The ABCs of Disease Mongering

DRUG BUST Alan Cassels

Alan Cassels, co-author of the international bestseller Selling Sickness: How the World’s Biggest Pharmaceutical Companies are Turning Us All Into Patients, returns with outrageous humour and more outrageous facts. In the irrepressible spirit of Edward Gorey’s The Gashlycrumb Tinies, Cassels offers up a great romp of disorders that go bump in the night and the industry-sponsored drugs that are marketed to make everything better again. While Cassels’ seditious and deliciously illustrated fable is not for the faint of heart, it is meticulously footnoted for use by health policy wonks of all shapes, sizes and chemical compositions. Take one (or two) of these for good humour. Trust us, your health care policy will feel better in the morning. To shed light on his reasons for writing his second book and his choice of format, Cassels employs the mock interview format below.

AC: Well, let’s take the flu, for example. Seeing as this is an ABC book, I use the letter F to describe the situation with “Ferdinand, who fears the flu… ” There is a huge amount of flu-mongering and it’s not only the vaccine manufacturers who want everyone to get their annual flu shot; the public health agencies are using fear of the Spanish Influenza epidemic of 1918 to get everyone to roll up their sleeves for the annual flu shot. It’s lowering drug every day. In my estima tion, cholesterol-mongering has elevated high cholesterol to the status of a disease in and of itself. Cholesterol-lowering drugs are being sold by the gazillions at the same time that the studies behind the drugs show that they are next to useless for most people.

Q: Who is behind this, beside the drug manufacturers?

AC: The campaign to medicate all of

Disease mongering is creating a perpetual state of health

anxiety, which, in itself, is an increasing health threat.

Everywhere we turn the media, advertising and even our

doctors are telling us that we are pre-diseased and potentially

sick and we need to do something about it.

16 . . OCTOBER 2007

Question: Didn’t your last book Selling Sickness cover this ground, about the pharmaceutical industry’s push to redefine illnesses and turn more of us into paying customers? Why a new book about disease mongering?

Alan Cassels: The absurdities of disease mongering keep getting more absurd. When Selling Sickness was printed in 2005, I could’ve written 20 more chapters on the phenomenon of

drug marketers pumping and promoting our fears about death and disease in order to sell more drugs. Disease mongering is creating a perpetual state of health anxiety, which, in itself, is an increasing health threat. Everywhere we turn the media, advertising and even our doctors are telling us that we are pre-diseased and potentially sick and we need to do something about it.

Q: Like what, for example? really not a very great idea.

Q: I shouldn’t get a flu shot?

AC: You shouldn’t get any medical treatment unless you know what your risk is to start with and what the benefits and harms might be related to the treatment. You also need to know what would happen if you did nothing.

Q: But if I did nothing and didn’t get the shot, I’d get the flu, wouldn’t I?

AC: Probably not. In fact, your likelihood of getting the flu if you are otherwise healthy is low. The likelihood that the flu shot would prevent you from catching the flu this winter is also low. Most people don’t know, and the public health agencies don’t go out of their way to explain, that there is no evidence to prove that mass flu campaigns prevent people from being hospitalized for the flu or missing work. I’d get the flu shot if they could show that people who got it missed work less often, but they can’t so I won’t.

Q: So why are public health agencies and doctors pushing expensive and unnecessary treatments on people?

AC: That’s really the nub of the book – who stands to gain from mongering diseases. Let’s take another example even more bizarre than the flu. With the letter C, we find Carol who is alarmed at her cholesterol. For a number of years, there has been a very strong, well-funded and near ubiquitous campaign to get ordinary people to: a) Feel enough fear to get a cholesterol test; b) Worry that their cholesterol is “high” and they need to lower it to avoid a heart attack and; c) Become convinced to take a cholesterolus for high cholesterol is certainly bank rolled by the manufacturers, but it doesn’t stop there. Others, including groups of physicians and cardiologists who define guidelines on when to treat high cholesterol, with the support of the foundations, are doing the really serious cholesterolmongering. The absurdities abound, especially when you hear that 80-yearold people and even children are being captured by the cholesterol mongers and told they need a pill to reduce their high cholesterol. The medical profession, inebriated on the largesse of Big Pharma, is not the whole problem. It’s also that so few doctors and even fewer patients are taking the time to question the Pharma propaganda they are exposed to.

Q: Is that what your book will do, show doctors some examples of the disease mongering propaganda they and their patients are being exposed to?

AC: I think so. It’d be nice if physicians read this book, but, really, it is intended for patients, sorry, oops, I mean people, to get them thinking about the disease mongering that surrounds us every day.

Q: Why did you choose to go with a format like an illustrated children’s book? I mean, The ABCs of Disease Mongering is a serious topic that you seem to be treating with a bit of whimsy. Why?

AC: I have a friend down at the Ministry of Health who has worked there for 23 years. When I told him that I was working on a book about disease mongering, he asked me with a straight face, “What’s that?” I reeled. Whoa, I realized I had to make the concept really simple,

even childlike, so I completely rethought my approach. I mean, if the health bureaucrats in our midst have never even heard of the concept of disease mongering, what better way to start than by trying to plant that seed in peoples’ heads?

Q: So a child’s book is the way to go?

AC: People like pictures. I do too. It’s a way to engage with the concept on a number of levels. See the picture, read the blurb associated with the letter, then check out the footnote for more information. This could be the first time anyone has seen a child’s book with references. And 26 examples – one for each letter of the alphabet – may be enough to drive the point home.

Q: But it’s not a child’s book, is it? Isn’t it deadly serious?

AC: It’s serious, but snarky. With atti

Big Pharma uses our fear

of looking bad or being

embarrassed to push those

products out the door.

tude. Kind of like me. For some things you really need to be light. You can’t beat people on the head because they won’t get it. You have to lead them in and for some people humour is going to be the way they get it. On one level, it’s hilarious that marketers are using our own absurd fears to sell us prod ucts. It’s certainly ripe for parody and ridicule, and laughing at those who are disease mongering us is a healthy way to respond.

Q: Speaking of which, some of your examples are just plain silly. I mean do they really have drugs for premature ejaculation (letter W), for facial wrinkles (letter V) or yellow toenails (letter Y)?

AC: By all means they do and instead of playing on our fear of death, Big Pharma uses our fear of looking bad or being embarrassed to push those products out the door. I think the weirdest example recently has to be the condition I refer to in W: “Wilber has a problem with his Wee Willy…” I mean, here’s a case, and there have been lots recently, where we know the side effect of a drug causes certain symptoms. In this case, the side effect of commonly prescribed antide pressants causes men to delay ejaculation. How one turns this into a market is not rocket science. There are many men who may “suffer” from premature ejaculation so bingo, put two and two together and there you go, a market. OK, it’s not that easy, but you get the point. It’s like having drugs in search of new diseases, instead of the other way around, which is what we usually think.

Q: Has this happened before, the known side effect of one drug being used to treat a new condition?

AC: Certainly this has happened before, the most familiar case being drugs for erectile dysfunction. The chem ical for sildenafil, commonly known as Viagra, was tested in the early days as a drug for angina. Sildenafil, as a vasodialator, relaxed smooth muscle allowing increased blood flow. The researchers found that it didn’t work very well with the class of enzymes dealing with the heart, but had more effect on those enzymes found in the erectile tissue of males. You can just imagine some clever guy in marketing, having his eureka moment when he found out what they could do with the pesky side effects from the drugs that men in the trial were experiencing. It’s a serendipity that launched a billion dollar industry.

Q: You wouldn’t say we are being disease mongered around impotence, would you?

AC: I have and I would say that. I’m glad you used the word “impotence” because that’s what we called it before it had its makeover by the focus groups and the market researchers. You see, in the early days of the market research for Viagra, the manufacturer learned very quickly that the name of the condition needed to be changed so that men would seek help for it. Impotence was common, frustrating for couples and very embar rassing. No one went to the doctor for that condition. Along comes “erectile dys function,” which is as antiseptic and clinical as a name could be, and it was a name that was ripe for marketing. The company spent millions enticing men to “Ask your doctor about ED…” because there was finally a treatment for their problem.

Q: The creation of the erectile dysfunction market was quite brilliant and successful as you say, so what is the problem?

AC: The problem is that erectile difficulties are not all due to a plumbing problem. And men who don’t do what they might need to do, in order to maintain their relationship, thinking they can solve their problems with a pill, might be very misled.

Q: Is it true that there are drugs for female sexual difficulties too?

AC: That’s the Brave New World. New conditions such as “hypoactive sexual desire disorder” – what we used to call the “Not tonight dear, I have a headache… ” condition – are being used to sell testosterone drugs for women, so that their lack of libido becomes an auto matic target for drug treatment.

Q: Is there a problem with that?

AC: Only if you’re a woman who doesn’t want to be as weak when it comes to sexual urges as men often are. I mean, really, what does being in control of yourself and your sexuality mean? A pill for arousal? What’s next, a pill to change your sexual preference? I say that only slightly in jest, of course, because we know clever people in labs are working on those very things.

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