Brownlee on Selling Anxiety

Shannon Brownlee in the Post on drug companies inventing new diseases:

It turns out that much of what we — and our doctors — think we know about many health problems has been shaped by drugmakers and their marketers. … Osteoporosis and osteopenia aren’t really diseases. Before the 1990s, doctors decided that you had osteoporosis if you were elderly and you broke a bone. When the pharmaceutical company Merck came up with its anti-bone-loss durg Fosamax, it wanted a broader market than just elderly fracture patients. The solution? The company helped fund a panel of medical experts to create diagnostic criteria for osteoporosis so that a diagnosis could be made before the patient actually broke a bone.

The panel’s first step was to define "normal" bone density as that of the average 30-year-old woman. Next, the experts chose as their cutoff for osteoporosis a statistical point that was slightly below the bone density of their normal 30-year-old — a definition they admitted was "somewhat arbitrary." Finally, they came up with a completely new disease — osteopenia — for bone density that fell somewhere between that normal 30-year-old and their arbitrary definition of osteoporosis.

Voila — 30 percent of post-menopausal women suddenly had a disease that needed to be treated early in order to prevent a problem — hip fracture — that wouldn’t occur for many years, if ever. According to the new guidelines, millions more women now had osteopenia, which their doctors needed to watch like hawks so that their patients could be treated once they progressed to osteoporosis. Merck then took the added step of helping doctors buy DEXA scanners, X-ray machines needed to scan your bones to get that all-important diagnosis. …

Fosamax … can cause necrosis (death) of the jawbone. What’s more, there aren’t any valid scientific studies to show that treating osteoporosis early will prevent fractures down the road. The drug can also trigger serious heartburn.

Added 6Apr: More from Brownlee:


Take the selling of Zantac, an anti-ulcer drug that came on the market in 1983 and paved the way for the blockbuster drugs that followed. First, Glaxo priced its new drug above its competitor, Tagamet — a bold move, Melody Petersen writes in Our Daily Meds, that "like an underweight boxer trying to fool the prizefighter with his swagger . . . implied that Zantac was better." In reality, Zantac was a "me-too" drug, chemically almost identical to Tagamet and no more effective.  

But it was the second half of Glaxo’s strategy that was truly dazzling. Rather than plowing the revenue from Zantac back into R&D, as was then customary in the drug business, the company decided to invest in marketing the daylights out of its drug. Glaxo funded studies intended to show Zantac’s superiority. It hired a battalion of sales reps, who flogged the drug relentlessly to doctors. Most brilliant of all, the company pioneered a ploy now used routinely in pharmaceutical marketing: It "condition branded" Zantac.  

Glaxo’s novel idea was to link its drug to the relief of a common but minor condition, then make consumers and doctors worry that the condition was a sign of a more worrisome disease. In this case, the minor condition was old-fashioned heartburn. Glaxo warned that heartburn was a sign of chronic reflux, which the company dubbed Gastro-Esophageal Reflux Disease, or GERD. Soon, millions of Americans were saying goodbye plop plop, fizz fizz, hello Zantac, an expensive prescription drug they started taking every day to ward off GERD, even though most episodes of reflux go away without treatment, and most heartburn can be relieved with an over-the-counter remedy.  

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  • Hmmm…. Ms Brownlee really conflates two points here.
    A) A Semantic debate about the nature of REAL disease as opposed to INVENTED disease, in which she seems to avoid acknowledging that health and sickness are intrinsically normative categories and as such, their definitions will invariably shift over time.

    B) Her belief that medical interventions in conditions that do not pose sufficient health risks to warrant it are becoming increasingly common and are counterproductive,

    What is really missing in her analysis, is an acknowledgment that the trade-offs involved in choosing to seek treatment in any given instance have as much do to with the priorities, values and risk tolerance ofthe patient as with any artifically binary distinction between sickness and wellness.

    New medicines provide more patient choice and that is surely a good thing.

  • Douglas Knight

    I would have liked this post more with some commentary, eg, “This is a nice example of how to manipulate people via biases (obedience to authority, binary essentialism).” I think people are too confident in their expectations of communication, in their expectation that others will fill in the blanks the same way.

  • Speaking of invented diseases, what do you folks think of the Szasz/Caplan take on “mental illness”?

  • Saturday links

    Islam has taken over the UN’s Human Rights CouncilThinking about prayer. Dr. BobDrug companies invent new diseases? Sometimes, maybe. Good example.The Fed caused the credit crunch. MankiwWriting mastery eludes NYC schoolkidsMercedes Marxists: The Clintons

  • Karen Davis

    As a woman who HAS been diagnosed with osteoporosis, this debate hits right at home. The point is that this type of publicity (the dangers of osteoporosis, etc.) DOES drive fear into our hearts on an emotional level and it’s hard to separate what’s real from what is designed just to scare us.

    I’ve been going to this site for HEALTH information because it IS science based and not Pharma industry driven. I think we need to seek really objective sources of information to balance the hype.

    What do you think??

  • Caledonian

    what do you folks think of the Szasz/Caplan take on “mental illness”?

    If we knew what they were, they’d be a part of neurology, not psychiatry. We’ve made great progress in negative hypotheses – we know a lot of things that they aren’t, but have little idea of what they are. And the most commonly-given explanation for them? Meaningless handwaving. It’s just “imbalance of the humours” with a modern term substituted.

  • Karen, the site you link to,, is a marketing tool for the dietary supplement industry! It is simply a competitor to the “Pharma industry” offering their own alternative drugs and treatments. I would not assume that it is science based simply because it has a scientific advisory board. See Robin’s recent comment on the pointlessness of such boards before you get impressed by this.

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