Academic journal article The Qualitative Report

Potency, Hubris, and Susceptibility: The Disease Mongering Critique of Pharmaceutical Marketing

Academic journal article The Qualitative Report

Potency, Hubris, and Susceptibility: The Disease Mongering Critique of Pharmaceutical Marketing

Article excerpt

Introduction

Disease mongering is a pejorative term used by critics to refer to (patent rather than generic) drug companies' involvement in informing the public and professionals about the illnesses targeted by their products (Applbaum 2006; Healy, 2004, 2006; Heath 2006; Moynihan & Cassells 2005; Moynihan, Doran, & Henry 2008,). Typically, a drug company is accused of misshaping perceptions of a disease or condition, or more pertinently, the perception of what is "normal" and what is not and what therefore should be treated (Angell 2004; Buckley, 2004; Caplan & Elliot 2004; Mintzes, 2006; Moynihan, 2002, Moynihan, Heath, & Henry 2002; Triggle 2005). Critics' main concern is that the marketing or "branding" of a condition creates excessive drug demand--with many people using a drug that they don't need, won't help them or could even make things worse (Heath, 2005, 2006; Mansfield, 2006, Moynihan & Cassells 2005; Moynihan & Henry, 2006).

Disease mongering has been defined as "extending the boundaries of illness" (Moynihan, Doran, & Henry, 2008) and may involve the pathologising of normal human variation, the depiction of risk factors as diseases or the invention of a new disease (Brody & Light, 2011; Grob, 2010; Meyer, 2003; Moynihan, Heath, & Henry, 2002; Payer, 1992). Critics cite numerous examples disease mongering involving conditions that used to be viewed as inconveniences, as a normal part of the aging process or social issues rather than diseases (Dear & Webb 2007; Moynihan, 2002, 2010; Moynihan & Cassells 2005; Moynihan, Heath, & Henry, 2002; Moynihan & Henry 2006). These include: mild forms of depression and anxiety, ADHD, social anxiety disorder, intermittent explosive disorder, attention deficit disorder, irritable bowel syndrome, restless legs, low bone mineral density, hypercholesterolemia, erectile dysfunction, pre-diabetes, prehypertension, premature ejaculation and female sexual dysfunction (Brody & Light 2011; Halasz, 2004; Hartley, 2006; Mintzes, 2002; Moynihan, 2003; Tiefer, 2006, 2007; Woloshin & Schwarz 2006).

Critics do not deny the existence of these disorders, the severity of symptoms or the value of medical treatment for many sufferers. What is argued is that each reflects a problematic widening of disease definitions that ultimately enables and legitimises medical intervention for as many people as possible (Alonso-Coello, Garcia-Franco, Guyatt, & Moynihan, 2008; Barbui & Tansella 2005; Doran & Henry, 2008; Herxheimer, 2003; Medwar, 2001; Verdous & Cougnard, 2003). Expanding the reach of a condition is problematic where it creates unwarranted concern (Heath, 2006), unnecessary use of medical services and technologies (Moynihan & Cassells, 2005), wastes resources on trivial lifestyle conditions or risk factors (Lexchin, 2001) at the expense of more serious diseases (Freemantle & Hill, 2002; Heath, 2005; Mintzes, 2006; Moynihan, Heath, & Henry, 2002) unnecessary patient exposure to risk; and the narrowing of treatment options to saleable products (Moncrieff, Hopker, & Thomas, 2005; Lexchin, 2006; Tiefer, 2007; Tracey, 2004; Woloshin & Schwarz 2006). The potential to prompt excessive use of medicines makes disease mongering a significant public health problem (Buckley, 2004, Moncrieff, Hopker, & Thomas 2005).

Although a relatively new idea in public discussion about pharmaceutical demand and public health, "disease mongering" has gained considerable currency (Moynihan, Doran, & Henry, 2008). Disease mongering frequently appears in commentary on pharmaceutical marketing in the popular news media (commonly "scare-quoted" or italicised) but is particularly prominent in the medical and public health professional media. Disease mongering has been the subject of an academic conference and the theme issue of high impact medical science journal (PLoS Medicine, 2006). …

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