funded scientists. It delivered a strikingly positive result. It showed that one treatment could significantly improve children’s anti-social behaviour. The treatment was entirely safe, and the study was even accompanied by a very compelling cost-effectiveness analysis.
“But did this story get reported as front page news? Was it followed up on the health pages, with an accompanying photo feature, describing one child’s miraculous recovery, and an interview with an attractive happy mother with whom we could all identify?
“No. This story was unanimously ignored by the entire British news media, despite their preoccupation with anti-social behaviour, school performance and miracle cures, for one very simple reason: the research was not about a pill. It was about a cheap, practical parenting programme!”
And if it’s just a regular, non-drug, non-medical kind of treatment for bratty kid behaviour – like a cost-effective parenting programme – it’s not going to make money for anybody the way that a diagnosis of oppositional defiant disorder can.
I love this WebMD clinical definition of oppositional defiant disorder, by the way:
“In toddlers, temperamental factors, such as irritability, impulsivity, and intensity of reactions to negative stimuli, may contribute to the development of a pattern of oppositional and defiant behaviours in later childhood.”
(Irritability? Impulsivity? Intense reactions to negative stimuli? If those were actual contibutors, according to my admittedly non-scientific observations as the parent of former toddlers, every second kid at St. Christopher’s Montessori preschool should have been institutionalized and on Ritalin).
What does make money, at any rate, is taking a normal, everyday event or personality trait, and then re-defining it as pathology by ‘medicalizing‘ it into a condition that must now be treated medically. Brilliant marketing and make-work strategy.
However, even aside from Big Pharma - who stand to gain the most from medicalizing virtually everything – many experts join Dr. Goldacre in lamenting the evolution of some clinical practices that may actually have little medical justification. For example, Dr. Thomas Szasz, in his controversial 2007 book called The Medicalization of Everyday Life, argues that routine neonatal circumcision is one practice that demonstrates how contemporary culture has unfortunately bought into medicalizing practice.
“Routine neonatal circumcision is not justifiable on health grounds (e.g. prevention of cancer or infection), is ethically and medically on a par with female genital mutilation, and, hence, is an essentially religious ritual that is legitimized as a medical practice to serve ideological, political, and religious interests.”
Dr. Szasz reserves his harshest criticism for psychiatrists, even though he is one himself.
He accuses his profession in general of protecting people from having to assume responsibility not only for their own health but also for the behaviours that make them ‘ill’, literally or figuratively.
He is well-known for his famous conclusions that mental illness is a harmful myth, that his own chosen profession of psychiatry is not a bona fide medical specialty, and that psychiatrists are not medical experts. You can guess his opinion on the use of insanity as a legal defense.
He maintains that whenever someone is viewed as being sick (ill, diseased) or their behaviour is viewed as the product of sickness (illness, disease), then that behaviour is now viewed as not really under the person’s rational control.
He lists resulting “deep harms” of not viewing people as the responsible authors of their own behaviour, such as the Catholic Church’s initial internal response to child-abusing priests.
“As a consequence, medicalized individuals are viewed as less responsible for their behaviour and as more fitting candidates for being the object of treatment by others. Such individuals are now classified in a way that enlists various practices to deal with them. For example, sick people fall within the domain of medical practice.
“People want a therapist-in-chief who is both physician and priest, an authority that will protect them from taking responsibility. Pandering politicians assure people that their maladies are ‘no-fault diseases’, promise them a ‘patient’s bill of rights’ and stupefy them with an inexhaustible torrent of prescription drugs and propaganda.”
Meanwhile, back in the U.K., Dr. Goldacre (who claims that he rarely even identifies himself as a medical doctor because he believes that “arguing from authority” is one of the biggest problems in the way that science is misrepresented by the media) offers this tidy history of his profession in a Bad Science column that he also calls The Medicalization of Everyday Life:
“Before 1935, doctors were basically useless. We had insulin, morphine for pain relief – a drug with superficial charm, at least – and we could do operations fairly cleanly, although with huge doses of anaesthetics, because we hadn’t yet sorted out well-targeted muscle-relaxant drugs. Then suddenly, between the 1930s and the 1970s, science poured out an almost constant stream of miracle cures.
“Everything we associate with modern medicine happened in that time: antibiotics, dialysis, transplants, intensive care units, heart surgery, every drug you’ve ever heard of, and more.
“For people who were ill, the difference was spectacular. If you got TB in the 1920s you died, pale and emaciated, in the style of a romantic poet. If you got TB in the 1970s, then in all likelihood you would live to a ripe old age. You might have to take rifampicin and isoniazid for months on end – they’re not nice drugs, and the side effects make your eyeballs and urine turn pink – but if all goes well, you would live to see inventions unimaginable in your childhood.”
Dr. Goldacre particularly laments disease mongering, which is what drug companies have had to do because all the good diseases are already taken. Disease mongering goes like this, says the good doctor:
“Because they cannot find new treatments for the diseases we already have, the pill companies have instead had to invent new diseases for the treatments they already have.
“Recent favourites include social anxiety disorder (a new use for SSRI antidepressant drugs), female sexual dysfunction (a questionable diagnosis in women), the widening diagnostic boundaries of restless legs syndrome, and even something called night eating syndrome.”
Read more about:
- Dr. Ben Goldacre’s provocative thoughts on the website called Bad Science
- the widely ignored British Medical Journal article about effective parenting programmes
- “The Medicalization of Everyday Life”, the book by Dr. Thomas Szasz
- ‘Extreme Exam Anxiety’ – Disability or Excuse?
- How To Turn A Condition Into a Disease by “Selling Sickness”
- Is Ugliness A Disease?
- Are You Being “Over-Diagnosed”?
- There’s A Pill for That!
- Are You a ‘Health-Seeker’ – or a ‘Disease-Seeker’? from my other site, Heart Sisters