Metacriticism

The use of prescription drugs is a nuanced and personal issue; however, the marketing of them is not. The deeper I dig into this topic the less convinced I am that direct-to-consumer (DCTAs) prescription drug ads offer much benefit to the consumer. One exception may be that they motivate viewers of the ads to go to their doctor in order to ask about the drug, where they may then receive a diagnosis and treatment for diabetes or high blood pressure. DTCAs get people to the doctor who otherwise might not go, but does this benefit outweigh the costs?

                In “Selling Sickness: The Pharmaceutical Industry and Disease Mongering” Moynihan et al. describe “disease mongering” as widening the definition of a disease and promoting it to prescribers and consumers (p. 886).

Disease mongering can include turning ordinary ailments into medical problems, seeing mild symptoms as serious, treating personal problems as medical, seeing risks as diseases, and framing prevalence estimates to maximize potential markets (Moynihan et al., p. 886).

Working with doctors and consumer groups, pharmaceutical companies help to raise awareness about under diagnosed and under treated illnesses, promoting them as common, severe and treatable. These “disease awareness” campaigns are closely tied to the companies’ marketing plans and work to promote new pharmaceutical products (Moynihan et al., p. 886). Financially funded by drug companies, the goal of the awareness campaigns is to influence the media to promote stories that generate fear about the disease and provide information about treatment.

                Pharmaceutical companies fund research that promotes medicalization, our perception that all of our problems can be treated with a drug. Ordinary problems like hair loss become medical conditions when studies show that hair loss can lead to panic and may affect mental health. This research was funded by Merck when its hair growth drug was first approved in Australia. Mild symptoms are viewed as a threat of serious illness in the case of irritable bowel syndrome (IBS), a disorder covering a wide range of symptoms. While some people are severely hindered by the symptoms of IBS, for most it is a mild disorder.  As part of the marketing for its new drug Lotronex GlaxoSmithKline designed an extensive education program to transform public opinion about IBS as a real and treatable disease. The goal of the program was to create the need for a drug and get prescribers to rethink the way the disease is managed. Pharmaceutical marketers help to shape public opinion about personal and social problems, as well. When Roche was advertising an antidepressant drug as a treatment for social phobia it inflated the numbers, saying one million people in Australia went undiagnosed. Government records suggest the number is closer to 370,000. Roche funded a conference on social phobia, and several stories appeared in the media helping to alter public opinion about shyness as a psychiatric disorder instead of a personal problem.

                When Moynihan et al. highlight risk factors perceived as diseases the discussion becomes more complex. The examples they use, high blood pressure, high cholesterol and osteoporosis, are commonly treated with medication, even in young adults. In a health psychology class I am taking we studied coronary heart disease, and the treatments for high blood pressure and high cholesterol were medications, alongside diet and lifestyle changes. One of the challenges for a health psychologist working with a cardiac patient is treatment adherence to the blood pressure medications, as some of the side effects are depression, fatigue and sexual impotence in males.  Since I perceive these risks as threats that can be treated with pharmaceutical drugs is that evidence that the marketing has worked? The drug corporations’ role in shaping the way osteoporosis is viewed has been extensive. “They have funded patient groups, disease foundations, and advertising campaigns (on both drugs and disease) targeted at doctors and have sponsored osteoporosis media awards offering lucrative prizes to journalists”(Moynihan et al., p. 889). In calling osteoporosis a “silent thief” they are creating fear in consumers (Moynihan et al., p. 889). They chip away at our perceptions of health, so healthy people request expensive therapies that offer marginal help. Maybe I am one of their victims. Even after reading the Moynihan et al. article I am not sure I believe their argument about risk factors being perceived as diseases.

Osteoporosis appears to be a disease that can be prevented with exercise, nutrition and possibly drugs. For evidence to support what I thought I knew I researched osteoporosis and the treatments. In diagnosing osteoporosis a doctor compares the results of the patient’s bone density scan against the bones of a young, healthy person and to average people of the patient’s age (NIH 2011). Moynihan et al. point out that bone density as a predictor of fractures is controversial. While the risk of low bone density is associated with fractures it is not a reliable enough predictor to be used in designing a therapeutic path for the patient. The medications used for the prevention of osteoporosis did not significantly reduce the risk of fractures in the women studied. The incidence of fractures was 3.8% in the placebo group and 2.1% in the group taking the drug alendronate (Moynihan 2002). This is a small increase compared to the side effects of alendronate which include “nausea, stomach pain, constipation, diarrhea, gas, change in ability to taste food, headache, dizziness, swelling of the joints, hands or legs, heartburn, difficulty swallowing, swelling of eyes, face, lips, tongue or throat, loosening of the teeth, eye pain” (AHFS 2011).

Osteoporosis is the weakening of bones that occurs as we age; however, it is the threat of bone fractures that is the actual risk to our quality of life. Because osteoporosis is embedded in my mind as the phantom that lingers in the shadows as I age, it has taken research and dissecting layers of belief to get to the actual threat of the disease. When making the decision whether or not to take medication now that may or may not prevent bone fractures years from now, it is difficult to justify choosing medication over exercise and nutrition. To me the side effects do not substantiate the benefits of the drug.  However, thinking about osteoporosis, the disease, as the threat is a much slipperier topic because disease and medicine are closely linked in my brain. Medicine as a way to treat bone fractures is not. Pharmaceutical companies probably know this, and that is why they are not just selling their drugs but the diseases they are meant to treat as well.

Who then can we trust? Where do I get my information about health and disease? If I am sick I get it from the doctor, and most of us have probably searched for the symptoms on the internet. However, much of what I have learned about health and wellness has been from others’ stories or from television. Without much awareness, ideas about disease and illness wash over us, forming our knowledge about the best ways to take care of our bodies. My doctor once commented that “we take our health for granted.” I am realizing that I do view health as something that can be restored by doctors, given back with medicine. Anything can be treated, and everything can be fixed. DTCAs contribute to these misconceptions.

Works Cited

American Society of Health-System Pharmacists. (2011, August 15). Alendronate. Retrieved from:  www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000018/

Moynihan, R., Heath, I. & Henry, D. (2002). Selling Sickness: The Pharmaceutical Industry and Disease Mongering. BMJ, 324, 886-890.

NIH Osteoporosis and Related Bone Diseases National Resource Center. (2011, October). Osteoporosis Handout on Health. Retrieved from: www.niams.nih.gov/Health_Info/Bone/Osteoporosis/osteoporosis_hoh.asp