Wednesday, 5 January 2011

Book review; Selling Sickness, Ray Moynihan & Alan Cassels

There is no doubt in my mind that over the last hundred or so years the contribution of the pharmaceutical industry to human health and longevity has been staggering and wide reaching. Time and time again, in every area of medicine they have delivered the goods that have revolutionised the practice of medicine. They deserve recognition for this and no-one should begrudge the living they make from their efforts.

There is however a less commendable side to the pharmaceutical industry. In their drive for ever greater profits many of them have turned to highly dubious practices in which perfectly healthy people are persuaded, together with their physicians, that they have a medical condition that requires “treatment”

This is done in a number of ways. If the condition is one which can be measured, such as cholesterol level or blood pressure they can attempt to persuade the medical profession to accept a successive lowering of the level at which to initiate treatment. This has been particularly successful in the case of statin therapy. In the 1990s the number of Americans potentially felt to require statins was 13 million. By 2004 this number had been increased to 40 million simply by the lowering of what was claimed to be the upper limit of normal. 

In other conditions it is even easier for them. Simply plant the idea in peoples minds that there are conditions that are massively under diagnosed and under treated by “education” and “disease awareness “ campaigns. Then provide figures that the prevalence of these condition is high and that common experiences are in fact symptoms of a disorder. This practice is not new, but has, over the last few years, led to the following claims of “disease” prevalence being made by various drug companies.

Mental disorder of all types 30%
Juvenile Attention Deficit Disorder 10%, with an increasing assertion that the condition persists into adulthood.
Pre-menstrual Dysphoric Disorder (WTF?) 7%
Social Anxiety Disorder (?????)13%
Osteoporosis/Osteopenia 50% of the over 50s
Irritable Bowel Syndrome 20%
Female Sexual Dysfunction 43% (43%???!!!)

Presented like this, it is obvious that these figures are complete bollocks. Not just false, but absurd and ridiculous, an insult to the intelligence. And yet by clever, persistent and assertive advertising they have persuaded the public and the medical profession to swallow it. It has been particularly successful in the USA where drug companies are allowed to advertise their products direct to the punters, and spend $3 billion per year doing just that.

The full extent and range of these disturbing practices is laid out in the book Selling Sickness, by Ray Moynihan & Alan Cassels.

I have reviewed a book once before. On that occasion I was asked to do so by the publishers. I bought my own copy, read it, enjoyed it, and said so.

No-one has asked me to review or promote this book. But I do recommend it, most strongly, to anyone who ever writes a prescription, and anyone else for that matter.

1 comment:

  1. As you may know, I have hammered on about this myself, without the kudos available to me, that is attached to your viewpoint. It is however, refreshing to see it voiced in your words.

    The use of 'surrogate end points' as a treatment protocol, for the 'worried well' is utilising vast resources within the NHS, to no useful purpose. That, together with nutritional advice bordering on insanity, meted out as medically sanctioned, but based on no sound scientific principle, is actually adding to the burden of illness, that you no doubt see in spades.

    Pharma lost it's way, in the 70's and has rapidly declined in intergrity, in inverse proportion to it's profits, ever since.