Thursday, February 10, 2011

Drugs in Search of a Disease

The conclusion in the NY Times op-ed today, “Better Drug Ads, Fewer Side Effects,” raised my hackles a bit. Ian Spatz raises the innocent and  reasonable sounding idea of “legislation that would allow drug companies to cooperate with one another, and with physician and patient organizations, to develop joint ad campaigns that are specific to certain diseases and conditions but not to any particular drug.” While this may be an improvement over the current plethora of erectile dysfunction drug ads, the proposal skirts an important issue.

Spatz optimistically concludes, “Instead, we’d get unbiased information about the medical conditions we care about, and encouragement to seek out the medicines and vaccines that can help us maintain and improve our health.”

Two problems are immediately evident. The first is that the emphasis remains on medicines. While I certainly value drug therapies, we would have a far healthier population if there were a more holistic approach and emphasis on nutrition, exercise, preventive care, and personal responsibility. Instead, patients are encouraged to seek instant gratification for any minor complaint, rather than taking any—let alone difficult—steps to alter their behavior or be an active, responsible participant in their well-being.

Secondly, this fuels disease mongering and the idea of some new drugs being in search of a disease. A fine example of this was the NPR story, "How A Bone Disease Grew To Fit The Prescription," which vividly described osteopenia having been created as a new disease. Not only was there a new need for a drug, but an entire industry rose up around special new x-ray machines, called densitometers, to diagnose osteopenia, and repeated diagnostic tests to monitor therapy. Then the “Bone Measurement Institute”, created by Merck, successfully lobbied Congress to pass the Bone Mass Measurement Act, which required Medicare to cover the costs of the scans. This biography of osteopenia and its multi-billion dollar industry is a must-read. It also makes me wary of the claim that this new model of patient education won’t just be a repeat of the same successful—for pharma—approach.

Note: Clinical research has shown that drugs for osteoporosis are effective are valuable and may be life-saving. Drugs for early osteopenia have not shown such benefit, and have many serious side effects).

This innocent sounding proposal to educate patients about diseases is promising—but only if it is not instead twisted into a tool to create new diseases and lucrative drugs.