Disease mongering

Pejorative term for expanding a disease's market for treatment

A collection of articles on disease mongering in PLoS Medicine (2006)

Disease mongering is a pejorative term for the practice of widening the diagnostic boundaries of illnesses and aggressively promoting their public awareness in order to expand the markets for treatment.

Among the entities benefiting from selling and delivering treatments are pharmaceutical companies, physicians, alternative practitioners and other professional or consumer organizations. It is distinct from the promulgation of bogus or unrecognised diagnoses.

## Term

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The term "monger" has ancient roots, providing the basis for many common compound forms such as cheesemonger, fishmonger, rumor monger and fleshmonger, for those who peddle such wares respectively. "Disease mongering" as a label for the "invention" or promotion of diseases in order to capitalize on their treatment was first used in 1992 by health writer Lynn Payer, who applied it to the Listerine mouthwash campaign against halitosis (bad breath).

Payer defined disease mongering as a set of practices which include the following:[1]

* Stating that normal human experiences are abnormal and in need of treatment
* Claiming to recognize suffering which is not present
* Defining a disease such that a large number of people have it
* Defining a disease's cause as some ambiguous deficiency or hormonal imbalance
* Associating a disease with a public relations spin campaign
* Directing the framing of public discussion of a disease
* Intentionally misusing statistics to exaggerate treatment benefits
* Setting a dubious clinical endpoint in research
* Advertising a treatment as without side effect
* Advertising a common symptom as a serious disease

The incidence of conditions not previously defined as illness being medicalised as "diseases" is difficult to scientifically assess due to the inherent social and political nature of the definition of what constitutes a disease, and what aspects of the human condition should be managed according to a medical model.[2] For example, halitosis, the condition which prompted Payer to coin the phrase "disease mongering", isn't merely an imagined social stigma but can stem from any of a wide spectrum of conditions spanning from bacterial infection of the gums to kidney failure, and is recognized by the Scientific Council of the American Dental Association as "a recognizable condition which deserves professional attention".[3]

## Examples

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Australian journalist Ray Moynihan has argued that the pharmaceutical industry engages in disease mongering to enlarge its profits, and that it harms citizens.[4] His use of osteoporosis as an example of a "made up" disease in this article prompted an angry retort from the president of the British National Osteoporosis Society, stating that the article was insulting to people with osteoporosis and vastly understated the risk of disabling fractures associated with the disorder.[5] Moynihan published a satire of disease mongering in the 2006 April Fool's Day issue of BMJ titled "Scientists find new disease: motivational deficiency disorder".[6]

Other conditions which have been cited as examples of disease mongering include: restless leg syndrome,[7] testosterone deficiency,[8] erectile dysfunction,[4] sluggish cognitive tempo,[9] Lyme disease,[1] and hypoactive sexual desire disorder.[10] Some of these conditions are recognized as medical disorders by professional medical societies[11] and the National Institute of Health and Clinical Excellence.[12] In 2014, an FDA advisory committee voted to limit the use of testosterone replacement therapy products due to potentially increased cardiovascular risk associated with their use.[13]

A 2006 Newcastle, New South Wales international conference, reported in PLoS Medicine, explored the phenomenon of disease mongering.[14]

## See also

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* medicine portal

* Inverse benefit law – Drug benefit-harm ratio falls with marketing
* Medicalization – Categorization of human problems as medical
* Medicalization of sexuality – Medical authority over sexual experiences
* Quaternary prevention
* Schooliosis – Misdiagnosis of scoliosis – an example of disease mongering due to overdiagnosis

## References

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1. ^ a b Payer, Lynn (1992). Disease-mongers: how doctors, drug companies, and insurers are making you feel sick. New York: J. Wiley. ISBN 978-0471543855.
2. ^ Frosch DL, Grande D, Tarn DM, Kravitz RL (January 2010). "A decade of controversy: balancing policy with evidence in the regulation of prescription drug advertising". Am J Public Health. 100 (1): 24–32\. doi:10.2105/AJPH.2008.153767. PMC 2791253. PMID 19910354.
3. ^ "nypediatricdds.com" (PDF). Archived from the original (PDF) on 2014-10-18.
4. ^ a b Moynihan R, Heath I, Henry D (2002). "Selling sickness: the pharmaceutical industry and disease mongering". BMJ. 324 (7342): 886–91\. doi:10.1136/bmj.324.7342.886. PMC 1122833. PMID 11950740.
5. ^ Edwards L (July 2002). "The pharmaceutical industry and disease mongering. Article was insulting to people with osteoporosis". BMJ. 325 (7357): 216, author reply 216. doi:10.1136/bmj.325.7357.216. PMC 1123728. PMID 12143857.
6. ^ Moynihan R (2006). "Scientists find new disease: motivational deficiency disorder". BMJ. 332 (7544): 745. doi:10.1136/bmj.332.7544.745-a. PMC 1420696. "[Neurologist Leth Argos and a team...] at the University of Newcastle in Australia say that in severe cases motivational deficiency disorder can be fatal, because the condition reduces the motivation to breathe."
7. ^ Moynihan R, Henry D (April 2006). "The fight against disease mongering: generating knowledge for action". PLOS Med. 3 (4): e191. doi:10.1371/journal.pmed.0030191. PMC 1434508. PMID 16597180.
8. ^ Vitry AI, Mintzes B (June 2012). "Disease mongering and low testosterone in men: the tale of two regulatory failures". Med. J. Aust. 196 (10): 619–21\. doi:10.5694/mja11.11299. PMID 22676868. S2CID 41710942.
9. ^ Aldhous, Peter (2014-09-30). "The Daydream Disorder". Slate. ISSN 1091-2339. Retrieved 2024-02-18.
10. ^ Tiefer L (April 2006). "Female sexual dysfunction: a case study of disease mongering and activist resistance". PLOS Med. 3 (4): e178. doi:10.1371/journal.pmed.0030178. PMC 1434501. PMID 16597176.
11. ^ Hatzimouratidis K, Amar E, Eardley I, et al. (May 2010). "Guidelines on male sexual dysfunction: erectile dysfunction and premature ejaculation". Eur. Urol. 57 (5): 804–14\. doi:10.1016/j.eururo.2010.02.020. PMID 20189712. S2CID 4640632.
12. ^ "www.guidelines.co.uk". Archived from the original on 2014-10-18.
13. ^ "FDA Panel: Limit Testosterone Drug Use – WebMD".
14. ^ Moynihan R, Henry D (eds). "A Collection of Articles on Disease Mongering". PLoS medicine, 2006. Archived from the original on 2006-09-01. Retrieved 2007-06-12.

## Further reading

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* Conrad, Peter (2007). The Medicalization of Society: On the Transformation of Human Conditions into Treatable Disorders. Baltimore: Johns Hopkins University Press. ISBN 978-0-8018-8585-3.
* Dalrymple, Theodore (September 2006). "Forced Smiles". New Criterion. 25.
* Day, Michael (29 August 2004). "Doctors' body accuses drug firms of 'disease mongering'". The Daily Telegraph. Archived from the original on 30 August 2004. Retrieved 26 July 2019.
* Doran, Evan; Hogue, Clare (2014). "Potency, Hubris, and Susceptibility: The Disease Mongering Critique of Pharmaceutical Marketing" (PDF). Qualitative Report. 19: 78.
* Moynihan, R; Henry, D (2006). "The fight against disease mongering: Generating knowledge for action". PLOS Medicine. 3 (4): e191. doi:10.1371/journal.pmed.0030191. PMC 1434508. PMID 16597180.

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Unnecessary health care

Causes|

* Direct-to-consumer advertising
* Overscreening
* Overdiagnosis
* Fee-for-service
* Defensive medicine
* Unwarranted variation
* Overmedication
* Overmedicalization
* Prescription cascade
* Quaternary prevention
* Disease mongering
* Political abuse of psychiatry

Overused health care|

* Caesarean delivery on maternal request
* Antibiotic misuse
* Benzodiazepine use disorder
* Opioid use disorder
* Psychoactive drug
* Proton-pump inhibitor
* Polypharmacy
* treatment of incidentaloma

Tools and situations|

* Deprescribing
* Choosing Wisely
* Medication discontinuation
* Withdrawal syndrome

Works about unnecessary health care|

* Overtreated
* The Treatment Trap
* Selling Sickness
* Overdosed America

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