Until recently, drug companies selling blockbuster drugs were the darlings of stock market investors. But of course, not all diseases are blockbusters, warns Martha Rosenberg in a recent AlterNet essay. Supply-driven marketing, also known as “Have Drug – Need Disease and Patients” – not only turns us into pill-popping hypochondriacs, she claims, but it distracts from Big Pharma’s drought of real drugs for real problems.
She reminds us that, in order to be considered a true blockbuster disease, a condition must:
- really exist but have huge diagnostic “wiggle room” and no clear-cut tests
- be potentially serious with “silent symptoms” said to “only get worse” if untreated
- be “under-recognized,” “under-reported” with “barriers” to treatment
- explain hitherto vague health problems that a patient has had
- have a catchy name — ED, ADHD, RLS, Low T or IBS — and instant medical identity
- need an expensive new drug that has no generic equivalent
Martha suggests the following conditions that just might turn into potential blockbuster diseases – the ones that Big Pharma hopes you get this year:
1. Adult ADHD (Attention Deficit Hyperactivity Disorder) is a diagnosis that has doubled in women age 45 to 65, and tripled in men and women 20 to 44, according to the Wall Street Journal. A drug ad in Psychiatric News, for example shows a pretty but pouting young woman, saying: “I’m Depressed. Could it be ADHD?”
Big Pharma also has to convince kids who grew up diagnosed as ADHD not to quit taking their meds as adutls, says Mike Cola of Shire (which makes the ADHD drugs Intuniv, Adderall XR, Vyvanse, and the Daytrana patch).
“We know that we lose a significant number of patients in the late teen years, early 20s, as they fall out of the system based on the fact that they no longer go to a pediatrician.”
2. Rheumatoid Arthritis is a serious and dangerous disease. Once upon a time, RA was diagnosed from the presence of “rheumatoid factor” and inflammation. But, thanks to Pharma’s supply-driven marketing, stiffness and pain may now be all that are required for the diagnosis today.
In addition to diagnostic wiggle room, RA has other blockbuster disease requirements. It will “only get worse” if untreated, warns WebMD, (the health website whose financial ties with drug companies like Eli Lilly have been investigated by the U.S. Senate Finance Committee, by the way). Abbott’s Heather Mason told the Chicago Tribune that RA is often “misdiagnosed and under-reported people often don’t know what they have.” So serious a disease, it costs over $20,000 a year to treat with the drug Humira, but so subtle you may not know you have it?
3. Fibromyalgia is another under-reported condition, characterized by widespread unexplained body pain. Fibromyalgia is “almost a textbook definition of an unmet medical need,” says Ian Read of Pfizer, which makes the first drug to be approved for fibromyalgia, the seizure pill Lyrica, which earns $3 billion a year in sales for Pfizer.
But Lyrica now has to fight off competition from Cymbalta, the first antidepressant to be approved for fibromyalgia. Eli Lilly has pre-positioned Cymbalta for the physical “pain” of depression in a campaign called “Depression Hurts” before the fibromyalgia approval. Treatment of fibromyalgia with either Lyrica or Cymbalta can hover around $10,000.
Big Pharma and stock markets may be happy with fibromyalgia drugs like Cymbalta, but many patients aren’t – often reporting alarming side effects including chills, jaw problems, eye problems and other distressing symptoms like suicidal ideation (a frequently-reported side effect of Cymbalta). Lyrica users have also reported memory loss, confusion, extreme weight gain, hair loss, impaired driving, disorientation, twitching, and worse.
And some patients take both drugs.
4. Middle of the Night Insomnia
Sleep disorders are a goldmine for Big Pharma because everyone sleeps – or watches TV when they can’t. To churn the insomnia market, drug companies roll out subcategories of insomnia, such as chronic, acute, transient, initial, delayed-onset, terminal, early-morning, menopausal, and the master category of non-restful sleep. Last fall, Big Pharma launched a new version of Ambien for “middle-of-the-night insomnia” called Intermezzo, even though Ambien is paradoxically notorious for middle-of-the-night awakenings: people “waking up” in an Ambien blackout and walking, talking, driving, making phone calls, and eating food.
5. & 6. Excessive Sleepiness and Shift Work Sleep Disorder
People with insomnia won’t be bright-eyed and bushy-tailed the following day – whether they didn’t sleep or whether they have sleeping pill residues in their system. In fact, Big Pharma tells us that they are actually suffering from the under-recognized and under-reported epidemic of Excessive Daytime Sleepiness. The main medical causes of EDS or ES are sleep apnea and narcolepsy, but last year Big Pharma rolled out a lifestyle-caused “Shift Work Sleep Disorder.” which can, fortunately, be treated with Schedule IV stimulant drugs like Provigil and Nuvigi.
Of course, wakefulness agents contribute to insomnia, which contributes to wakefulness problems in a kind of perpetual pharmaceutical jet lag.
7. Insomnia That Is Really Depression
Sleep disorders have also given a new lease on life to antidepressant drugs. Doctors now prescribe more antidepressants for insomnia than they do sleeping pills. They also often combine them, since, as the industry-friendly WebMD explains:
“Insomnia and depression often occur together, but which is the cause and which is the symptom is often unclear. Depressed patients with insomnia who were treated with both an antidepressant and a sleep medication fared better than those treated only with antidepressants.”
As Martha Rosenberg says:
“Ka-ching!”
She concludes her Alternet piece by warning that many of the new blockbuster diseases from adult ADHD to fibromyalgia are treated with new drugs piled on top of existing ones that aren’t working, a Pharma contrivance called polypharmacy.
Dr. Gilbert Welch, along with his co-authors Drs. Lisa Schwartz and Steven Woloshin, wrote in the New York Times* a couple years ago that what’s actually making us sick is what they call “an epidemic of diagnoses”. For example:
“This epidemic is a threat to your health. It has two distinct sources.
“One is the medicalization of everyday life. Most of us experience physical or emotional sensations we don’t like, and in the past, this was considered a part of life.
“Increasingly, however, such sensations are now considered symptoms of disease. Everyday experiences like insomnia, sadness, twitchy legs and impaired sex drive now become diagnoses: sleep disorder, depression, restless legs syndrome and sexual dysfunction.
“While these diagnoses may benefit the few with severe symptoms, one has to wonder about the effect on the many whose symptoms are mild, intermittent or transient.“
.
* “What’s Making Us Sick Is an Epidemic of Diagnoses” – New York Times, January 2, 2007
See also:
- Are You Being Over-Diagnosed?
- New ‘Desire Drug’ Claims that Sex Really IS All in Her Head
- There’s A Pill For That!
- Is Ugliness A Disease?
- The Medicalization of Everyday Life
- “We Never Imagined People Would Think of Osteopenia as a Disease”
- Are You A Health-Seeker, or a Disease-Seeker? (from my other site, Heart Sisters)
- Catastrophizing: Why We Feel Sicker Than We Actually Are (also from Heart Sisters)
The Ethical Nag 
The real problem is DTCA (Direct To Consumer Advertising) which I believe became legal under Clinton. The U.S. is one of two countries in the world that allows the practice and it creates an incentive for this type of behavior and over-utilization of drugs. We need to ban DTCA again.
Thanks, Mark. Only the U.S. and New Zealand currently allow the practice of DTC advertising. More on this here.
I should say you’re wrong about RA though. It ideally should be detected early and treated aggressively. I would be very surprised if there was a significant level of misdiagnosis to give Humira, as no insurer would reimburse without documentation of disease. Further RA is progressive and debilitating, causing increasing pain, deformity, and disability with time. Disease-modifying drugs represent a major improvement in therapy for autoimmune diseases that had few effective treatments aside from pain relief and sledgehammers like steroids.
I agree in general, Mark. Trouble is, there is no single laboratory test or x-ray which can diagnose rheumatoid arthritis. A combination of test results, a clinical examination, and the patient’s medical history help determine the diagnosis. And about 20% of patients who do have RA test negative for the rheumatoid factor. Insurers are already paying for a number of drugs despite questionable diagnostics (osteopenia is a good example).
Psychiatry is another field in which large populations of people have become patients based on what’s called the DSM-IV “birdwatcher’s guide” to diagnosing. More on this at: How The ‘Shrinks Bible’ Can Make You Sick.
We are all sick now – only some of us do not know it yet. We should be grateful to those who are seeking to do nothing more than increase our “awareness” that we have these conditions and need treatment. 🙂
Yes, I’m pretty sure I have all of these conditions . . .
Those of you who are joking about having serious and debilitating conditions like RA are what really makes me sick. “I’m pretty sure I have all of these conditions” – Carolyn Thomas. Really, Carolyn? Walk a day in my shoes (every step will be painful so get ready) and see if you’re still joking about having “these conditions” (RA is not a condition, for the record, it’s an autoimmune disease).
Martha Rosenberg is a scare-mongering opportunist. It’s ironic, really. She writes about how “big pharma” wants to “over” medicate to make money. Well, what is she doing? She’s writing article after article with high-paying keywords (coincide? Nope!), slightly changing some articles and recycling them again (Do you know how long this article’s been around in how many different forms?!), all the while not actually doing her homework on what she’s writing about, and ignoring when her inaccuracies are brought to her attention. She does not understand the basic principles of autoimmune diseases such as RA, and how it’s diagnosed and treated. For example, she portrays the concept of suppressing the immune system as drugs like Humira do as something scary and crazy — when in reality, that is exactly WHY they work for autoimmune disease, because the immune system is attacking itself and currently one of the few treatments is to suppress the immune system. She acts as if suppressing the immune system is some terrible side effect of the drugs when, in fact, it is the exact PURPOSE of the drug. She displays ignorance and laziness on an alarming scale. Perhaps she should talk to doctors and patients about these diseases rather than quoting WebMD! That’s what a REAL reporter would do … or just anyone who actually cared about what she was writing about being factual and accurate.
I have psoriatic arthritis, a close cousin of RA. There is NO test for what I have. Does that mean it doesn’t exist? What an asinine suggestion. Would you like to see pictures of my deformed toes? Oh, and in case you’re wondering, the toes became deformed during the years it took doctors to figure out what was wrong with me — because yes, INDEED, it is possible to have pain (not subtle!) and not know what is wrong with you while having a very serious disease (combating yet another asinine suggestion). Since being diagnosed and being treated with biologics, the deformities have stopped. Imagine that!
Lastly, as someone living with an autoimmune disease for several years, I can say with absolute certainty that no health insurance is covering the RA drugs Mizz Rosenberg is talking about without a hell of a lot of diagnostic methods. I’ve had to fight tool and pitted nail to get my medications covered. So there’s yet another completely untrue statement by Mizz Rosenberg.
I encourage you to stop posting inflammatory, scare-mongering, inaccurate, untrue statements such as this. Wouldn’t THAT be the ethical thing to do?
I have a problem with doctors prescribing and administering Remicade. I took my daughter who has Crohn’s to a major city for a consult with a GI specialist and he prescribed Remicade ASAP as it had been nine weeks since her last infusion. He set up the infusion for late that afternoon but my daughter was tired from the colonoscopy and we drove home. I made arrangements with the local infusion treatment room to administer the Remicade upon receipt of the GI’s orders. He refused to fax any orders!!! His infusion room is booked for a week but my daughter’s need is not important. It seems that the money to be made administering Remicade is more important than my daughter receiving a timely dose.