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

HAI 25th Anniversary Conference Motivational Deficiency Disorder You are not lazy you are sick

HAI 25th Anniversary Conference

HAI 25th Anniversary Conference

HAI 25th Anniversary Conference

HAI 25th Anniversary Conference 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." (http://bmj.bmjjournals.com/cgi/content/full/332/7546/0-f).

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

HAI 25th Anniversary Conference

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

HAI 25th Anniversary Conference 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

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

HAI 25th Anniversary Conference Disease-mongering: ‘classification’ (Moynihan et al. BMJ 2002; 324: 886-891 ) 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

HAI 25th Anniversary Conference 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”

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

HAI 25th Anniversary Conference “The death rate in women with hip fractures is greater than the incidence of all female cancers combined”

HAI 25th Anniversary Conference 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

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

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

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