EVIDENCE-based medicine has started to make a real impact in the past decade. Yet as we move towards more rational treatment in some areas, in others there is a trend in the opposite direction. Every year diseases new to science emerge 鈥� complete with the drugs to treat them. These are products of disease mongering.
It has long been a tactic of pharmaceutical companies to try to increase the number of people who can be prescribed their drugs. They argue for symptoms that are a little out of the ordinary, such as elevated blood pressure, to be redefined as diseases. They lobby for problems previously seen as social or cultural to be redefined as disorders that would benefit from drug therapy.
Thus our medicine cabinets are filling with the likes of antidepressants to treat 鈥渟ocial anxiety鈥� (shyness) and 鈥減remenstrual dysphoric dysfunction鈥�, appetite suppressants, and stimulants to improve the educational performance of children. Another disorder to receive attention from disease mongers is bipolar disorder, or manic-depression. This can be a debilitating condition, but the bar for diagnosing it has been lowered. Drugs once reserved for treating periods of mania are being prescribed for permanent use, and psychotropic drugs are now being dished out to children diagnosed as bipolar (see 鈥淧oles apart鈥�).
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One line of argument is that people are no longer patients but consumers: drugs for these complaints should be sold over the counter like groceries. That would be fine, except that some of them are very dangerous, do not work, or both. If caution demands that doctors continue to prescribe these drugs, then another problem follows: no country can afford an equitable health service while funding drugs companies鈥� every invention.
This will not be an easy problem to solve. Governments have let drug companies become the main educators of politicians, doctors and the public on many medical issues. Many people sitting on official advisory panels receive industry funding. Patient action groups, desperate for solutions and often with pharmaceutical company support, back treatments for which there is little or no scientific evidence. Determined patients may arrive at their doctors armed with dubious information gleaned online. Some doctors may be eager to try trendy drug treatments, even if they have not been tested or approved for the disorder in question, or may find them the easiest way to placate a distressed patient.
At the centre of this tangled web are the pharmaceutical companies. For them, bending the will of politicians, doctors and the public may be a cheaper route to sales than inventing new drugs, but that is no excuse. Alongside the boardroom mantra of 鈥渋ncrease shareholder dividend鈥� should sit the medical dictum 鈥渄o no harm鈥�. Disease mongering is harming individuals and health services. It is a juggernaut that needs to be stopped.
