Pharmaceutical giants make billions persuading us we have illnesses that only their products can cure

by Jackie Shaw

London, UK [February 6, 2008] It’s a medical scandal. The pharmaceutical giants are making billions by persuading us we have illnesses that only their products can cure.

This the real DRUG ABUSE.

PHARMACEUTICAL firms operate in an entirely different league from practically every other business. In no other sector are the existing markets so lucrative, the opportunities for expanding them so great and the competition so intense.
The profits they make are immense. Take the world's top ten drugs. In 2003, they earned their manufacturers a staggering £28.4 billion. Indeed, each of these products represents more income than most companies see in a lifetime.
Since new drugs are so hard and expensive to produce, it makes sense for the companies to expand existing markets or, more controversially, create new ones for drugs they already have. This means trying to persuade people that they are more unhealthy than they might have realised.

This practice - 'inventing' diseases to sell more of their products - has now been highlighted in a special edition of a leading medical journal and was the theme of a conference of medical experts in Australia this week who are concerned that these giant firms are deliberately turning healthy people into patients.
According to the researches, minor problems that are a normal part of life, such as symptoms of the menopause, are becoming increasingly 'medicalised'. At the same time, risk factors such as high cholesterol levels and osteoporosis are being presented as diseases in their own right.
A typical example is Viagra. When it was launched in 1997, consumer surveys suggested that one in ten men struggled to achieve an erection. Now, the figure is one in six.
The reason for this apparent collapse in manhood is simple: more companies competing for a slice of the £1.7 billion erectile dysfunction market.
The introduction of long-lasting 'weekender' versions of the love pill and a stream of others in the pipeline (sniffable, rub-on-able, inhalable), has meant more companies with their greater marketing efforts are intent on convincing men they have a problem.
It may be that publicity simply makes men more open to admitting erectile problems. But that publicity also shows how companies influence how sickness is perceived.
It is not just erectile dysfunction that, it is claimed, has been hyped up to boost pharmaceutical sales, but a whole range of other common conditions such as irritable bowel syndrome, female sexual dysfunction, 'restless legs' (involuntary muscle spasms), attention deficit disorder, and bipolar disorder (commonly known as manic depression) .
The condition may vary but the template remains the same, say the researchers. First, a drugs company comes up with a potential product and then defines the disorders that it might treat - and the symptoms of that disorder.
The symptoms are dramatised and packaged with a name. Next, a medical conference must be set up to spread the word.
Doctors, paid by the pharmaceutical companies, explain the disease and finally - and most crucially - get the message out there that the condition is treatable by the drug the company has produced.
However, the public doesn't see the billions of pounds at stake in the promise of a treatment; they only listen to the suggestion that they might need it.
They are simply grateful that there is a product that they can take - despite the fact that non-drug alternatives, such as a balanced diet, sufficient sleep, exercise or complementary therapy, can often be more effective.
Consider how this selling of sickness works in the case of irritable bowel syndrome (IBS).

THE British drugs giant GlaxoSmithKline launched a medical promotion in Australia for the bowel drug Lotronex, a drug that never made it on to the market.
As I say in my book, a leaked document from its medical PR company, In Vivo, said: 'IBS must be established in the minds of doctors as a significant disease state.'
This is done, again, through medical conferences where drugs companies pay doctors and experts to give papers about certain conditions and diseases. The papers are written up in medical journals and a new disease is born.
But doctors aren't the only people vulnerable to the drug industry's colossal influence. Another In Vivo document said patients 'need to be convinced that IBS is a common recognised medical disorder'.
GlaxoSmithKline defended its position before House of Commons's Health Select Committee last year. UK Medical Director Dr Stuart Dollow said: 'I do not recognise the fact that people are suggesting that we are inventing diseases. That is not something that we would do.'
Drugs companies commonly sponsor patient self-help groups, which help spread the word about drugs via the internet and other media. Then again, examine the treatment of depression. .
When GlaxoSmithKline's antidepressant drug Paxil (called Seroxat in Britain) was approved for the treatment of general anxiety disorder (GAD) in the U.S. five years ago, very little was known about the condition.
Only one in 100 people in the U.S. was diagnosed with it each year.
But at the time of the drug's launch in April 2001, news reports suggested as many as ten million Americans were suffering from an unrecognised disease that had symptoms such as restlessness, fatigue, irritability, muscle tension, nausea, diarrhoea and sweating.
On the same day, a patient group called Freedom From Fear released details of a telephone survey which revealed that 'people with GAD spend the equivalent hours of a full-time job' worrying.
Surprise, surprise - the media contact for the survey was an account executive at GlaxoSmithKline's PR firm.
GAD is-not the only condition that the drug is licensed to treat. Indeed, most Prozac-type anti-depressants are used for a whole range of conditions such as painful periods, depression, panic attacks, irritable bowels, incontinence, shyness or social anxiety - anything, in short, that has some kind of anxiety at its root. Critics say the truth is these drugs are a triumph of branding which cynically play on people's morbid fear that there must be something wrong with them.
U.S. bioethicist Carl Elliot says if a company is the sole manufacturer of a drug which tackles social anxiety disorder, it is clearly in its interest to broaden the definition of the disorder.
Indeed, Paxil's product director, Barry Brand, confirmed this attitude when he told the magazine Advertising Age: Every marketer's dream is to find an unidentified or unknown market and develop it. That is what we were able to do with social anxiety disorder.'
OF COURSE, in some cases, these conditions are real sources of suffering and drugs clearly have a role to play. But the public are not necessarily best served by products that only deal with the symptoms rather than the cause and which marginalise all non-pharmaceutical approaches.

A former editor of the New England Journal of Medicine, Dr Marcia Angell, has pointed out how the diagnostic criteria for 'abnormal' levels of blood pressure, cholesterol, obesity and bone density have all changed over the years to expand the markets for disease.
This is a long and sophisticated process but it essentially involves drugs companies conducting studies into the dangers of, say, high blood pressure, and then pushing for revised guidelines on what is safe, thus creating a new market of patients who need treatment.
Human metabolic syndrome is another area that bas been exploited by the drugs companies. It covers a cluster of common disorders, such as obesity, high cholesterol and raised blood pressure.
Not recognised before 1998, it is now said to be approaching epidemic levels with no less than 115 million sufferers worldwide and each component part is an example of 'disease' being a much more fluid concept than one might have supposed.
High blood pressure (hypertension) was once defined as blood pressure above 140/90. An expert panel then introduced something called prehypertension in 2003, which embraces readings between 120/80 and 140/90.
Overnight, people with blood pressures in this range found they had a medical condition.' says Dr Angell
But it is the cholesterol-reducing drugs that best shows how the boundaries have changed.
These drugs lower levels of bad cholesterol and have been shown to prevent heart attacks and save patients' lives.
Collectively, they earn more than £17billion a year and companies compete intensely for a greater share of this market. As they do studies to show the value of their drugs, miraculously, the cut-off point for high cholesterol has gradually lowered.
'Once it was reserved for blood cholesterol levels over 280mm per deciliter,’ says Dr Angell. Then it fell to 240. Now most doctors try to knock it down to below 100.

BECAUSE the patents on all drugs eventually expire, new heart drugs to raise levels of good cholesterol are being developed. Their success will be partly determined by 'how much 'normal' levels of good cholesterol can be raised.
The idea that people's health is not as good as it ought to be is conveyed in surveys that show what is normal and what is not.
Ray Moynihan, an Australian journalist, who has examined the issue 'of drug firms 'inventing' diseases to boost their profits, looked into another tactic used by the pharmaceutical companies - questionnaires.

They are widely issued to the public with the result that people are made familiar with diseases or ailment they never knew existed - and become more concerned about their own health.
One broadly-circulated questionnaire produced results which showed that 43 per cent of-women sampled thought that they couldn't have sex properly.
Intriguingly, Mr Moynihan found the questionnaire's authors had links to Pfizer, which, at the time, was testing Viagra on women. The study had asked 1,500 women, aged 18 to 59, if they had experienced anyone of a list of seven problems for a period of at least two months over the previous year.
One area concerned a lack of desire for sex and another anxiety about sexual performance. Nothing was asked about the length of the woman's relationship with her partner, which is a major factor in most people's sex lives.
In subsequent trials, the women given Viagra reported an improvement in their sex life - but an even greater improvement was noted by those who were given a placebo.
Nevertheless, surveys such as these have resulted in female sexual dysfunction being established as a disease and many lucrative treatments are in the pipeline to deal with it.
But such drug products totally disregard the existence of alternatives such as bunches of flowers and other tokens of appreciation that have improved women's sexual responsiveness over centuries and which can work out better and a lot more cheaply.

But, of course, these sensible solutions don't sell drugs.

• JACKY LAW is the author of Big Pharma: How The World's Biggest Drug Companies Control Illness.