Something strange is happening in medicine, according to physician,  bioethicist and author Dr. Carl Elliott in his landmark article in The Guardian called Is Ugliness a Disease?  No longer, he claims, is medicine being used merely to cure illness. “Medicine is now being used in the pursuit of happiness. We take Viagra at bedtime and Ritalin before work. We inject Botox into our wrinkled brows and rub Rogaine on our balding heads. We swallow Paxil for shyness, Prozac for grief, and Buspar for anxiety.

“For stage fright we use beta blockers; for excessive blushing and sweating, we get endoscopic surgery. We ask surgeons to trim down our noses and suck fat from our thighs in the pursuit of what we believe to be our true selves. 

“Not all of this is new, of course. Cosmetic surgeons were setting up shop as far back as the 1930s, and antidepressants and anxiety drugs have been around for more than 50 years. Yet at no time in history have we been such enthusiastic consumers of “enhancement technologies” in medicine. What has happened to bring about such a dramatic change?

“In our market-based health care system, the pharmaceutical industry has achieved unprecedented financial power. Since the early 1990s, the pharmaceutical industry has been the most profitable industry in North America, with margins exceeding 18%. With profit has come power.

“The drug industry has also ratcheted up its spending on doctors. The number of drug representatives employed to make promotional pitches directly to doctors rose by 57% during the 1990s. Perhaps most remarkably, the drug industry now funds 40% of continuing medical education in our  medical schools.

“As drug industry profits have increased, so have the number of new medical disorders, from social anxiety disorder and premenstrual dysphoric disorder to erectile dysfunction and irritable bowel syndrome.

“The industry sells drugs by selling the illnesses they treat.

“How does the industry sell illnesses? As psychiatrist Dr. David Healy has pointed out, they do it by:

• funding patient support groups
• sponsoring public awareness campaigns
• funding symposia and special journal issues devoted to the disorders their drugs treat
• sponsoring “professional education” for physicians.

“When restrictions on direct-to-consumer advertising were lifted in the U.S. in 1997, the drug industry began to bombard television viewers and magazine readers with ads for their drugs.

“In 2001, GlaxoSmithKline spent more money advertising Paxil and the newly popular “social anxiety disorder” for which it is prescribed than Nike spent advertising its top shoes.

“This is not simply a matter of the industry creating illnesses out of thin air. The suffering these interventions treat is often genuine. But much of it differs sharply from the kind of suffering that comes from ordinary medical conditions. Often (though not always) it is social in nature.

“If you have diabetes or heart disease, you suffer regardless of who is watching you or how they perceive you. But the suffering that comes from being too short, too shy or too small-breasted is bound up with the way these characteristics are seen by other people. Yet once social problems can be treated by medical technologies, they come to be seen as medical problems. Then doctors are much more comfortable treating them.

“When the FDA approved synthetic growth hormone to treat short stature in children, the agency cited studies showing that if an ordinary short child is injected with growth hormone for a period of several years, they may gain a few extra centimetres of height when they reach adulthood. Never mind that many studies have also shown that short children are just as psychologically healthy and happy as taller children. Many pediatricians (and perhaps many more parents) insist that being short is such a serious handicap for a child that it deserves medical treatment. One commentator in the New England Journal of Medicine has called the condition of being short “psychologically disabling”.

“An unfulfilled life is seen as a lesser life, one that has failed to meet the promise of what a human life could be. It is:

• a life lived as a man, when you are really a woman
• a life lived as a bashful blusher, when you should really be the life of the party
• a life lived as Woody Allen when you feel you should be Cary Grant

“Seen in this light, “enhancement technologies” such as Prozac, Ritalin, cosmetic surgery, growth hormone and sex-reassignment surgery are not merely ways to look and feel better. They are instruments of self-fulfilment.

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© Carl Elliot The Guardian

Read the rest of Carl Elliott’s illuminating article in the Guardian.

He teaches bioethics and philosophy at the University of Minnesota. He is the author of six books, including White Coat, Black Hat: Adventures on the Dark Side of Medicine and Better Than Well: American Medicine Meets the American Dream. Check out his blog in which sibling rivalry with his lesser brother is demonstrated at a frightening yet hilarious level.

See also: 

• How To Turn A Condition Into a Disease by “Selling Sickness”
• There’s a Pill For That!
• Are You Being “Over-diagnosed”?
• The Medicalization of Everyday Life
• Are You a ‘Health-Seeker’ – or a ‘Disease-Seeker’? from my other site, Heart Sisters