Most people will believe whatever they're told to believe - even about their well-being
19 June 2006
In my perusals of the international press I read recently a leader in the International Herald Tribune and in an article in Le Monde diplomatique on the same subject -the selling of pharmaceuticals to the worried well: The pharmaceutical companies of the world need to persuade more than the ill to consume their products. Those without ill health must have some concern about the profits of these companies and consume their goodies, too.
A leader called "redefining hypertension" on May 31, 2006 in the International Herald Tribune began:
"If the American Society for Hypertension hoped to devise an expanded definition of the condition that would be scientifically and ethically defensible, it sure picked the wrong way to do it. Virtually every key step in its efforts to redefine hypertension from mere high blood pressure to a broader syndrome has been financed by pharmaceutical companies that would gain by selling drugs to more people."
According to Stephane Saul in the New York Times of May 20, 2006 Merck, Novartis and Sankyo for as little a financial contribution as $75,000 to the American Society for Hypertension and $700,000 for after dinner lectures, have been allowed a big part in the redefinition of hypertension. No longer will it be described as a blood pressure reading of 140/90 or above - there will now be a condition called pre-hypertension for those with blood pressure readings of at least 120/80. Apparently 65 million Americans have BPs of 140/90 and 59 million with readings of 120/80. The only adults that can be left are those who are so hypotensive that they can't stand up to get to the doctor to get a reading.
"The proposed redefinition does not recommend any specific treatment, but," the leader concludes, "it would seem likely to expand the use of medications." After all, no one wants to get heart attacks, strokes and so on.
I was glad to see that some prominent members of the society complained that "the new definition is not grounded on solid scientific evidence and inevitably bears the taint of financial ties with the industry."
The final sentence of the leader reads "No guidelines produced this way will have much credibility." I would like to think so but the credulous will believe whatever they want to believe. The population of the United States of America is 5 percent of the planet but they consume 50 percent of the world's pharmaceutical drugs. I would think the pharmaceutical giants are sowing seeds in fertile fields. On this topic for Le Monde diplomatique as one would expect a leader was not enough; a full page was needed in the May edition. Merck's name came up again. Apparently, thirty years ago the then chief executive, Henry Gadsden told Fortune magazine in an interview of "his distress that Merck's potential markets had been limited to sick people." He said he would have preferred Merck to be more like the chewing gum manufacturer Wrigley, because then Merck "would be able to sell to everyone." It had long been his dream to make drugs for healthy people. The authors of the article, Ray Moynihan and Alan Cassells conclude his dream has come true.
As they point out, the pharmaceutical companies' marketing strategies now target the healthy. "The ups and downs of daily life have become classified as mental disorders, common complaints are transformed into frightening conditions and more and more people are turned into patients." There is a lot of money to be made in telling healthy people they are sick.
So, my medical colleagues, where are we in all this? We know that the inappropriate prescription of antibiotics plays an important role in the development and spread of MRSA but as my parliamentary colleague Dr Liam Twomey TD said one day during a meeting of the Joint Oireacthas Committee on Health and Children "Many patients feel a consultation which ends without a prescription is a failed consultation" - or words to that effect.
Direct marketing to patients for all sorts of ailments, or what the drug companies think they should feel are ailments, not to mind the internet searches carried out by the worried well, mean that far more than antibiotics are requested now. The Le Monde article cites "shyness" being described as "social anxiety disorder" and pre-menstrual tension as "premenstrual dysphonic disorder". A Manhattan advertising executive Vince Parry, who specialises in medical advertising, has written a book called The Art of Branding a Condition. In it he divulges that way little known conditions can be given fresh attention, an old disease can be re-defined and renamed and sometimes a whole new dysfunction created. "Parry's personal favourites include erectile dysfunction, adult attention deficit disorder and premenstrual dysphonic disorder (which is so controversial a classification that some researchers say it doesn't exist)." And I'll bet Parry's customers have a cure for all these ills. (Is Viagra still being recommended for better sex for women, does anyone know? What will we do to cure the newly medicalised Road Rage, by the way?)
While all this is going on, we, in the corridors of power in Leinster House are inundated with emails by patients or their relatives regarding drug reactions. One correspondent in particular has focussed on SSIAs and a connection with suicide, particularly in children. I do read the Irish Medicines Board's communications and it does seem she has a point. They are useful but are the too widely prescribed? A huge percentage of the Irish population seems to be on some sort of antidepressant or other anti-psychotic drug. Couldn't some people just be distressed from a sad incident in their lives rather than depressed?
Does everyone have to be on statins? I do know they are very useful in diabetics who already have cardiovascular disease and a high cholesterol and I'm sure many others as well but I seem to meet more and more people with no clinical signs or symptoms but a cholesterol level over 4.5 who are on them, some times with very unpleasant side effects. A friend of mine in London, late sixties, cyclist, tennis player, was discovered to have a cholesterol level of 6. A few days after starting treatment with statins he couldn't pull a cork out of a bottle or open a pot of jam not to mind cycle or shout "who's for tennis" and it took him months to get back to normal.
This is all very irritating when there are plenty of diseases for us to treat. The final annoyance was to find that the international sugar industry had eventually defeated the World Health Organisation regarding recommended daily intake of refined sugar. For years WHO suggested an upper limit of calorie intake for sugar of 10 percent of daily diet. The international sugar industry wanted this raised to 25 percent and since the industry is very powerful in the US the threat of withdrawal of the US finance from WHO was made if the WHO didn't shape up. In the end, the new WHO recommendations do not have any particular percentage mentioned, which I suppose satisfied the sugar industry to some extent. With Type II diabetes and other conditions associated with obesity being epidemic one would have to wonder where common sense has gone in this wild, wild world.
Senator Mary Henry, MD
