"One of the first duties of the physician is to educate the masses not to take medicine."
The Principles and Practice of Medicine (1892)
"We have a system that nobody but Big Pharma is happy with."
former Oregon governor John Kitzhaber, now with the Foundation for Medical Excellence
A progressive hospital administrator is currently touring the country, speaking out on the virtues of disease prevention. He begins his presentation with the observation that the modern medical system is not really focused on prevention or health promotion at all. As he puts it, "We don't have a health care system in this country. What we have is a disease treatment system."
This bold statement is highly effective in getting audiences on board with the idea that the priorities in modern medicine are seriously out of whack. But the situation is actually far worse than our administrator makes it out to be. The problem is not so much that we have a "disease treatment system." Rather, the problem is that we have a "disease promotion system."
Big Pharma wants your body
"How can this be?" you might ask. Surely the health care industry is inefficient, over-priced and frustrating to both patients and providers. But isn't the whole point to help people get better? Not anymore it's not. If you've been paying attention to trends in media and marketing, you know that the pharmaceutical industry has seized control. Big Pharma has been let out of its cage and is now tyrannizing the medical marketplace. Not content to simply promote products for existing diseases, Big Pharma now promotes a wide range of human afflictions and expands the definitions of disease; their goal is to manufacture new, more profitable disorders.
To get a sense of how warped the system has become, consider these facts:
- Big Pharma now spends more than $5.5 billion to promote drugs to doctors-more than what all U.S. medical schools spend to educate medical students. (New England Journal of Medicine, June 23, 2005 "The Lessons of Vioxx")
- Major drug companies employ about 90,000 sales representatives - one for every 4.7 doctors in the United States. (American Medical Association)
- The total pharmaceutical marketing budget is $25 billion. (Forbes magazine "Just Say NO!" by Robert Langreth Nov. 29, 2004)
- Drug firms have spent $800 million since 1998 buying influence, including $675 million on direct lobbying of Congress. No other interest group has spent more money to sway public policy. (Center for Public Integrity)
Big Pharma has had a free ride for a long time, but finally, some people are starting to sit up and take notice. For example, consider Selling Sickness: How The World's Biggest Pharmaceutical Companies Are Turning Us All Into Patients by Ray Moynihan and Alan Cassels. The story on the front flap summarizes the whole sordid mess: "Thirty years ago, Henry Gadsen, the head of Merck, one of the world's largest drug companies, told Fortune magazine that he wanted Merck to be more like chewing gum maker Wrigley's. It had long been his dream, he said, to make drugs for healthy people-so that Merck could "sell drugs to everyone." Three decades on , the late Henry Gadsen's dream has come true." Moynihan and Cassels lay out their case in methodical detail, telling us about Big Pharma's efforts to expand the patient pool and create new diseases. Their conclusion: "there's a lot of money to be made telling healthy people they're sick."
Disease by definition
To understand Big Pharma's power over our health, it's important to understand how disease is managed in large populations. Most medical conditions are defined by a set of numbers. If we broaden the range of those numbers, even slightly, and apply it to a population of millions of people, the consequences can be profound. For example, think about the numbers that are attached to your blood pressure. If it's above X, you're officially "diseased" and a candidate for medication. If it's below X, you're "healthy." But X is determined, not by some perfect medical formula, but by consensus within the medical community.
Exact cut-off points are debatable and relative. This is where Big Pharma steps in. If they can expand the statistical definition of a disease, even by a small margin, they can cash in. One or two percentage points, spread across America or better yet, the world, adds up to millions of newly created patients. Thus it comes as no surprise to hear that Big Pharma has become an active participant in the process of defining disease. By pouring money and influence into experts, conferences and journals, Big Pharma stretches the definitions and expands the patient pool.
The power of suggestion
It would be one thing if human disease was a matter of absolutes, but it's not. Social and cultural forces play an immensely powerful role in determining how we interpret our physical experience. Is obesity a disease? Workaholism? Weak sexual desire? Social anxiety? It's easy to imagine situations in which any physical sensation or experience of the human body might be labeled as health or disease, depending on the context. Our health is the product, not simply of genetics and biochemistry, but also of human influence. As intensely social animals, we pay close attention to the physical well-being of our families and friends. If people in the tribe speak of getting one disease or another, we naturally begin to wonder if such afflictions are part of our experience as well.
If everyone around us is complaining about headaches or low back pain, we may very well decide to join the gang. Have you ever noticed how trendy diseases can be? One month it's eating disorders, the next month it's carpal tunnel syndrome, fibromyalgia or irritable bowel syndrome. None of these conditions even existed 100 years ago, but now they're "epidemic." Similarly, medical students frequently observe how closely their physical sensations parallel the conditions that they're studying. "Med student's disease" is legendary. Big Pharma is well aware that disease is creatable; they know full well that their customers are vulnerable to suggestion. By manipulating images, ideas and narratives, they shape the way people think about their bodies and in turn, their health.
The greatest therapy is the least advertised
It's important to be aware of Big Pharma's relentless disease promotion, but we should also take note of what's gone missing along the way. That is, whatever happened to exercise? Technically, Big Pharma's direct-to-consumer marketing campaigns are "commercial speech" but they also become a form of education. People learn about their bodies from all kinds of sources and in this sense, Big Pharma's pitch has become part of a larger health-education curriculum. In the process, exercise is being squeezed out of the picture. Health professionals know that exercise is an immensely powerful therapy with effects that are both broad and deep. And yet, its powers are completely obscured by mega-profit therapies. Tragically, the most powerful therapeutic tool in our collection is also the one that is the least often promoted. In fact, when we do hear about exercise in commercial media, it's usually presented in the negative.
When Big Pharma promotes drugs for conditions in which exercise is highly effective, they make sure to emphasize the failure of fitness. "If you've tried exercise and diet and your cholesterol is still high, ask your doctor about our miracle pill." The sub-text to such promotions is that exercise is likely to fail and that you'll probably have to "ask your doctor" anyway, so there's no point in even trying. Over time, consumers are conditioned to bypass movement entirely and go directly for the pills. A particularly egregious example of this approach is brought to us on behalf of Avandia, a blood sugar drug by GlaxoSmithKline. The advertisement pictures a frustrated middle-aged male, slumped on a bench in a stark, depressing fitness facility. The defeated expression on his face tells us that he's had his fill of exercise. "If diet and exercise won't get your blood sugar number down, adding Avandia can help" the ad tells us. The meta-message is obvious; exercise is a drag, so you may as well go directly to the pharmacy.
UneedUs: The axis of disempowerment
Like true drug dealers, Big Pharma makes it a point to promote dependency in its customers. The mission is simple: get people thinking about drugs as a first-line solution to physical problems. "You can't manage your health on your own: you need us. You need us to design the drugs and test them in clinical trials. You need us to monitor your symptoms and adjust your dosage. You can't possibly know your body on your own. You are powerless." Ultimately, this systematic disempowerment produces the precise opposite of health; a weak, dependent and passive population. Hippocrates would be appalled.
Fueled by fear
Not surprisingly, fear plays a big role in Big Pharma's marketing style. Lurking behind the smiling faces of happy drug consumers is the implicit threat of physical disaster. If you don't "ask your doctor" your body will fall into an inevitable sink hole of disease and your loved ones will be dragged along with you. We see this threat in many ads, but one particularly vivid example has recently appeared on health-related websites. Users are greeted with a big question mark and the ominous message, "What you don't know could kill you." Follow the link and you'll discover that "You may be at triple the risk of developing the condition again in the future." What's this?" you wonder as you click through. "Talk to your doctor and click here for your online risk assessment. It's a visit that could save your life or the life of a loved one." This fearvertisement turns out to be a pitch for deep-vein thrombosis, an occasionally serious condition that is currently being hyped into a compelling medical emergency.
Universal disease: the dreams of medical marketers
While romantics dream of universal health, Big Pharma dreams of the inverse, a world in which the entire population is afflicted by chronic, incurable syndromes that require frequent diagnostic tests, expensive specialists and pharmaceuticals. The ideal Big Pharma customer is afflicted with disease throughout his lifespan. He is literate enough to read medical advertising, yet docile enough to follow directions "Ask your doctor about the green pill." He doesn't know what the green pill is, but he asks his doctor anyway, just to be sure. A particularly chilling manifestation of this vision comes, not from Big Pharma itself, but from one of its pusher clients, Target. An advertisement in popular news magazines showcases its newly designed medication bottles with personalized, color-coded rings "to clearly identify the medication for each family member." The advert shows three smiling children and their father, each with his own personalized bottle of drugs. The assumption is clear: if you're a human being, you are supposed to be on something.
Turning disease into the default
Big Pharma's direct-to-consumer strategy is not mere advertising. It is an audacious attempt to rework the default status of the human body. As Moynihan and Cassels put it in Selling Sickness, the goal of Big Pharma is "putting disease at the center of human life" For the vast majority of human history, vigorous, robust health has been the default. Yes, there were plenty of infectious diseases, suffering and early death in the mix, but if you managed to avoid the pathogens and the predators, your body would be strong and resilient. The norm, as it is for all animals, is health. Big Pharma wants to change all that. From this point forward, you are assumed to be diseased. You may be asymptomatic at the moment, but that's a temporary state. By redefining what's normal, we can make you sick merely by moving a few data points on a graph. Given the right kind of management, you will soon become a patient/customer. Once you are absorbed into the body of Big Medicine, you will become dependent for life.
Call to action
Obviously, we need is an antidote to Big Pharma. (Hmm...Maybe there's a pill for that..."Taken once a day, this convenient new medication will decrease your anxiety about pharmaceutical marketing and help you live free again. Ask you doctor about Pharmaway.") Satire aside, we can begin by taking matters of health into our own hands. We start by taking care of our bodies with a movement-based lifestyle and a food-based diet. Craft a lifestyle that promotes health and independence and don't deal with Big Pharma unless it's absolutely necessary. (Avoid Big Pharma like the plague!) Don't believe what you see in a Big Pharma advertisement and don't allow your relationship with your body to be defined or distorted by fear marketing. Use pharmaceuticals only as a last resort. Give your body a chance to seek out homeostasis on its own. Let your natural regulatory mechanisms do their thing. Make your body stronger with robust physical movement, stress relief and joy. It's really the best approach; just ask your doctor.
Selling Sickness: How The World's Biggest Pharmaceutical Companies Are Turning Us All Into Patients Ray Moynihan and Alan Cassels, Nation Books 2005
The Truth About Drug Companies: How They Deceive Us and What to Do About It
Suddenly Sick: The Hidden Big Business Behind Your Doctor's Diagnosis
Seattle Times, June 26 - June 30, 2005
No Free Lunch: an alliance of health care providers who believe that
pharmaceutical promotion should not guide clinical practice