Selling Sickness

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

Monday, August 01, 2005

Book Review: Oprah Magazine

One Nation, Overmedicated
Have we handed drug companies the power to define diseases? It's time to take back our health.

IN A PROVOCATIVE NEW BOOK, Selling Sickness: How the World's Biggest Pharmaceutical Companies Are Turning Us All into Patients, our nation's growing reliance on "lifestyle" medications is put in the spotlight. Ray Moynihan, an award-winning medical writer, and Alan Cassels, a drug policy researcher at the University of Victoria in British Columbia, argue that Big Pharma tries to medicalize our lives, then works to convince us that its products are the only cure.

And we believe it, the authors say; drugging ourselves to treat problems that may not even be real diseases, including severe PMS (now rebranded premenstrual dysphoric disorder) and shyness (now social anxiety disorder).

When medications do have proven benefits, Moynihan and Cassels write, pharmaceutical companies often exaggerate a product's usefulness to encompass the widest possible group of patients--some of whom are unlikely to derive benefit from the drug. As one example, Selling Sickness highlights the widespread marketing of cholesterol-lowering drugs to healthy women:
Reliable research has shown that some groups, like men with known heart disease, clearly benefit from medication that can reduce their risk of heart attack. There's much less proof that the drugs help women with no history of disease.

The book's charges are compelling, but we shouldn't throw the baby out with the snake oil: Women who do have heart disease may need a prescription to lower their cholesterol, and certain patients with other ailments, such as osteoporosis or attention deficit disorder, really can benefit from medications. The problem isn't the drugs themselves--it's the hyperactive way they're promoted, the way consumers clamor for them, and the way too many doctors and patients believe there's a pill for every ailment.

There's no simple solution, but you can do some things to protect yourself. Ask tough questions before accepting a prescription:

* Exactly what condition is this medication supposed to treat?
* Are there nondrug approaches (such as diet or exercise) that I can try first?
* Has this medication been proven useful in patients like me (that is, people who are my age, my sex, my level of health)?

If your doctor doesn't have an answer to that last question, consumer-friendly; impartial Web sites can help you do the research yourself:

* Consumer Reports' new site ( provides information about the effectiveness of approximately 100 drugs.
* The Medical Letter offers in-depth analysis of both new and older medications on its site (

You can take back control over the prescriptions in your bathroom cabinet. As Selling Sickness reminds us, if you get suckered into using medications you don't need, the only benefit is to the companies that sell them.
By Jerry Avorn, MD
Jerry Avorn, MD, is a professor of medicine at Harvard Medical School and the author of Powerful Medicines: The Benefits, Risks, and Costs of Prescription Drugs (Knopf)