Selling Sickness

How the World's Biggest Pharmaceutical Companies are Turning us All into Patients

Tuesday, July 26, 2005

Book Review: Dallas Morning News

Authors take us to task for our pill-popping ways
05:58 PM CDT on Monday, July 25, 2005

By SHERRY JACOBSON / The Dallas Morning News
If Ray Moynihan and Alan Cassels are right, Americans are in a lot of trouble, medically speaking.

The co-authors of a new book, Selling Sickness: How the World's Biggest Pharmaceutical Companies Are Turning Us All Into Patients, make a strong case against the pill-popping habits of many Americans. And they're talking legal pill-popping.

The authors see a ploy by which drug companies have persuaded otherwise healthy people to take expensive medications they don't really need. The book takes aim at our habit of using pills to control such dreaded conditions as high cholesterol, high blood pressure, osteoporosis and menopause.

Drug manufacturers have achieved a virtual stranglehold on global health care, but the situation appears worse in the United States, the authors say. In this country, pharmaceutical companies brazenly seem to be inventing new diseases and then offering up new medications as a timely solution. The news media, always eager to report on the latest medical breakthroughs, unwittingly dupe the public into swallowing the pills, they write.

The authors launch their attack as outsiders to the U.S. health care system. Mr. Moynihan is an Australian journalist who has covered the business of health care for nearly a decade, including prize-winning reports in the British Medical Journal. Mr. Cassels is a Canadian health policy researcher in British Columbia.

As someone who has written about medical problems for years, I've got to admit that the book makes a pretty convincing argument that the public is being manipulated in obvious ways. There's no denying that Americans are forking over a fortune in hopes of avoiding severe illnesses, and that drug companies are getting richer in the process. That's certainly cause for suspicion.

But the authors make their strongest case by dissecting pharmaceutical claims that a certain medication can prevent a certain disease. Take high blood pressure, for example.
U.S. medical guidelines indicate that more than 40 million Americans suffer from high blood pressure or hypertension, a condition that increases the risk of suffering a heart attack or stroke. One medication purports to cut the risk by a third. So why not take it?

The authors want you to examine the numbers more closely in order to understand how much these pills are likely to help. If you have elevated blood pressure but no other health complications, your risk of suffering a heart attack or stroke could be about 3 percent during the next five years. When medication cuts that risk by a third, you end up with a 2 percent risk. Your actual risk drops by a mere percentage point.

When you look at it that way, the need for daily blood pressure medication, which is costly and could have serious side effects, seems not so critical.

"Drugs are often promoted using these statistical gimmicks that exaggerate benefits," write Mr. Moynihan and Mr. Cassels. "Advertisements to doctors and patients will claim that a drug offers a 33 percent reduction in the risk of a heart attack, without explaining that in actual fact you have to take the drug for five years in order to lower your risk from 3 percent to 2 percent."

The authors also theorize that drug companies pressure government regulators, particularly the U.S. Food and Drug Administration, to create new disease categories and then broaden the definition to snag more customers. The authors wonder whether new categories of illness, including pre-menstrual dysphoric disorder, social anxiety disorder, irritable bowl syndrome and female sexual dysfunction, even exist but for the drugs that have been invented to tackle them.

The book also tackles doctors for promoting the benefits of medication without revealing their financial connections to the drug's manufacturer. Such conflicts of interest have become rampant in modern medicine, but they seem even more insidious these days.

The book likewise chastises Hollywood celebrities who market their personal health problems on talk shows without mentioning that drug companies are paying them to sell the appropriate remedies for these ills.

And the news media, of course, take a major hit for not blowing the whistle on the entire charade.

What's a conscientious health-care consumer supposed to do?

The authors urge consumers to employ a "healthy skepticism" whenever they hear claims of a new, but rampant, disorder and, of course, to be wary of the perfect remedy that would combat it.

But consumers also need to be smart enough to know when they're sick enough to need the medication.

Even the most skeptical health-care consumer has to learn to swallow the pills that could save or extend a life.

The authors wisely conclude: "Sometimes, of course, diseases are real, painful and deadly, and treatment with the latest and most expensive drug or other medical technology or procedure is highly desirable."

The trouble is you have to know the difference.

Selling Sickness
How the World's Biggest Pharmaceutical Companies Are Turning Us All into Patients
Ray Moynihan and Alan Cassels
Nation Books, New York, $25 // Image2 end -->
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