Crozet Annals of Medicine: The Trouble with Disease Mongering
By Dr. Robert C. Reiser
It is good to be back from vacation, back to the world of diseases. Medicine moves fast and you can’t be away for too long without missing something.
I was gone for nearly a month and I have already missed several new diseases and developments.
Apparently Ebola is not only ravaging West Africa but may now be massing at our southern border, at least according to Congressman Phil Gingery, MD. Dr. Gingery, a Republican from Georgia, sent a letter to the CDC demanding action to prevent the wave of unaccompanied immigrant children crossing the U.S. border from transmitting diseases such as swine flu, dengue, ebola, TB and even Smallpox to U.S. citizens. Wow. Then he held a press conference to announce his alarm.
I am not sure which is weakest, Dr. Gingrey’s grasp of geography (we don’t share a border with Africa, the only place where Ebola exists), history (smallpox has been eradicated from the world since 1977) or medicine (dengue is not transmitted person to person). I guess what is weakest is the good doctor’s social conscience, demonizing immigrant children as vectors of contagion.
Rep. Gingrey is engaging in a type of fear mongering called disease mongering and there is a lot of it going around.
Disease mongering consists of convincing a group of people that a new danger to their health has been discovered. It is usually done by drug companies to sell new pharmaceuticals.
As my career has unfolded, I have watched in wonderment as diseases I had never encountered in standard medical texts have risen to afflict the population. One of the first patients I saw upon my return from vacation was a nervous lady looking for a refill for her Restless Leg Syndrome (RLS) prescription medicine. The diagnosis of restless legs syndrome requires the presence of the following four criteria:
- An urge to move the legs due to an unpleasant feeling in the legs.
- Onset or worsening of symptoms when at rest or not moving around frequently.
- Partial or complete relief by movement for as long as the movement continues.
- Symptoms that occur primarily at night and that can interfere with sleep or rest.
My patient had none of these; she had insomnia and anxiety.
While RLS had been described in sporadic medical reports for hundreds of years, it was only when GlaxoSmithKline began marketing a drug for it in 2003 that the shockingly high prevalence of the disease (10 percent of adults) was posited. Apparently almost 40 million Americans have this disease. That is a lot of prescriptions. I am not sure how we ignored this extraordinarily common disease for so long. Even today in my practice I only encounter a tiny percentage of patients reporting it, complaining about it or on medication for it. So where did that 40 million number come from? If you guessed a single-question survey study funded by GlaxoSmithKline you would be correct. Hrumph, madam! Perhaps I am not back in the world of diseases at all.
While I essentially never see any patients on medicine for RLS, I am amazed at how many of my male patients are on Viagra for an only recently discovered epidemic of erectile dysfunction. Once again what I was taught in medical school is in conflict with a drug company’s promotional materials. According to drug manufacturer Pfizer’s web site, over 50 percent of men over the age of 40 have difficulty getting or maintaining an erection. This unreferenced statement is patently untrue according to every study done on the topic. Nevertheless, Pfizer has managed to convince patients and their doctors that erectile dysfunction (ED) is a serious source of psychological stress and a disease state when, again, the studies do not support that conclusion at all. This disease mongering is worth $2 billion a year for Pfizer and another $2 billion a year for Lilly, the makers of Cialis, another ED drug.
I will never forget one of the first patients I saw on Viagra. He was brought in by ambulance after fainting during intimate relations. He had taken both Viagra and then nitroglycerin when he developed chest pain. Remember what the ad says, check with your doctor to make sure you are healthy enough for sex! He was not.
Viagra and nitroglycerin should never be mixed; the combination can lead to dangerously low blood pressure and subsequent fainting as had happened to my patient. What happened next was worse though. The medics informed us that his wife was on her way directly behind them. When she arrived five minutes later she was understandably agitated and demanded to know what had happened. As I explained some of the physiology behind her husband fainting during his exertions she seemed at first confused and then furious. It seems her husband was not with her when he had his unfortunate swoon. She had been called by the medics to come to the hospital when they had arrived on the scene.
Sometimes the cure is worse than the disease.