It's a medical scandal. The pharmaceutical giants are making billions by persuading us we have illnesses that only their products can cure.

This is the real Drug Abuse
by Jacky Law

Drugs companies commonly sponsor patient self-help groups, which help spread the word about drugs via the internet and other media. Then again, examine the treatment of depression.

When GlaxoSmithKline's anti-depressant drug, Paxil (called Seroxat in Ireland) was approved for the treatment of general anxiety disorder (GAD) in the U.S. five years ago, very little was known about the condition. Only one in a 100 people in the U.S. was diagnosed with it each year.

But at the time of the drug's launch in April 2001, news reports suggested that as many as ten million Americans were suffering from an unrecognised disease that had symptoms such as restlessness, fatigue, irritability, muscle tension, nausea, diarrhoea and sweating.

On the same day, a patient group called Freedom from Fear released details of a telephone survey which revealed that 'people with GAD spent the equivalent hours of a full-time job' worrying.

Surprise, surprise - the media contact for the survey was an account executive at GlaxoSmithKline's PR firm.

GAD is not the only condition that the drug is licensed to treat. Indeed, most Prozac-type anti-depressants are used for a whole range of conditions such as painful periods, depression, panic attacks, irritable bowels, incontinence, shyness or social anxiety - anything, in short, that has some kind of anxiety at its root. Critics say the truth is the drugs are a triumph of branding which cynically play on people's morbid fear that there must be something wrong with them.

U.S. bioethicist, Carl Elliot, says if a company is the sole manufacturer of a drug which tackles social anxiety disorder, it is clearly in its interest to broaden the definition of the disorder.

Indeed, Paxil's product director, Barry Brand, confirmed this attitude when he told the magazine Advertising Age: "Every marketer's dream is to find an unidentified or unknown market and develop it. That is what we were able to do with social anxiety disorder."

Of course, in some cases, these conditions are real sources of suffering and drugs clearly have a role to play. But the public are not necessarily best served by products which only deal with the symptoms rather than the cause and which marginalize all non-pharmaceutical approaches.

A former editor of the New England Journal of Medicine, Dr Marcia Angell, has pointed out how the diagnostic criteria for 'abnormal' levels of blood pressure, cholesterol, obesity and bone density have all changed over the years to expand the markets for disease. This is a long and sophisticated process but it essentially involves drugs companies conducting studies into the dangers of, say, high blood pressure, and then pushing for revised guidelines on what is safe, thus creating a new market of patients who need treatment.

Human metabolic syndrome is another area that has been exploited by the drugs companies. It covers a cluster of common disorders, such as obesity, high cholesterol and raised blood pressure.

Not recognised before 1998, it is now said to be approaching epidemic levels with no less than 115 million sufferers world wide and each component part is an example of 'disease' being a much more fluid concept than one might have supposed.

High blood pressure (hypertension) was once defined as blood pressure above 140/90. An expert panel then introduced something called prehypertension in 2003, which embraces readings between (120/80 and 140/90).

"Overnight, people with blood pressure in this range found they had a medical condition," says Dr Angell.

But it is the cholesterol-reducing drugs market that best shows how the boundaries have changed. The drugs lower levels of bad cholesterol and have been shown to prevent heart attacks and save patients' lives.

Collectively, they earn more than 24billion euros a year and companies compete intensely for a greater share of this market. As they do studies to show the value of their drugs, miraculously, the cut-off point for high cholesterol has gradually lowered. "Once it was reserved for blood cholesterol levels over 280mm per deciliter," says Dr Angell. "Then it fell to 240. Now most doctors try to knock it down to below 100".

Because the patents on all drugs eventually expire, new heart drugs to raise levels of good cholesterol are being developed. Their success will be partly determined by how much 'normal' levels of good cholesterol can be raised.

The idea that people's health is not as good as it ought to be is conveyed in surveys that show what is normal and what is not.

Ray Moynihan, an Australian journalist, who has examined the issue of drugs firms 'inventing' diseases to boost their profits, looked into another tactic used by pharmaceutical companies - questionnaires.

They are widely issued to the public with the result that people are made familiar with diseases or ailments they never knew existed - and become more concerned about their own health.

One broadly circulated questionnaire produced results which showed that 43 per cent of women sampled thought they couldn't have sex properly.

Intriguingly, Mr Moynihan found the questionnaire's authors had links with Pfizer, which, at the time, was testing Viagra on women. The study had asked 1,500 women, aged 18 to59 if they had experienced any one of a list of seven problems for a period of at least two months over the previous year.

One area concerned a lack of desire for sex and another anxiety about sexual performance. Nothing was asked about the length of the woman's relationship with her partner, which is a major factor in most people's sex live.

In subsequent trials, the women given Viagra reported an improvement in their sex life - but an even greater improvement was noted by those who were given a placebo.

Nevertheless, surveys such as these have resulted in female sexual dysfunction being established as a disease and many lucrative treatments are in the pipeline to deal with it.

But such drug products totally disregard the existence of alternatives such as bunches of flowers and other token of appreciation that have improved women's sexual responsiveness over the centuries and which can work out better and a lot more cheaply.

But of course, these sensible solutions don't sell drugs.
Daily Mail, 13th April 2006

Jacky Law is the author of Big Pharma:How the World's Biggest Drugs Companies Control Illness