There is an apparently limitless amount of money to be made from marketing pharmaceutical remedies for diseases and even more from remedies to reduce risk factors for disease. An emphasis on the treatment of disease minimises political responsibility for those fundamental causes of disease that are located within the structure of society, and substantial and lucrative professional careers have been built on the endless pursuit of new diseases or risk factors for disease.

More fundamentally, disease mongering exploits the deepest atavistic fears of suffering and death. Throughout history, humanity has kept such fears at bay by accepting burdens and sacrifices in the present in the hope of future salvation. In earlier times, the mediator was religion and the salvation was to come after death. Now, for those without religious belief, death has become more final, and salvation must be sought before death in an ever-expanding longevity. An adequate response to the false hopes raised by disease mongering will demand, from those in positions of power and influence, an ability to acknowledge, accommodate, and move beyond these profound existential fears [1]. Such ability is rare.

The way forward will rely on a capacity to rediscover courage and stoicism as both private and civic virtues, alongside seeking a radical realignment of the relationship between economic, political, and professional interests. Doctors and biomedical scientists, in particular, have a responsibility not only to put their own house in order but to provide much better advice to politicians and to the public, both as patients and as citizens.

The Challenge to Professionals
The first step has to be a genuine disentanglement of the medical profession from the pharmaceutical industry—there really is no such thing as a free lunch [2]. The pharmaceutical industry spends millions of dollars supporting the “education” of doctors because it is in its economic interest to do so (Figure 1). If prescribing activities and industry profits were not affected by this support, it would not be offered. Doctors can only provide appropriately independent and authentic advice to patients and, indeed, to politicians if they are seen to be completely independent of other powerful interests. Politicians genuinely interested in the welfare of patients and the health of citizens should actively promote such independence [4].

Figure 1. Percentage of Doctors That Use Information Provided by Drug Company Representatives in Their Clinical Practice [Click to Enlarge image]

Data derived from [3]
(Image: Adapted from a slide presentation created by No Free Lunch, http://www.nofreelunch.org/downloads/Nofreelunch%20Presentation.ppt)

Disease mongering exploits the deepest atavistic fears of suffering and death.
Beyond this, there is a need for better science that has the integrity to demand more explicit acknowledgment of the limits of medical knowledge, less extrapolation beyond research findings, and much more responsible use of statistics, so that the true extent of the benefits and harms of proposed treatments can be properly understood.

The rhetoric surrounding disease mongering suggests that it will promote health, but the effect is in fact the opposite. Much disease mongering relies on the pathologising of normal biological or social variation and on the portrayal of the presence of risk factors for disease as a disease state in itself. When pharmaceuticals are used to treat risk factors, the vicious circle is completed because “anyone who takes medicines is by definition a patient” [5].

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