Book Review: Victoria Times Colonist

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When sickness is profitable, there's a problem
by Penny Draper

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Selling Sickness: How the World's Biggest Pharmaceutical Companies Are Turning Us All Into Patients by Ray Moynihan and Alan Cassels; Greystone Books, 241 pages, $32.95

Feeling fatigued? Stressed? Anxious? Chances are there is a disease specially designed to fit your symptoms. And there's somebody out there who will sell you the drug to go with it.

Selling Sickness, by Ray Moynihan and Alan Cassels, is a meticulous study of the methods used by big drug companies to market diseases and sell them to healthy people. It's a scary book. The authors use common conditions such as high cholesterol, high blood pressure and osteoporosis to describe the techniques used by pharmaceutical companies to sell their wares to an ever-growing segment of the population. Whether they are selling drugs or fear is debatable; the only surety is that when healthy people are turned into patients, huge profits can be made.

The book is divided into 10 chapters, each devoted to a "condition," which is then attached to a marketing scheme. The section on high cholesterol, for instance, focuses on the conflict of interest that exists between the drug companies, the doctors and the organizations responsible for drug safety.

The section on social anxiety disorder (sometimes known as shyness) reflects upon the ethics of positioning a "neglected disorder" in the marketplace to create a demand even before the drug treatment is approved for use, and certainly before the addictive properties of the drug are publicly known.

In another chapter, menopause ceases to be part of the natural aging process and becomes a curable deficiency disease.

Other chapters talk about the use of paid celebrities to popularize disease, the invention and branding of diseases, flawed science, suppressed reports, statistical gimmicks, lifestyle drugs and even "astro-turfing," which is described as the creation of fake grassroots movements.

The authors prevent the book from becoming a horror story by asserting that most of the drugs profiled do indeed help some people. But the same drugs can become dangerous when prescribed to people who don't need them. Are drug companies filling "an unmet need" or "meeting an un-need"?

When faced with the fact that the United States spends $25 billion annually on drug marketing, one has to wonder what else that money could be doing.

One of the most interesting aspects of this book is its Canadian perspective. Alan Cassels is a drug policy researcher at the University of Victoria. He interprets the largely U.S.-based information, explaining the potential consequences here at home and raising questions like the potential effect over-prescribing has on a public health care system.

At times the book becomes repetitious, each chapter offering still more examples of the same nasty business. There are numerous citations, with no less than 40 pages of footnotes. For those who generally avoid the small print, be aware that in this book it's fascinating and well worth the effort. Check out some of the websites, links and articles listed in the footnotes and the depth and breadth of the research becomes evident.

The book may look like a textbook, but it reads easily.

Selling Sickness is "offered as part of an ongoing conversation ... to promote a more rational and informed public debate about human health...." In that it succeeds. No answers to the problem of big pharma are offered. But good questions are raised, questions I'll be asking when I next visit the doctor.

Penny Draper is a Victoria writer.

OTHER BOOKS OF INTEREST

Bitter Pills: Inside the Hazardous World of Legal Drugs by Stephen Fried; Bantam; $21

Journalist Stephen Fried's investigation of the international pharmaceutical industry is a personal take on the issue, begun after his wife had a severe reaction to a new antibiotic. It includes an appendix of adverse drug reactions.

Profit is Not the Cure: A Citizen's Guide to Saving Medicare by Maude Barlow; McClelland & Stewart; $21.99

Barlow raises the issue of medical profit as part of the debate over private/public health care systems.

Why We Get Sick by Randolph M. Nesse and George Williams; Vintage; $21

Nesse and Williams's older but still interesting book explores why humans are vulnerable to disease from a Darwinian point of view. He postulates that knowing why we become ill could help us decide if a pill will help -- or hinder -- our recovery