- NEW YORK (Reuters Health)
- Recent medical advances and the accompanying flood of new drugs for a
range of ills threaten to "medicalize" every human condition
and behavior, according to some experts.
-
- And, they say, the advent of genetic screening could
eventually mean that apparently healthy people will be labeled
"sick"
decades before an actual diagnosis.
-
- In an issue of the British Medical Journal dedicated
to the topic of "medicalization," international researchers look
at the pros and cons of screening for disease-related genes,
direct-to-consumer
drug advertising and what some see as the modern-day phenomenon of treating
everyday problems--from balding heads to unremarkable performance in the
bedroom--as medical conditions in need of treatment.
-
- As part of the special issue, the journal polled readers
on what they thought were the top current "non-diseases." Among
the most popular were baldness, freckles, cellulite, penis envy and road
rage. The number-one vote-getter was "aging."
-
- Some call it "disease mongering." In one
article,
Ray Moynihan, a journalist with Australian Financial Review, and co-authors
describe what they see as "informal alliances" among drug
companies
and some doctors and consumer groups. They argue that drug companies
provide
medical experts and patient groups offer "victims" to attest
to a given condition's severity and draw attention to a new
"breakthrough"
treatment.
-
- The authors also point to several examples--such as hair
loss and excessive shyness--of what can be regarded as normal human
conditions
that have been made medical conditions because there is a pill available
for them.
-
- In another article, Barbara Mintzes of the University
of British Columbia in Vancouver, Canada, argues that prescription-drug
advertising to consumers--currently allowed only in the US and New
Zealand--is
helping to medicalize "normal human experience."
-
- "Relatively healthy people are targeted," she
writes, "because of the need for adequate returns on costly
advertising
campaigns."
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- Many of these advertising dollars, according to Mintzes,
are spent on relatively new, expensive drugs intended for long-term use
in large groups of people, such as medications for cholesterol, impotence
and anxiety. And while studies prove these drugs work, the ads for them
tend to target a wider audience than the evidence supports, Mintzes said
in an interview with Reuters Health.
-
- She cited cholesterol-lowering drugs as an example,
saying
that the evidence that they cut heart disease death risk is "much
better" for patients with existing heart disease. But ads, Mintzes
noted, are targeted at a much broader population.
-
- In a counterpoint to Mintzes' article, officials with
the Whitehouse Station, New Jersey-based drug company Merck argue that
consumer advertising helps the public make informed choices about their
health and treatment.
-
- And evidence shows there is under-diagnosis of many major
diseases and disease risk factors for which treatment exists, according
to Silvia Bonaccorso and Jeffrey Sturchio.
-
- But Mintzes argued that advertisers and public health
experts often have different views on what ailments need "awareness
raising." Others say that as medicine has forayed into advertising,
it has also gotten deeply involved in people's sex lives. When it was
launched
in 1998, the impotence drug Viagra "became the world's most popular
medicinal drug ever," write Graham Hart and Kaye Wellings.
-
- And while many men with erectile dysfunction are thankful
for the little blue pill, they add, using an "overly medical"
approach to sex threatens to ignore the relationship dynamics and other
factors that go into sexual behavior.
-
- The UK public health experts note that forms of
gynecological
surgery aimed at enhancing sexual pleasure have recently emerged. And in
the US, about one third of men and even more women now say they've had
sexual dysfunction--a sign, Hart and Wellings say, of a new obsession with
sexual gratification and feelings of inadequacy.
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- Hart, of the University of Glasgow, told Reuters Health
that his concern is that the term "sexual dysfunction" is being
used to cover a range of behaviors or feelings that may be natural for
some people--such as a libido that's lower than it used to be.
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- "If people are in happy, loving relationships in
which, over time, sex plays a less important part, this should not be seen
as problematic or dysfunctional," he said.
-
- Looking a bit into the future, UK genetics researchers
say that genetic tests "could drive a new wave" of
medicalization.
With the exception of a relatively small number of medical conditions
directly
caused by a single defective gene, genetic screening cannot predict whether
a person will develop a disease, note David Melzer, of the University of
Cambridge, and
-
- Ron Zimmern, of Strangeways Research Laboratory in
Cambridge.
With diseases with multiple underlying factors--including major killers
like heart disease and cancer--screening for disease-related gene
variations
can only give people information on their statistical risks, Melzer and
Zimmern write.
-
- "Genetic tests for markers that may not result in
symptoms for half a century or more could be new examples of a process
of premature medicalization--of attaching the 'disease' label before it
has been established that prevention or treatment is clearly
beneficial,"
they argue. Genetic technologies, the authors write, could be a "major
benefit to society, but their introduction must be measured...and, most
importantly, based on best evidence."
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- SOURCE: British Medical
Journal
2002;324:863-864, 883-885, 886-891, 896-900, 908-911.
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