Inventing a disease
Monday, April 20th, 2009
A new drug to treat overactive bladder hit pharmacy shelves this month. The pill is similar to others on the market – for folks who need the bathroom often and sometimes have accidents. Pharmaceutical companies say the condition is widespread and under-treated. Critics say it's just another case of drug company disease mongering. (photo Flickr/e-magic)
To be clear: no one disputes that overactive bladder is a serious condition that medication can help. Tamara Bavendam is a urologist and a medical director at Pfizer. She says overactive bladder can cause a range of problems – from inconvenience to mental anguish.
Bavendam: People may go to the bathroom as often as 20 times a day. And sometimes if they're not able to get to the bathroom in time they can actually wet themselves, have an accident.
Medications are designed to calm the bladder and quell the urge. Bavendam says that, because of the embarrassing nature of the disease, people often don't tell their doctors about it. And she adds that one in six people have overactive bladder. That's when the eyebrows go up. John Mack is a blogger and publisher of Pharma Marketing News.
Mack: Is it as much of a problem for as many people as the industry seems to be claiming?
Critics say no: It's a case of disease mongering — where companies, doctors, and the media exaggerate the extent of a condition. Other examples the critics cite: irritable bowel or restless leg syndrome. Bioethicist Art Caplan at the University of Pennsylvania says pharmaceutical advertising has hyped disease claims to broaden a drug's market.
Caplan: We've seen something like that go on with our favorite drug Viagra. The erectile dysfunction drugs originally started out being marketing to people with impotency, diagnosed by a doctor. But if you look at the ads today, they're marketing to men who are just a little worried they might have a sexual failure.
Caplan says the evidence of disease mongering lies in comparisons between countries.
Caplan: With a disease like attention deficit disorder, which I think is real, but is far far far over-diagnosed in children because of heavy marketing. It's not very prevalent in Germany. and there are probably 4 or 5 times the number of kids diagnosed with it in the United States.
John Mack says he has evidence overactive bladder has also been hyped by the industry. In 2002 he attended a presentation by a company detailing its success in inventing overactive bladder.
Mack: It really made an impression on me because it was the first time somebody actually said that they created a disease.
That company, Pharmacia, was since bought by Pfizer, and its bladder-control drug continues to be the market's best seller. Pfizer couldn't confirm or deny the validity of the presentation. Steve Permut is a medical professor at Temple University. He says he doesn't think pharmaceutical companies have invented diseases.
Permut: We know when there's a disease…I don't know of anything that I've prescribed that isn't for an acknowledged medical condition.
And Permut says advertising can make people aware that treatments exist for a condition they've been enduring. But Permut, who does earn money from a pharmaceutical marketing group, worries that drug-company advertising can turn pills into front-line treatments, rather than last resorts.
Permut: The pharmaceutical companies spend billions of dollars a year on both advertising directly to the public and to the profession, and they wouldn't do it unless they thought they could influence sales.
Even when a condition is real, drugs may prove to be a less effective, more expensive treatment — and one laden with side effects. Permut says overactive bladder often can be improved with simple lifestyle changes — like avoiding caffeine and not drinking so much.