1. Disease-mongering Selling sickness
HAI 25th Anniversary Conference
Disease-mongering Selling sickness
David Henry
Faculty of Health
University of Newcastle
New South Wales

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Motivational Deficiency Disorder
You are not lazy you are sick

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Reaction
Thousands of sites carried MoDeD – some featuring it as serious news, others as April Fool’s Joke
We gave many overseas interviews (CNN, BBC, NPR, Voice of America, Chicago Tribune, Business Week, PR Week)
Complaints to the BMJ. The editor of the the Dominion Post thundered "Credibility is hard earned, you damaged yours and ours as a result." (

7. Why did people believe it?
Plausible disorder and pathogenesis
Intuitive appeal
Impressive scientific language
Credible academic sources and journal
Typical statistics (prevalence, cost of illness)
Expectation of continual medical progress
Blamelessness: transfer of responsibility

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".....an expanding medical establishment, faced with a healthier population of its own creation, is driven to medicating normal life events (such as the menopause), to converting risks into diseases, and to treating trivial complaints with fancy procedures.." Roy Porter 1996

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Disease-mongering
Disease-mongering is a useful term to describe a form of medicalisation where the primary motive is to market products and services
Treating the sick is not as profitable as treating the healthy members of society (they are more of them)
Close relationships between industry, the medical profession, patient support groups and a compliant media lead to enormous pressure to fund new treatments

11. Candidates for disease-mongering
HAI 25th Anniversary Conference
Candidates for disease-mongering
Obesity
Ageing
Sexual dysfunction (male and female)
‘Social anxiety disorder’
Forgetfulness
Mood swings
Anger / intermittent explosive disorder
Osteoporosis
Hyperactivity/learning disabilities
Bipolar Disorder
Unhappiness (incl post-traumatic stress disorder)
Menopause
Irritable bowel
Genetic testing
Minor skin lesions

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Disease-mongering: ‘classification’ (Moynihan et al. BMJ 2002; 324: )
Ordinary processes and life experiences treated as medical problems
Mild symptoms as portents of serious disease
Personal or social problems as medical ones
Risks conceptualised as diseases
Prevalence and outcomes exaggerated

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Irritable Bowel
In Vivo Communications
“IBS must be established in the minds of doctors as a significant and discrete disease state”
“Patients need to be convinced that IBS is a common and recognised medical disorder”
Need for an “advisory board with one KOL from each state in Australia”

14. Mongering of social phobia
HAI 25th Anniversary Conference
Mongering of social phobia
"You may even need to reinforce the actual existence of a disease and/or the value of treating it. A classic example of this was the need to create recognition in Europe of social phobia as a distinct clinical entity and the potential of antidepressant agents such as moclobemide to treat it,"
Pharmaceutical Marketing 2001

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“The death rate in women with hip fractures is greater than the incidence of all female cancers combined”

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Corporate relations
Medical profession: close associations, genuine conflicts of interest, in kind and financial support, advisory panels, opinion leaders, guidelines, increasing government and police interests
Patient support groups: single diseases, often financially strapped, naïve
Media: uncritical, hurried, naïve, obsequious, PR-driven, waiting for the next ‘breakthrough’, susceptible to framing effects

17. Why is DM so successful? Plays on our deepest fears
Need to conform to idealised notions of appearance and behaviour
The alliances of corporations, PR companies, doctors and patient organisations are very powerful
Highly motivated and effective companies
We live in a world of marketing

18. Disease-mongering campaign
HAI 25th Anniversary Conference
Disease-mongering campaign
The aim was to make disease-mongering a ‘meme’ : (Dawkins 1976) "a unit of cultural transmission, or a unit of imitation."
Created a ‘disorder’ – Motivational deficiency Disorder – launched on April 1st 2006
Commissioned a series of papers in a journal – PLoS Medicine April 10th 2006
Held a Conference April 11th to 13th 2006

19. HAI 25th Anniversary Conference
Conclusion
With each condition featured here there are individuals in whom the distress caused by it justifies management
But the art of medicine is to define for each condition and each individual where the line is drawn between the probability of benefit and harm