Being Dubbed 'Disease'?
NEW YORK (Reuters Health) - Recent medical advances and the accompanying
flood of new drugs for a range of ills threaten to "medicalize"
every human condition and behavior, according to some experts.
And, they say, the advent of genetic screening could eventually
mean that apparently healthy people will be labeled "sick" decades
before an actual diagnosis.
In an issue of the British Medical Journal dedicated to the
topic of "medicalization," international researchers look at the
pros and cons of screening for disease-related genes, direct-to-consumer
drug advertising and what some see as the modern-day phenomenon
of treating everyday problems--from balding heads to unremarkable
performance in the bedroom--as medical conditions in need of treatment.
As part of the special issue, the journal polled readers on
what they thought were the top current "non-diseases." Among the
most popular were baldness, freckles, cellulite, penis envy and
road rage. The number-one vote-getter was "aging."
Some call it "disease mongering." In one article, Ray Moynihan,
a journalist with Australian Financial Review, and co-authors
describe what they see as "informal alliances" among drug companies
and some doctors and consumer groups. They argue that drug companies
provide medical experts and patient groups offer "victims" to
attest to a given condition's severity and draw attention to a
new "breakthrough" treatment.
The authors also point to several examples--such as hair loss
and excessive shyness--of what can be regarded as normal human
conditions that have been made medical conditions because there
is a pill available for them.
In another article, Barbara Mintzes of the University of British
Columbia in Vancouver, Canada, argues that prescription-drug advertising
to consumers--currently allowed only in the US and New Zealand--is
helping to medicalize "normal human experience."
"Relatively healthy people are targeted," she writes, "because
of the need for adequate returns on costly advertising campaigns."
Many of these advertising dollars, according to Mintzes, are
spent on relatively new, expensive drugs intended for long-term
use in large groups of people, such as medications for cholesterol,
impotence and anxiety.
And while studies prove these drugs work, the ads for them tend
to target a wider audience than the evidence supports, Mintzes
said in an interview with Reuters Health.
She cited cholesterol-lowering drugs as an example, saying that
the evidence that they cut heart disease death risk is "much better"
for patients with existing heart disease. But ads, Mintzes noted,
are targeted at a much broader population.
In a counterpoint to Mintzes' article, officials with the Whitehouse
Station, New Jersey-based drug company Merck argue that consumer
advertising helps the public make informed choices about their
health and treatment.
And evidence shows there is under-diagnosis of many major diseases
and disease risk factors for which treatment exists, according
to Silvia Bonaccorso and Jeffrey Sturchio.
But Mintzes argued that advertisers and public health experts
often have different views on what ailments need "awareness raising."
Others say that as medicine has forayed into advertising, it
has also gotten deeply involved in people's sex lives. When it
was launched in 1998, the impotence drug Viagra "became the world's
most popular medicinal drug ever," write Graham Hart and Kaye
And while many men with erectile dysfunction are thankful for
the little blue pill, they add, using an "overly medical" approach
to sex threatens to ignore the relationship dynamics and other
factors that go into sexual behavior.
The UK public health experts note that forms of gynecological
surgery aimed at enhancing sexual pleasure have recently emerged.
And in the US, about one third of men and even more women now
say they've had sexual dysfunction--a sign, Hart and Wellings
say, of a new obsession with sexual gratification and feelings
Hart, of the University of Glasgow, told Reuters Health that
his concern is that the term "sexual dysfunction" is being used
to cover a range of behaviors or feelings that may be natural
for some people--such as a libido that's lower than it used to
"If people are in happy, loving relationships in which, over
time, sex plays a less important part, this should not be seen
as problematic or dysfunctional," he said.
Looking a bit into the future, UK genetics researchers say that
genetic tests "could drive a new wave" of medicalization. With
the exception of a relatively small number of medical conditions
directly caused by a single defective gene, genetic screening
cannot predict whether a person will develop a disease, note David
Melzer, of the University of Cambridge, and Ron Zimmern, of Strangeways
Research Laboratory in Cambridge.
With diseases with multiple underlying factors--including major
killers like heart disease and cancer--screening for disease-related
gene variations can only give people information on their statistical
risks, Melzer and Zimmern write.
"Genetic tests for markers that may not result in symptoms for
half a century or more could be new examples of a process of premature
medicalization--of attaching the 'disease' label before it has
been established that prevention or treatment is clearly beneficial,"
Genetic technologies, the authors write, could be a "major benefit
to society, but their introduction must be measured...and, most
importantly, based on best evidence."
SOURCE: British Medical Journal 2002;324:863-864, 883-885, 886-891,
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