Selling Sickness

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

Monday, September 19, 2005

Press Release: Disease mongering" will bankrupt our health system

For Immediate Release

"Disease mongering" by pharmaceutical companies threatens
to bankrupt Canada's public health system

Authors of new book warn that drug company marketing techniques
are turning us all into patients

Daily media articles say that the Canadian public health system is in
jeopardy, and fingers are pointed at everything from doctor shortages to
government mismanagement and bureaucratic greed. But Ray Moynihan and
Alan Cassels, authors of the new book, Selling Sickness: How the world's
biggest pharmaceutical companies are turning us all into patients, point
the finger at another cause: drug company funded disease creation.

Using their dominating influence in the world of medical science, drug
companies are working to widen the very boundaries that define illness.
Mild problems are painted as serious disease, so shyness becomes a sign
of social anxiety disorder and pre-menstrual stress a mental illness
redefined as pre-menstrual dysphoric disorder. Everyday sexual
difficulties are seen as sexual dysfunctions, the natural change of life
is a disease of hormone deficiency called menopause, and distracted
office workers now have adult ADD. Just being 'at risk' by having an
elevated blood pressure or cholesterol level has become a 'disease' in
its own right.

"Too often the aim is to lower the bar and turn healthy people into
patients," says Alan Cassels, co-author of Selling Sickness, and drug
policy researcher at the University of Victoria in British Columbia.
"And lowering the bar makes more and more of us candidates for the
latest pills promoted by the pharmaceutical industry."

Selling Sickness reveals how expanding the boundaries of illness and
lowering the threshold for treatments is creating millions of new
patients and billions in new profits, in turn threatening to bankrupt
national healthcare systems all over the world. Canada's publicly
funded healthcare system is not immune.

"From their domination of guideline committees, their involvement in
physician 'education' and their marketing of fear to consumers, the
pharmaceutical industry is using its immense power to drive more and
more of us towards another prescription," warns Cassels. And, he notes,
"a health system that allows drug companies to play a role in defining
who is sick is fundamentally unhealthy."

With many health problems, there are people at the severe end of the
spectrum suffering genuine illness, or at very high risk of it, who may
benefit greatly from a medical label and a powerful medication. But for
the relatively healthy people who are spread across the rest of the
spectrum, a label and a drug may bring great inconvenience, enormous
costs, and the very real danger of rare but deadly side effects.

As the authors of Selling Sickness note, with plenty of detail,
pharmaceutical company marketing executives don't sit down and actually
write the rules for how to diagnose illness, but they increasingly
underwrite those who do. The industry now routinely sponsors key
medical meetings, in Canada and around the world, where disease
definitions are debated and updated. Eight of the nine 'experts' who
created the most recent cholesterol guidelines in the US had undisclosed
ties to the pharmaceutical industry. The new guidelines shifted the
definition of 'high' cholesterol so drastically that it meant another 40
million Americans should be taking cholesterol-lowering drugs. In
Canada, recent guideline changes to cholesterol treatment, if
implemented, would put 500,000 more people on cholesterol-lowering

Added to this is the fact that the bulk of clinical trials on new
medication is funded directly by the drug manufactures rather than the
public or not-for-profit sources. And that this research is then
disseminated at scientific meetings, events and conferences sponsored by
the pharmaceutical industry, and often hosted by medical societies or
patient groups that are themselves partially underwritten by drug
companies. "The reach and the scale of the industry's influence is
really quite breathtaking in its scope," notes Cassels.

"Many Canadians would be horrified to know that drug company money is
also involved in funding much of the Continuing Medical Education of
Canadian physicians. Yet I feel that we are never going to achieve
rational prescription drug use in this country until we get the drug
money out of our medical education system," argues Cassels.

And then there is the barrage of drug advertisements that hit consumers
every time they turn on the TV. While direct-to-consumer advertising of
prescription drugs is illegal in Canada, drug manufacturers here mount
'disease awareness campaigns,' which constantly urge you to 'see your
doctor' for practically everything. "There are many different
promotional strategies used in the selling of sickness, but the common
factor amongst them all is the marketing of fear," says Cassels.

Soaring sales have made drug companies the most profitable corporations
on the planet during particular years of this past decade. But the flip
side of healthy returns for shareholders is the unsustainable increase
in costs for those funding the health system. Selling Sickness tells us
that we need the pendulum to swing back towards a rational and
appropriate use of pharmaceuticals for everyone who is sick. "Our
health care system will collapse if we continue to allow for-profit
enterprises to define who is sick and who needs treatment," says
Cassels. "Now is the time to start having the conversation about
whether we want to continue to allow pharmaceutical greed, not
appropriate need, to be driving our health care expenditures."

For author interviews, contact:
Alan Cassels
Cell: 250-888-7992

About the Authors:
Alan Cassels is a drug policy researcher at the University of Victoria,
in British Columbia. He has spent most of the last ten years studying
how clinical research about prescription drugs is communicated to policy
makers, prescribers and consumers, and has produced several full-length
documentaries for CBC Ideas, including "Manufacturing Patients," which
deals with the subject of selling sickness.

Ray Moynihan has been covering the business of health care for almost a
decade as an award-winning broadcast journalist and more recently with
the British Medical Journal. He is a regular contributor to the New
England Journal of Medicine and the Lancet and was a Harkness Fellow in
health care policy based at Harvard University.

Selling Sickness: How the world's biggest pharmaceutical companies are
turning us all into patients by Ray Moynihan and Alan Cassels is
published in Canada by Greystone Books (2005) and
in the US by Avalon Publishing Group,