Selling Sickness and Drugs

Below find a movie recommendation, a suggested article, and a book review.
All excellent.
– Angela


The movie The Constant Gardiner is at theatres now. It’s a fictionalized expose of the pharmaceutical drug industry. Great reviews. Don’t miss it.


Doctors for Donuts
Buying the Medical Profession
by Alan Cassels

Alan Cassels, a drug policy researcher at the University of Victoria, provides a chilling look at how the world’s largest pharmaceutical companies are turning healthy people into patients. Employing sly marketing campaigns that convince people they have something wrong with them, Big Pharma creates niches for drugs it hopes will become blockbusters. Critical to the commercial success of these drugs is the cooperation of the doctors who wield the power to write the prescriptions. So it is that billions of warm donuts – and free drug samples – are gifted to doctors and their receptionists across the world, compliments of the drug detailers, the sales reps whose job it is within the pharmaceutical empire to ensure that doctors prescribe these magic bullets to their patients.

Cassels has just co-authored a book called Selling Sickness: How the World’s Biggest Pharmaceutical Companies Are Turning Us All Into Patients. See review below.


Big pharma: It’s enough to make you sick

Saturday, August 6, 2005 Page D8, Globe and Mail

Selling Sickness:
How the World’s Biggest Pharmaceutical Companies
Are Turning Us All Into Patients
By Ray Moynihan and Alan Cassels

GreyStone, 254 pages, $32.95

The pharmaceutical industry is global. It’s also powerful and rich. And
lately, it’s all over the news. Notices of different drugs pulled off
the market (Vioxx) or having to carry “blackbox” warnings for users
(SSRIs, DepoProvera) blazon newspapers’ front pages. Cheryl Ladd and
Kirk Douglas grace the entertainment pages telling us to “ask our
doctors” about the medical marvels that helped them or their “loved
ones” — and can also help us — while Guy Lafleur pushes Viagra in the
sports section. Then, in the business section, we read details of the
trial of drug-company giant Merck accused of suppressing facts about the
dangers (deadly for perhaps thousands) of Vioxx, its medication for
arthritis and acute pain.

We’ve generally assumed that the pills we take are necessary, that they
work and are safe — and that celebrities are entertainers, not health
educators. We expect physicians to prescribe what they know is good for
us, and government regulators to safeguard our health. But given all the
recent news, could these assumptions be wrong?

Ray Moynihan’s and Alan Cassels’s Selling Sickness throws light on these
taken-for-granteds, revealing some hard truths about pharmaceuticals and
those who make, sell, regulate, prescribe and front for them. Drawing on
extensive interviews and wide-ranging documents, these long-time,
knowledgeable researchers of the pharmaceutical industry develop a
chilling story of drug salesmen wining and dining physicians to
encourage them to prescribe their newest, priciest product; of companies
reporting only studies with favourable results to regulators; of experts
heavily funded by drug companies writing clinical guidelines that change
the threshold for “abnormality” and establish treatment standards; and
of large sums of (hidden) money given to high-profile celebrities who
help “brand” some product.

The 10 case studies in Selling Sickness illustrate the tactics Pharma
(current shorthand for the entire industry) uses to sell sickness, among
them: medicalizing the ordinary (menopause, for example); framing mild
symptoms as diseases (shyness morphs into a psychiatric diagnosis);
giving social conditions (being “too tired for sex”) a medical label
(“female sexual dysfunction”); creating “epidemics” by constantly
changing diagnostic guidelines (e.g., lowering the bar for treatment of
“high” blood pressure or “high” cholesterol). The extensive details
Moynihan and Cassels provide make it all too clear how artificial — and
elastic — the categories that separate the “normal” from the not-normal
are; how little good taking branded pills for many “abnormalities” may
actually do; and worse, how much harm these medicines can cause when the
research that gets them regulatory approval is, as is often the case,
hidden, short-term or biased.

The selling of sickness seems to follow a familiar pattern. A
pharmaceutical company identifies a wedge condition, set of symptoms or
“risk factors”; hires a PR firm to come up with a “disease” name,
ideally something catchy with a pronounceable acronym (e.g., SAD);
develops a drug, or adapts an existing one, to tout as a “fix” for this
new medical problem; and begins massive marketing to physicians and the
public. The media pick up the story, suggesting that the “new” disease
is greatly undiagnosed/undertreated; the market expands; drugs sales
rise. And voila! Another blockbuster is born.

To read Selling Sickness is to realize that the pervasive and systemic
operations of the pharmaceutical industry may be much more dangerous
threats to the health of Canadians than the currently demonized waiting
lists that delay joint or eye surgery. It’s not just one company making
a bad drug. Rather, almost an entire industry seems engaged in
manipulating our lives, working to make us all patients in need of a
cure or, perhaps, just the “not-yet-sick” waiting for some pill to be
developed that will fix something we didn’t know we had.

As Moynihan and Cassels suggest, Pharma sells sickness mostly to make
money. Whether they sell up front or through patient groups or
celebrities, they can only do this because governments are also taking
part, creating the conditions in which diseases can be created and
profits made. This probably dates back to the 1980s, when health was
labelled a “growth industry” and the Canadian government (along with
that of the United States) lowered taxes for corporations, changed
patent and advertising laws and regulations in favour of business, and
altered how drug reviews are financed so as to speed approvals.

Selling Sickness meets the criteria for being “evidence-based,” and has
the right credentials: Five of the 10 cases described here were first
laid out in the British Medical Journal in 2002. However, it is not the
first book to call attention to the phenomenon captured in the phrase “a
pill for every ill,” or, perhaps more apt today, “an ill for every
pill.” More than 20 years ago, women’s groups in Canada and the United
States raised alarms about the turning of menopause into a “hormone
deficiency” state, as well as about the use — and evident harms — of
insufficiently tested drugs sold to women to prevent miscarriage or

Lessons learned from the women’s health movement (then and now) offer
models for how to deal with today’s sickness- and drug-sellers. But
Moynihan and Cassels don’t sufficiently acknowledge the persisting
gender bias of drug development and the decades-old medicalizing of
women’s bodies, even though six of the 10 conditions analyzed in Selling
Sickness are conditions experienced by — and treated more in — women
than men.

This is not coincidence: Women are sold sickness and also use drugs more
often than men. Moynihan and Cassels are at their best detailing how
selling sickness is happening. But their analytic lens isn’t
sufficiently wide, so they don’t connect their themes to ongoing
activities with huge potential to create diseases-in-waiting for drugs
of the future (e.g., brain imaging to “see” why we [mis]behave as we do,
or gene mapping to seek DNA patterns that make us “susceptible” to just
about anything). Moreover, while Selling Sickness has abundant
references to the actions of the U.S. Food and Drug Administration, the
Canadian content sometimes feels more like an “add on” than part of an
integrated whole.

A range of well-intentioned proposals is now under consideration in
Canada and elsewhere to rein in some of the worst practices described in
Selling Sickness. These include mandatory public registration of all
drug trials, mandatory reporting of adverse drug effects and updated
requirements for declarations about sources of funding by researchers,
“expert” advisers and patient groups. If these come into practice,
perhaps they’ll alleviate some problems. But by themselves, they can’t
prevent the growing health burden caused by the continued massive
selling of sickness — and of harmful drugs.

Attaining this will also require tackling upstream driving forces and,
for example, changing tax and patent laws to prevent the development of
“me too” drugs; excluding entirely those with drug-company ties from
decision-making and from regulatory bodies that judge if our medicines
are effective and safe; enforcing laws against direct-to-consumer
advertising of drugs and outlawing completely the “see your doctor”
variety. And maybe even creating a publicly funded independent institute
to do drug trials.

Selling Sickness is an important exposé of many of the dangers of
letting corporate interests determine both who is sick and how to treat
them. It shows why we must demand of government a firm, accountable,
transparent commitment to ensuring we get the safe and effective
medicines we need when we are sick with real diseases. But as always,
primary prevention will be even better for our well-being, and this will
require social policies that give everyone access to the resources that
protect our health and keep us well.


Abby Lippman is a professor of epidemiology at McGill University and
often uses this as a cover for her activism with Women and Health
Protection, where she is on the steering committee, and with the
Canadian Women’s Health Network, where she is chairwoman of the board.