Peddling paranoia: selling cures for imaginary diseases is where the drug industry really rakes in the cash, argues Alan Cassels. Real need barely enters the picture - Skewing the Market

New Internationalist, Nov, 2003 by Alan Cassels

Eli Lilly, facing the end of its patented blockbuster, Prozac, recently relaunched the famous drug with a fancy new pink makeover and a nifty name--Sarafem. This 'Prozac in Pink' is now marketed as a treatment for severe PMS (now reshaped into the more medical-sounding PMDD--Pre-Menstrual Dysphoric Disorder).

Drug giant GlaxoSmithKline has taken paroxetine (Paxil in North America, Seroxat in Europe) and had it approved to treat what we used to call social phobia or shyness, now reclassified as 'social anxiety disorder' (SAD). Barry Brand, Paxil's product director, told the journal Advertising Age: 'Every marketer's dream is to find an unidentified or unknown market and develop it. That's what we were able to do with social anxiety disorder.' (1)

The creation of disease categories in psychiatry has not been without controversy. San Diego-based psychiatrist Loren Mosher, in his letter of resignation to the American Psychiatric Association, said: 'Psychiatric have become the minions of drug company promotions.' He blasted the drug-industry shaped definitions of mental disease: 'No longer do we seek to understand whole persons in their social contexts--rather we are there to realign our patients' neurotransmitters.'

Managing 'risk'

Disease prevention in healthy people with so-called 'risk factors' like high blood pressure or high cholesterol is another lucrative market. These measurable markers are carefully defined to encompass vast numbers of healthy people.

High blood pressure 'medicalized' becomes 'hypertension', now the leading pharmaceutically treated 'condition' in the world. Of course anti-hypertensive drugs do help people who have high blood pressure or who have had a previous heart attack or stroke. But the drugs get pushed on healthier, younger people with very little evidence as to their impact on health or longevity.

In 1999 when the World Health Organization held meetings to set high-blood-pressure guidelines, Big Pharma made sure their interests were well represented. What resulted were recommendations not based on the best evidence, but based on the best support for pharmaceutical treatments.

Drug companies also support patient groups or programmes that are warm to their interests such as the National High Blood Pressure Education Program in the US. Earlier this year this group sounded warnings about 'pre-hypertension', which ratcheted down the definition of high blood pressure from 140 over 90 to 120 over 80, thus turning millions more people with 'borderline' high blood pressure into medication-needing patients overnight.

The trend of big pharmaceutical companies morphing into nothing more than marketing organizations is reflected in data from the drug makers themselves. The Pharmaceutical Research and Manufacturers Association (PhRMA) in the US reports that, since 1995, R&D staff of US brand-name drug companies have decreased by 2 per cent, while marketing staff have increased by 59 per cent. Currently, 22 per cent of staff are employed in R&D, while 39 per cent are in marketing. (2)