Tuesday, December 19, 2006

Disease Mongering Podcast

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Never heard of Disease Mongering? Read "Disease Awareness or Disease Mongering?".

  • Neil H. Gray, Managing Partner, Healthcare Trends & Strategies, LLC
  • Alex Sugerman-Brozan, Director, Prescription Litigation Access Project
Go to the Pharma Marketing Talk Channel Page to listen in.

Disease mongering is a term that was coined by the late journalist Lynn Payer to describe what she saw as the confluence of interests by some doctors, drug companies, patient advocacy groups and media in exaggerating the severity of illness and the ability of drugs to "cure" them. Today's definition includes the accusation that, for example, cardio metabolic syndrome is really a cluster of risk factors for patients with diabetes, hypertension and heart disease. This podcast provides a highly interactive debate incorporating the view points of people from both ends of the spectrum. It also explores the concern that pharma may be loosing credibility with physicians and the general public by "creating" these syndromes.

Some examples of "diseases" that the authors of a PLoS report consider "mongered" include:
  • Restless leg syndrome - Prevalence of rare condition exaggerated
  • Irritable bowel syndrome - Promoted as a serious illness needing therapy, when usually a mild problem
  • Menopause - Too often medicalised as a disorder when really a normal part of life
Some questions addressed in this podcast include:
  • What's your viewpoint on this issue? Is it a legitimate issue? Are the diseases mentioned verifiable medical conditions or do they represent fake diseases invented by pharmaceutical marketers? Who's the authority on defining an illness?
  • Are marketers overstating the prevalence of these and other conditions in order to inflate sales? Isn't there a danger that by doing so, they set themselves up for failure to meet target goals (I'm thinking of the ED market here)? Would this lead to an ever-increasing need to widen the scope of the condition?
  • How do patient advocacy groups and the media benefit from disease mongering? Is the pharmaceuticfal industry establishing and funding patient advocacy groups for this purpose?
  • Is "disease awareness" just a euphemism for disease mongering? Is there a danger that legitimate disease awareness will morph into or spill over into disease mongering? How can pharma companies prevent that from happening? Is it necessary to take disease awareness out of marketing like CME was?
  • Is the pharmaceutical industry losing credibility by promoting treatments for previously unknown conditions for which there are relatively few suferrers? Restless Leg Syndrome comes to mind.


  1. Anonymous10:05 PM

    As someone who has suffered from IBS for the past ten years, I would not say my symptoms are always mild. My illness has led to some very uncomfortable situations in which I have had to leave social or work situations because of the discomfort. I am disappointed that people like you still dont understand the impact that IBS can have on a sufferers life. I am confident that given time research will show that IBS is not a made up disease, but is a physical problem caused by something such as a bacteria or other unknown problem. Please try to have some more compassion!

  2. Thanks for the comment ... if you are a real person and not a hack from the IBS ad agency hiding under anonymity!

    In either case, I am not unsympathetic to the plight of many people who ACTUALLY have the full-blown medical conditions mentioned here. We can debate if some of these conditions are real medical conditions or not -- that's not my main point.

    My point is that many pharma marketers overstate the number of sufferers in order to boost sales. And when these sales fail to materialize, they "send in more troops," bombarding the airways with more ads and harassing doctors with more reps, which decrease the credibility of the industry further.

  3. John --

    A sense of history provides a nearlessly endless source of amusement in these debates...though accompanied, I must say, with considerable frustration.

    A decade ago, the pharmaceutical industry was under attack from many quarters (including some of those who today have taken up the "disease mongering" cudgels) for neglecting "orphan diseases" (such as RLS) in favor of more prevalent conditions (with greater revenue potential). This was held up as an example of the industry's inveterate greed and lack of concern for suffering patients who were too few in number to provide a gravy train.

    IBS causes real suffering. So does RLS. (The term most commonly used among sleep specialists for the uncontrollable urge to move one's legs at night is "tormenting.") And among the more ominous manifestations of menopause (beyond "mere" hot flashes) is a sharp increase in the risk of cardiovascular disease and death (which, until the completion of the Women's Health Initiative study, virtually every thought leader in cardiovascular medicine and gynecology regarded as an urgent indication for *wider* use of HRT).

    Mainstream medical opinion, however, continued (and continues) to regard many of these real (and serious to the sufferer) conditions as "just part of life" or otherwise undeserving of treatment.

    There's plenty the pharmaceutical industry can be held accountable for. (And those who know me know I don't hesitate to point it out.) But discovering effective treatments for previously untreatable or undertreated conditions is not, IMHO, one of them.

    Bruce Grant
    (Full Disclosure: I am an "ad agency hack")

  4. Hello Bruce! Glad to hear from you. I am thrilled how raising these issues in my blog encourages people like you to contribute!

    You do raise a good point. However, as is often the case, this is not a black and white issue. Take the case of Restless Legs Syndrome. In the beginning of the ad campaign there was little mention of what the accepted criteria were that would warrant a diagnosis of RLS. I forget how many episodes you must have. The point is that the marketing had very little disease awareness and cast a wide net, as marketing is wont to do. But ReQuip is not sugar water to be taken lightly by someone who has ocassional "jimmy legs" (a term someone else used to describe this condition).

    But when does this cross a line and become "disease mongering?" That certainly depends on the eye of the beholder.

    I also note that the RLS Foundation has close and suspicious ties to GSK, the marketer or Requip. the web site for the Restless Leg Syndrome Foundation, which said it was incorporated in 1992, yet the earliest press release available on its web site is dated November 14, 2005, just one day before the press announcement of FDA approval of Requip in the US. GSK and Boehringer Ingelheim are "Gold Level Sponsors" of the Foundation (for more on the connection, see http://pharmamkting.blogspot.com/2006/04/restless-pharma-marketing.html).

    Now, the question becomes, if the RLS Foundation is a front set up by GSK rather than a legitimate patient advocacy oragnization, has the line been crossed?

    You mention orphan drugs and RLS in the same comment, which I think is stretching the point. There are PLENTY of legitimate diseases that KILL people out there that truly need drugs for treatment.

    So, I don't think your history lesson really applies -- it's apples and oranges.

  5. Business is not financial science, it's about trading.. buying and selling. It's about creating a product or service so good that people will pay for it.
    -Anita Roddick

    The present times see high pressure selling tactics in the pharma field. It is this that is creating the furore of “sickness marketing” in the pharma environment. Marketing ought to be a value delivery process from the company point of view but very much a trust building exercise from the customer point of view. And in this regard the emerging discipline of INTERNAL MARKETING where in we pay a lot of attention to employee training to the way they deal with delivering brand experiences to customers will help in building trust. As such numbers alone should not drive business strategy. Intangibles have a lot of influence on business processes. It is true that if you chase quality you get quantity. This goes by the name of soft skills today and that has to permeate every quarter (pun intended!) of a pharma organization.

    It is not only about restless legs syndrome.. we have awareness building programmes on conditions like menopause, erectile dysfunction, restless legs syndrome, sleeplessness, tiredness in children, ADD (Attention Deficit Disorder), IBS (Irritable Bowel Syndrome), SAD (Social Anxiety Disorder), loss of BMD (Bone Mineral Density) to expand business potentials for products. Marketing departments in co-ordination with clinical research departments see emerging markets for conditions like Diabesity (central abdominal obesity in diabetics), Hidden Hunger (subclinical micronutriuent malnutrition), prediabetes and prehypertension. Over zealous marketing in a way has made doctors and the public wary of product promotions, clinical trial results and new product launches.

    In fact I urge you to see my new post INTERNAL MARKETING – for the cutting edge on www.pharmaceuticalshealthcare.blogspot.com for more interesting points on this aspect. – Sunil S Chiplunkar


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