Thursday, July 28, 2005

Hypochondria as a Marketing Tactic. You do feel sick, don't you?

Mother Jones has an extended article on the marketing of new diseases.

From a pharmaceutical company's perspective, the big money can be made not only by selling drugs to the sick, but by selling drugs to the healthy, the people who don't even know that they need drugs yet. A recent Reuters Business Insight report, designed for drug company executives, suggested that the drug companies can reap billions by "creat[ing] new disease markets." That involves convincing people that "problems they may previously have accepted as, perhaps, an inconvenience"—such as, for instance, the distress that can accompany PMS—are in fact "worthy of medical intervention." In other words, nothing short of the medicalization of everyday troubles. Cheerfully, the report believes that drug companies are up to the task: "The coming years will bear greater witness to the corporate sponsored creation of disease."

From this we get the marketing of psych drugs for new uses.

Consider this story. In 1998, Lilly, one of the world's largest pharmaceutical companies, was on the verge of losing its patent on fluoxetine (more commonly known as Prozac) worth over $2 billion annually. However, if Lilly could find a new use for the drug, the patent could be extended. That year, Lilly helped fund a "roundtable" of researchers to gather in Washington D.C., along with staff from the Food and Drug Administration to discuss a scientifically controversial condition called "premenstrual dysphoric disorder" (PMDD), which had only recently, and after much controversy, been included in the appendix of the Diagnostic and Statistical Manual—the bible of psychiatric disorders—as a disorder "under evaluation." But the Lilly-funded researchers soon published an article in a small medical journal suggesting, falsely, that the debate was over and that PMDD could now be considered a "distinct clinical entity," distinct from the stress and tension that can accompany ordinary PMS.

Lilly has not said what role it played in turning the "roundtable" into a journal article, but by 1999, the article helped convince the FDA to approve the use of fluoxetine to treat PMDD—and extended the patent until 2007. Lilly simply repackaged the drug in lavender pill-form, renamed it Serafem, and began marketing it to women. Never mind that independent researchers questioned whether PMDD even existed as a condition. Never mind that Europe's drug regulators raised serious questions about PMDD and criticized Lilly's clinical trials that purported to show the benefits of Serafem. Never mind that even the industry-friendly FDA was appalled at Lilly's television ads, with their too-vague tagline: "Think it's PMS? It could be PMDD." Undaunted, Lilly continued its advertising barrage, trying to convince women who thought they were experiencing regular PMS-related distress that, actually, they might well have a serious disorder that required heavy medication. Soon thereafter, both Pfizer and GSK got their own anti-depressants approved for treating PMDD. For all intents and purposes, the "debate" over whether PMDD was a disorder—let alone requiring medication with serious side-effects—was over. Industry money had carried the day.

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