"Findings from the first long-term trial of the concept of prescribing drugs to young people at risk of schizophrenia, but not yet exhibiting the disorder, raised more questions than they answered, experts said" (see FDLI SmartBrief, May 2, 2006).
According the New York Times article on this subject "Critics have charged that treating people for a disorder that has not yet been diagnosed is not only premature but stigmatizing, especially for adolescents. The new study was intended in part to clarify the trade-off between the risks and the potential benefits of preemptive treatment."
It was difficult to enroll subjects for this study, but the investigators "eventually enrolled 60 people, most of them adolescents, who scored highly on a scale that assesses risk for psychosis. The scale rates severity of more than a dozen symptoms, including suspiciousness, grandiosity and bizarre thoughts."
The clinical investigators might have been able to recruit a few thousand more subjects if they rated pharmaceutical company marketers on that scale. Pharma marketers are a suspicious bunch to begin with ("Congress is out to get us!") and are known to be grandiose ("The market for this drug is huge!"). Add now bizarre thoughts -- "We could treat people with our product before they even exhibit symptoms!"
First there was "Disease Mongering" whereby drug companies are said to attempt to "enlarge the market for a treatment by convincing people that they are sick and need medical intervention" (see "Disease Awareness or Disease Mongering?"). Now there's pre-emptive treatment!
What's next? How about "pre-emptive marketing?"
Soon, we may be required to have our children undergo genetic testing at birth to reveal possible future medical problems. There will be no need for pre-emptive clinical trials -- "it's in the genes!" -- just pre-emptive marketing to convince people that they will someday have aq condition that should be treated now!
They'll have us treating children starting at the age of 2 not just for schizophrenia, but for high blood pressure, high cholesterol, erectile dysfunction (ED)... you name it!
Of course, kids cannot "ask their doctors if this treatment is right for them." Therefore, pre-emptive drug ads would be aimed at parents. I envision these ads appearing in parents' magazines and on daytime TV talk shows. Imagine the creative possibilities! It will be a golden time for ad agencies.
Drug companies are considering these "bizarre thoughts" because they have very few new drugs to offer and must ever expand the market for the old ones, for which they "grandiosely" set unrealistic marketing goals, which they "suspect" will be met with opposition by regulatory authorities unless they lobby the hell out of Congress.
The possibilities are endless. Now that drug companies have convinced us that there's a condition called "pre-hypertension," can "pre-pre-hypertension" be far behind? After all, don't we all suffer from "pre-pre-hypertension?" And what about "pre-mortality syndrome?" What a market there'd be a for a drug to treat that!
ReplyDeleteThis notion is particularly scary when you're talking about mental illnesses, many of which have fairly uncertain diagnoses to begin with, particularly for kids.
In some disease states being "pre-emptive" may have some value. It is hard to believe that diabetes or thyroid deficiency simply "appear" in patients. Bearing in mind that the approved medical description of these diseases is limited, could it be that early (off-label?) intervention might benefit patients?
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