How to turn a condition into a disease by “selling sickness”

“Selling sickness” means that the line between healthy and sick becomes blurred – and demand for medical treatment increases. If you’re a drug company, it’s a swell way to get consumers to demand treatment that may or may not even be necessary. So says a Dutch study that investigated industry-funded information campaigns around common conditions like restless legs syndrome, overactive bladder and heartburn.

These “ask your doctor” campaigns focused on symptom advertising or disease mongering.

Dutch law, as in Canada (but not, significantly, in only two countries: the U.S. and New Zealand) prohibits “Direct To Consumer” public advertising of prescription drugs. You might well wonder why these two countries are the only ones on earth who still permit this marketing practice.

But merely informing the public about medical conditions and health is still apparently permitted in most countries. As long as there are no direct or indirect references to a specific drug, for example, current legislation and regulation in the Netherlands regard these campaigns as “informative”. But the Dutch researchers warn that:

“Any form of influence with the apparent purpose of promoting the prescription, supply or use of a medicine or instigation of the same constitutes advertising.”

This kind of DTC promotion means that consumers are motivated to visit their physicians, either through the direct “ask your doctor” message or through a self-test. Some physicians, however, are concerned that we’re being educated by drug companies attempting to convince us that a common health condition is actually a disease that – of course – needs their expensive brand name pharmaceuticals to treat.

Consider the newly minted “disease” called restless legs syndrome. This condition actually exists, for about 2-3% of the adult population. Its most common symptoms include painful sensations in the legs, especially when sitting or lying down.  According to the National Institutes of Health, there are simple lifestyle changes and activities that reduce symptoms in most people diagnosed with restless legs syndrome.  These include:

  • decreased use of caffeine, alcohol, and tobacco
  • supplements to correct deficiencies in iron, folate, and magnesium
  • changing or maintaining a regular sleep pattern
  • a program of moderate exercise
  • massaging the legs
  • taking a hot bath
  • using a heating pad or ice pack

Big Pharma, however, wants us to believe that restless legs syndrome is not just a common condition of aging that will often respond well to these simple non-drug therapies, but an actual disease that desperately needs a drug to “cure” it.  Drugs called dopaminergic agents (largely used to treat Parkinson’s disease) have indeed been shown to reduce symptoms of restless legs when they are taken at bedtime, and are considered the initial treatment of choice. But although dopamine-related medications are effective in short-term management of restless legs symptoms, longterm use can lead to worsening of the symptoms for many individuals.

This doesn’t stop Big Pharma from wanting to convince us to keep taking their drugs for this “disease”.

So here’s what we already know about this type of drug ad campaign:

  • DTC public information campaigns are effective
  • they prompt more people to go to their family physician
  • physicians then more often prescribe medicines for the condition

That is the target of the campaign. But according to the insiders at Healthy Skepticism, these tactics lead to overburdened doctors and can have a negative impact on the rational use of medicines.

Healthy Skepticism explains that, even long before a medicine becomes available on the market, Big Pharma’s pre-marketing activities begin as part of a drug company’s disease awareness campaigns.

These disease awareness campaigns involve many parties, are often designed in cooperation with a marketing agency, and typically include:

  • a news release to the media about the introduction of a new drug, possibly in combination with research results that show the severity of the disease burden
  • the news release is then picked up by media, who often interview the medical specialists featured in the news release
  • the marketing agency supports the press release with websites about the ailment, television and radio commercials, newspaper ads and paid editorial content in magazines or on television programs
  • pharmacies and doctors’ offices offer brochures, directing consumers to the product website

The Dutch research project, Gezonde Scepsis, is an initiative of the Dutch Institute for Rational Use of Medicine, supported by the Netherlands Health Care Inspectorate and the national Ministry of Health. Researchers concluded:

“Our research shows that the pharmaceutical industry makes use of the leeway offered by current definitions of the term ‘information’ to market their medicines through symptom advertising.

“Pharmaceutical companies carry out campaigns to draw consumers’ attention to diseases or conditions for which a drug solution is available. These campaigns have a demonstrable effect on increased use of these drugs.”

All good news for Big Pharma marketing, wouldn’t you say?

See also:

10 thoughts on “How to turn a condition into a disease by “selling sickness”

  1. Pingback: Netherlands Today

  2. I had no idea that drug companies’ Direct To Consumer advertising is legal in the US and New Zealand but in every other country it is banned!!?? What gives here!?

  3. The list of non-drug, non-invasive remedies that help to improve life for those with R.L.S. should be every doctor’s FIRST approach to the diagnosis instead of reaching for the prescription pad. Appreciate this info about the Dutch study, thanks.

  4. Pingback: Dr. Joe Today

  5. So glad I stumbled across this blog!

    Doubly so because it is written by a Canadian woman who is rightly concerned about Big Pharma and the dubious methods it employs to sell its goods to a largely ignorant public. The North American public has been groomed to accept a great deal of nonsense via media of all sorts for a long time. Put on a white coat, throw a stethoscope around your neck, assume a posture of authority, speak in measured tones, and voila! instant recognition, acquiescence, and acceptance.

    An Alfred Kinsey moment…complete with skillful marketing and access to a higher power…in his case, John D. Rockefeller. Bawd-y science as practiced by the ‘scientist’ who procured his scientific data – including photographs of minor children being abused – from sexual predators. If there was any peer review of Kinsey’s ‘science’, it likely came from the ‘circle of friends’ with whom he engaged in his own pecadilloes. Yet, the impact of his ‘scientific’ research has been lauded for its landmark discoveries.

    That Big Pharma has been shielded comes as no surprise. There is an agenda being satisfied somewhere. The ‘peeps’ are at the bottom of the caring ladder.

  6. I suffer from restless leg syndrome, and NONE of the “simple lifestyle changes” mentioned above does a thing to reduce the problem. I suffered for 6-7 years with sleepless nights before trying medication. It is the only thing that has helped for RLS.

    While I realize that big pharmaceutical companies are influencing doctors and other medical practitioners too much, I am actually grateful that the medication I take came onto the market!

    • Thanks for sharing your perspective here. Just to clarify: nobody is implying that RLS (or overactive bladder, heartburn and other conditions mentioned) do not exist. As I wrote here, about 2-3% of the adult population have been appropriately diagnosed with RLS. For those people, and only those people, medications may indeed be the first treatment of choice IF all of the lifestyle changes recommended by the NIH are ineffective. What concerns me (and what this post is about) is how the pharmaceutical industry is aggressively attempting to expand their market share to widen the definition of those who “need” their drugs, many of which carry significant side effects.

      • I do realize that this is the case, with pharmaceutical companies attempting to increase their customer base by encouraging people to take medications they don’t need.

        But I sometimes think that people are actually less likely to take medication than many would think, especially medications for mental illnesses, because they believe they should be able to tough it out and recover on their own. Peter Kramer, the author of “Talking Back to Prozac” says that when it comes to medication, people who suffer from depression are actually under-treated and have a much worse prognosis as a result.

        Even with medications for asthma, people will under medicate, thinking they don’t really need it and can actually damage their lungs. I would wager that the vast majority of RLS sufferers go years without proper sleep before taking medication and many more never seek treatment. Yes, there are lots of prescriptions being handed out, but not all of them are filled, and repeats very often go unfilled.

        • Well, if GlaxoSmithKline (and other drug companies that make RLS drugs – like Requip, for example) have anything to say about it, these Direct to Consumer ads will soon be educating even the most uninformed patient of the need to take their drugs, necessary or not.

          Kramer’s NYTimes opinion piece is one-sided, as might be expected from a psychiatrist (the profession‘s first line of treatment is famously the prescription pad). Check the July 24th post here: “A Philosopher’s Take on Big Pharma Marketing” on this very subject, or read “10 Non-Drug Ways to Treat Depression”, in which Johns Hopkins researchers report: “Antidepressants are being prescribed for uses not supported by clinical evidence.”

          • Well, everyone with an opinion is one-sided, I guess! Kramer was one of the first people to actually question the wide-spread use of anti-depressants when SSRIs first came onto the market. As for non-drug treatments for depression, of course they are important, but medications can make the difference between being well and having a life of sickness and misery for some people.

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