6 HAI 25th Anniversary Conference ReactionThousands of sites carried MoDeD – some featuring it as serious news, others as April Fool’s JokeWe 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." (http://bmj.bmjjournals.com/cgi/content/full/332/7546/0-f).
7 Why did people believe it? Plausible disorder and pathogenesisIntuitive appealImpressive scientific languageCredible academic sources and journalTypical statistics (prevalence, cost of illness)Expectation of continual medical progressBlamelessness: transfer of responsibility
9 HAI 25th Anniversary Conference ".....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
10 HAI 25th Anniversary Conference Disease-mongeringDisease-mongering is a useful term to describe a form of medicalisation where the primary motive is to market products and servicesTreating 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 ConferenceCandidates for disease-mongeringObesityAgeingSexual dysfunction (male and female)‘Social anxiety disorder’ForgetfulnessMood swingsAnger / intermittent explosive disorderOsteoporosisHyperactivity/learning disabilitiesBipolar DisorderUnhappiness (incl post-traumatic stress disorder)MenopauseIrritable bowelGenetic testingMinor skin lesions
12 HAI 25th Anniversary Conference Disease-mongering: ‘classification’ (Moynihan et al. BMJ 2002; 324: )Ordinary processes and life experiences treated as medical problemsMild symptoms as portents of serious diseasePersonal or social problems as medical onesRisks conceptualised as diseasesPrevalence and outcomes exaggerated
13 HAI 25th Anniversary Conference Irritable BowelIn 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 ConferenceMongering 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
15 HAI 25th Anniversary Conference “The death rate in women with hip fractures is greater than the incidence of all female cancers combined”
16 HAI 25th Anniversary Conference Corporate relationsMedical profession: close associations, genuine conflicts of interest, in kind and financial support, advisory panels, opinion leaders, guidelines, increasing government and police interestsPatient support groups: single diseases, often financially strapped, naïveMedia: 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 behaviourThe alliances of corporations, PR companies, doctors and patient organisations are very powerfulHighly motivated and effective companiesWe live in a world of marketing
18 Disease-mongering campaign HAI 25th Anniversary ConferenceDisease-mongering campaignThe 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 2006Commissioned a series of papers in a journal – PLoS Medicine April 10th 2006Held a Conference April 11th to 13th 2006
19 HAI 25th Anniversary Conference ConclusionWith each condition featured here there are individuals in whom the distress caused by it justifies managementBut 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
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