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The new thin pill: pg 5

NEW YORK (Wired, October 2006):

75 million Americans may have something called metabolic syndrome. How Big Pharma turned obesity into a disease – then invented the drugs to cure it.

Getting an indication is key, because it would further establish metabolic syndrome as a bona fide disease. So goes the domino effect of recognition: First the National Institutes of Health and the American Heart Association identify metabolic syndrome as a disease, then the FDA creates an indication, and then the HMOs – which have largely refused to reimburse patients for obesity treatments – agree to pick up the tab for metabolic syndrome prescriptions, thus making physicians more likely to prescribe them for their patients. The only drawback is that the market could be too big: If the HMOs see a diagnosis that fits 75 million Americans and a potential bill for $18 billion, they might simply refuse to pay it.

That, of course, is the demographic ripple effect of diseases like metabolic syndrome. As the medical establishment reaches further down the causal chain to identify more risk factors and spot them earlier, and as it assigns names, definitions, and treatments to these diagnoses, more and more people are swept into the disease net. Add in our genetic biomarkers and it's clear that disease won't be something we can avoid anymore. It will be something we simply have, just as we have freckles or wear glasses. We will all carry our disease portfolios and will be identified through our ailments – or more precisely, our inclinations toward certain ailments. Metabolic syndrome is just the latest step on this path.

On one level, this is the inevitable progress of medicine. But on another, it makes the idea of disease – or of health, for that matter – a meaningless abstraction. "We all already have a disease," Kahn says. "Life – it's a terminal disease, you know."

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