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Elizabeth Loder: Inventing disease and pushing pills

14 Mar, 13 | by BMJ

Elizabeth LoderThe recent 2013 Selling Sickness conference in Washington, DC was chock full of fascinating speakers. In an earlier blog I discussed my participation in a panel discussion at the conference, and Rachel Hendrick has also blogged about the meeting. It was difficult to choose from the topics on offer during the two day gathering, and many of the most enticing talks seemed to be scheduled concurrently with others that were equally intriguing. Since there were so many speakers and topics at the meeting who deserve attention, here are some selected highlights from my notes with links to more information about their work:

Jeremy Gruber of the Council for Responsible Genetics spoke about the large amount of money being poured into research on genetics: “What the world of genomics doesn’t want you to know is that the vast majority of morbidity and premature mortality come from smoking, overeating, and lack of exercise. For research in behavioral and social sciences, where even a small improvement in our ability to alter behaviour could yield significant benefits, funding is low.”

Rachel Liebert took a provocative look at what she terms “psychic policing,” surveillance, and disease mongering in public education. She noted that in the wake of the recent Connecticut school shootings the popular Dr Oz called for “a homeland security approach to mental illness,” voicing the popular but unproved assumption that most school shootings are carried out by the mentally ill and that “the proper response is medical.” According to Ms Liebert, the classroom is “at risk of becoming a psychiatric assessment unit” where teachers and others are on constant high alert for any unusual behavior that might indicate a budding psychiatric problem. Ms Liebert provided examples of commercial companies that have developed costly programmes to mitigate perceived risks and improve school safety. She suggested this might be considered disease mongering since it fosters discussion about psychiatric illness rather than access to guns. She refers to this as the “intersection of medicalisation and securitisation.”

Making fun of the concept of “pre-disease” and its contribution to medicalisation, a psychiatrist in the audience stood up and said “My diagnosis is pre-psychosis, but I’ve warded it off by wealth, education, an intact family, and living in safe neighborhoods. I have connections in my church. The treatment has worked marvelously and I’ve avoided hospitalisation. I want to thank the genome project for adding thousands of papers that show it’s nurture not nature that determines we will be healthy…we automatically assume [a drug] is the treatment… but really it’s the matrix in which the gene exists. It’s the environment.”

Rhetorician Judy Segal of the University of British Columbia compared old advertisements for patent medicines with the pharmaceutical advertisements of today. Depressingly little has changed. “Drug marketing is one way consumers learn what their symptoms might add up to,” said Dr Segal. “Patent medicine ads hailed an audience that was tired, nervous, constipated, and broadly disappointed. Drug ads today are much the same…We are broadly vulnerable and at least a little sick. We are at our computers with better resources, but with many of the same concerns. Lydia Pinkham’s vegetable compound helped to constitute the female subject now considering Yaz for moodiness, Premarin for a menopausal vagina, Gardasil for her daughter, and Zoloft for depression.”

Finally, for pure fun I advise you to watch the following list of videos. These are just some of those shown at the “Selling Sickness Popcorn Showcase” on the first evening of the conference. The first on the list is my favorite. Enjoy!

Elizabeth Loder is US research editor, BMJ

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