BMJ  2006;332:871 (15 April), doi:10.1136/bmj.332.7546.871

News

Disease awareness campaigns turn healthy people into patients

London

Media and advertising campaigns that apparently aim at increasing public awareness of underdiagnosed illnesses are really marketing tools for drug companies in search of new customers, say a group of authors and researchers who met in Australia this week for a conference on "disease mongering."

The conference on disease mongering, held in Newcastle, Australia, was timed to coincide with a theme issue of the journal PLoS Medicine, published by the US Public Library of Science (PLoS).

April's issue of PloS Medicine carries 11 peer reviewed articles on disease mongering, which is defined by this month's guest editors as "the selling of sickness that widens the boundaries of illness and grows the markets for those who sell and deliver treatments."

The issue's guest editors, David Henry of the University of Newcastle, Australia, and the journalist Ray Moynihan, a contributor to the BMJ, are also the organisers of the conference. They argue that the corporate sponsored creation of disease turns healthy people into patients, wastes precious resources, and risks iatrogenic harm.

Dr Henry described a de facto alliance between pharmaceutical marketers, journalists, and patient advocacy groups. "They aren't consciously working together, but they have converging interests," he said.

Patient advocacy groups, often funded by the drug industry, become willing partners in the promotion of disease, said Mr Moynihan.

Among the diseases highlighted in PloS Medicine as subjects of disease mongering campaigns are male and female sexual dysfunction, attention deficit hyperactivity disorder, bipolar disorder, and restless legs syndrome.

In one of the articles Steven Woloshin and Lisa Schwartz of Dartmouth Medical School in New Hampshire reviewed newspaper coverage of restless legs syndrome, which began to attract media attention in the United States soon after GlaxoSmithKline launched an awareness campaign in 2003.

The company, which had recently begun testing its drug ropinirole (Requip) in patients with restless legs syndrome, issued a press release describing the condition as widespread and underdiagnosed.

The article's authors analysed 33 newspaper articles focused on the disease that were published since the company's campaign. They found that journalists uncritically accepted high estimates of prevalence—often based on poor evidence—and overstated the benefits of treatment.

Dr Woloshin said that for journalists such a story contains "irresistible elements: big public health crisis, doctors missing diagnoses, a miracle drug available."

He said, "In general, health reporting often lacks sufficient scepticism, so it's not surprising that the claims about restless legs and ropinirole get repeated in an uncritical way."

The US Food and Drug Administration approved ropinirole as a treatment for restless legs syndrome last year, and the disease is now the subject of a GlaxoSmithKline advertising campaign aimed at US consumers. The advertisements encourage the public to see a doctor, without mentioning any specific drugs.

These campaigns are often accompanied by aggressive marketing to doctors of the drug itself, said Mr Moynihan. He said that such advertising is "insidious, it's often invisible, and any serious health department has to start regulating it."

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Longer versions of these articles are on bmj.com

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PLoS Medicine theme issue on disease mongering

Gavin M Yamey
bmj.com, 14 Apr 2006 [Full text]