A progressive hospital administrator is currently touring the
country, speaking out on the virtues of disease prevention. He
begins his presentation with the observation that the modern medical
system is not really focused on disease prevention or health promotion
at all. As he puts it, "We don't have a health care system
in this country. What we have is a disease treatment system."
This bold statement is highly effective in getting audiences
on board with the idea that the priorities in modern medicine
are seriously out of whack. But the problem is not so much that
we have a "disease treatment system." Rather, the problem
is that we have a "disease promotion system."
wants your body
"How can this be?" you might ask. Surely the health
care industry is inefficient, over-priced and frustrating to both
patients and providers. But isn't the whole point to help people
Not anymore it's not. If you've been paying attention to trends
in media and marketing, you know that the pharmaceutical industry
has seized control. Big Pharma has been let out of its cage and
is now tyrannizing the medical marketplace. Not content to simply
promote products for existing diseases, Big Pharma now promotes
a wide range of human afflictions and expands the definitions
of disease; their goal is to manufacture new, more profitable
To get a sense of how warped the system has become, consider
Big Pharma now spends more than $5.5 billion to promote drugs
to doctors. This is more than what all U.S. medical schools
spend to educate medical students. (New England Journal
of Medicine, June 23, 2005 "The Lessons of Vioxx")
Major drug companies employ about 90,000 sales representatives.
One for every 4.7 doctors in the United States. (American Medical
The total pharmaceutical marketing budget is $25 billion. (Forbes
magazine "Just Say NO!" by Robert Langreth Nov. 29,
Drug firms have spent $800 million since 1998 buying influence,
including $675 million on direct lobbying of Congress. No other
interest group has spent more money to sway public policy. (Center
for Public Integrity)
Big Pharma has had a free ride for a long time, but finally,
some people are starting to sit up and take notice. For example,
Sickness: How The World's Biggest Pharmaceutical Companies Are
Turning Us All Into Patients by Ray Moynihan and Alan
story on the front flap summarizes the whole sordid mess:
"Thirty years ago, Henry Gadsen, the head of Merck, one
of the world's largest drug companies, told Fortune
magazine that he wanted Merck to be more like chewing gum maker
Wrigleys. It had long been his dream, he said, to make drugs
for healthy people so that Merck could "sell drugs to everyone."
Three decades on , the late Henry Gadsen's dream has come true."
Moynihan and Cassels lay out their case in methodical detail,
telling us about Big Pharma's efforts to expand the patient pool
and create new diseases. Their conclusion: "there's a lot
of money to be made telling healthy people they're sick."
Disease by definition
To understand Big Pharma's power over our health, it's important
to understand how disease is managed in large populations. Most
medical conditions are defined by a set of numbers. If we broaden
the range of those numbers, even slightly, and apply it to a population
of millions of people, the consequences can be profound.
For example, think about the numbers that are attached to your
blood pressure. If it's above X, you're officially "diseased"
and a candidate for medication. If it's below X, you're "healthy."
But X is determined, not by some perfect medical formula, but
by consensus within the medical community. Exact cut-off points
are debatable and relative.
This is where Big Pharma steps in. If they can expand
the statistical definition of a disease, even by a small margin,
they can cash in. One or two percentage points, spread across
the world, adds up to millions of newly created patients. Thus
it comes as no surprise to hear that Big Pharma has become an
active participant in the process of defining disease. By pouring
money and influence into experts, conferences and journals, Big
Pharma stretches the definitions and expands the patient pool.
The power of suggestion
It would be one thing if human disease was a matter of absolutes,
but it's not. Social and cultural forces play an immensely powerful
role in determining how we interpret our physical experience.
Is obesity a disease? Workaholism? Weak sexual desire? Social
anxiety? It's easy to imagine situations in which any physical
sensation or experience of the human body might be labeled as
health or disease, depending on the context.
Our health is the product, not simply of genetics and biochemistry,
but also of human influence. As intensely social animals, we pay
close attention to the physical well-being of our families and
friends. If people in the tribe speak of getting one disease or
another, we naturally begin to wonder if such afflictions are
part of our experience as well. If everyone around us is complaining
about headaches or low back pain, we may very well decide to join
Have you ever noticed how trendy diseases can be?
One month it's eating disorders, the next month it's carpal tunnel
syndrome, fibromyalgia or irritable bowel syndrome. None of these
conditions even existed 100 years ago, but now they're "epidemic."
Granted that many of these diseases exist now because of our culture
and lifestyle, but their everyday emphasis is overwhelming. Similarly,
medical students frequently observe how closely their physical
sensations parallel the conditions that they're studying. "Med
student's disease" is legendary.
Big Pharma is well aware that disease is creatable; they know
full well that their customers are vulnerable to suggestion. By
manipulating images, ideas and narratives, they shape the way
people think about their bodies and in turn, their health.
The greatest therapy is the least advertised
It's important to be aware of Big Pharma's relentless disease
promotion, but we should also take note of what's gone missing
along the way. That is, whatever happened to exercise
to prevent disease?
Technically, Big Pharma's direct-to-consumer marketing campaigns
are "commercial speech" but they also become a form
of education. People learn about their bodies from all kinds of
sources and in this sense, Big Pharma's pitch has become part
of a larger health-education curriculum.
In the process, exercise is being squeezed out of the picture.
Health professionals know that exercise is an immensely powerful
therapy with effects that are both broad and deep. And yet, its
powers are completely obscured by mega-profit therapies. Tragically,
the most powerful therapeutic tool in our collection is also the
one that is the least often promoted.
In fact, when we do hear about exercise in commercial
media, it's usually presented in the negative. When Big Pharma
promotes drugs for conditions in which exercise is highly effective,
they make sure to emphasize the failure of fitness. "If you've
tried exercise and diet and your cholesterol is still high, ask
your doctor about our miracle pill." The sub-text to such
promotions is that exercise is likely to fail and that you'll
probably have to "ask your doctor" anyway, so there's
no point in even trying. Over time, consumers are conditioned
to bypass movement entirely and go directly for the pills.
A particularly egregious example of this approach is brought
to us on behalf of Avandia, a blood sugar drug by GlaxoSmithKline.
The advertisement pictures a frustrated middle-aged male, slumped
on a bench in a stark, depressing fitness facility. The defeated
expression on his face tells us that he's had his fill of exercise.
"If diet and exercise won't get your blood sugar number down,
adding Avandia can help" the ad tells us. The meta-message
is obvious; exercise is a drag, so you may as well go directly
to the pharmacy.
Fueled by fear
Not surprisingly, fear plays a big role in Big Pharma's marketing
style. Lurking behind the smiling faces of happy drug consumers
is the implicit threat of physical disaster. If you don't "ask
your doctor" your body will fall into an inevitable sink
hole of disease and your loved ones will be dragged along with
We see this threat in many ads, but one particularly vivid example
has recently appeared on health-related websites. Users are greeted
with a big question mark and the ominous message, "What you
don't know could kill you." Follow the link and you'll discover
that "You may be at triple the risk of developing the condition
again in the future." What's this?" you wonder as you
click through. "Talk to your doctor and click here for your
online risk assessment. It's a visit that could save your life
or the life of a loved one." This fearvertisement turns out
to be a pitch for deep-vein thrombosis, an occasionally serious
condition that is currently being hyped into a compelling medical
Universal disease: The dreams of medical marketers
While romantics dream of universal health, Big Pharma dreams
of the inverse, a world in which the entire population is afflicted
by chronic, incurable syndromes that require frequent diagnostic
tests, expensive specialists and pharmaceuticals. The ideal Big
Pharma customer is afflicted with disease throughout his lifespan.
He is literate enough to read medical advertising, yet docile
enough to follow directions "Ask your doctor about the green
pill." He doesn't know what the green pill is, but he asks
his doctor anyway, just to be sure.
A particularly chilling manifestation of this vision comes, not
from Big Pharma itself, but from one of its pusher clients, Target.
An advertisement in popular news magazines showcases
its newly designed medication bottles with personalized, color-coded
rings "to clearly identify the medication for each family
member." The advert shows three smiling children and their
father, each with his own personalized bottle of drugs. The assumption
is clear: if you're a human being, you are supposed to be on something.
Turning disease into the default
Big Pharma's direct-to-consumer strategy is not mere advertising.
It is an audacious attempt to rework the default status of the
human body. As Moynihan and Cassels put it in Selling Sickness,
the goal of Big Pharma is "putting disease at the center
of human life"
For the vast majority of human history, vigorous, robust health
has been the default. Yes, there were plenty of infectious diseases,
suffering and early death in the mix, but if you managed to avoid
the pathogens and the predators, your body would be strong and
resilient. The norm, as it is for all animals, is health.
Big Pharma wants to change all that. From this point forward,
you are assumed to be diseased. You may be asymptomatic at the
moment, but that's a temporary state. By redefining what's normal,
we can make you sick merely by moving a few data points on a graph.
Given the right kind of management, you will soon become a patient/customer.
Once you are absorbed into the body of Big Medicine, you will
become dependent for life.
Call to action
We need to start by taking care of our bodies with a movement-based
lifestyle and a food-based diet. Craft a lifestyle that promotes
health and independence and don't deal with Big Pharma unless
it's absolutely necessary. Don't believe what you see in a Big
Pharma advertisement and don't allow your relationship with your
body to be defined or distorted by fear marketing.
Use pharmaceuticals only as a last resort. Give your body a chance
to seek out homeostasis on its own. Let your natural regulatory
mechanisms do their thing. Make your body stronger with robust
physical movement, stress relief and joy. It's really the best
approach; just ask your doctor.
Reference Source 139