Lynn Payer

John Wiley & Sons, $12.95, pp 292

ISBN 0 471 00737 4

This title is now only available direct from the USA. See www.wiley.com

Rating:

 

Lynn Payer's Disease-Mongers is passionate, provocative, and prescient. The book's thesis is simple, compelling, and for many people utterly counter-intuitive: doctors, drug companies, and device manufacturers are engaged in "broadening the definitions of diseases" in order to increase demand for their products and services. Since the book was first published in 1992, the evidence has mounted that Payer's disturbing view of the medical establishment is all too accurate.

Payer quickly establishes her argument that the boundaries of disease are fluid, and that there are too many vested interests trying to push those boundaries as wide as possible. In tough, accessible prose she details the way that doctors, drug companies, test makers, medical writers, hospitals, courts, and insurance companies are all caught up in a frenzy of disease-mongering: "Trying to convince essentially well people that they are sick, or slightly sick people that they are very illis big business."

Payer also explores the many tactics of the disease-mongers, including turning normal life into a disease (for example, menopause), exaggerating the suffering attached to mild problems (for example, premenstrual syndrome), and using extreme, unrepresentative examples of severe symptoms when depicting a common condition (for example, bone-thinning). Payer's criticisms of the media are particularly biting, arguing that it often forms part of an "unholy alliance" with industry and the medical profession, to make a condition look as widespread and serious as possible.

But the book is in fact much bigger than a critique of disease-mongering. It also introduces a lay audience to the move to an evidence based approach in medicine, and ends with constructive suggestions for reshaping the US healthcare system.

Disease-Mongers is not a well known book, partly because of its own flaws. Although Payer synthesises highly complex scientific evidence and makes it comprehensible to a wide lay audience, she has not crafted a racy non-fiction narrative.

The best things about this book are its three central claimswhich are illustrated by plenty of examples, and backed by good evidence from the world's leading medical journals. Firstly, more and more of the processes and ailments of life are being seen as medical problems. Second, self interested forces seek to make those medical conditions look as widespread and serious as possible. Thirdly, the therapies for these problems are oversold: their benefits are played up, their harms are played down.

To write the book off as gratuitously anti-doctor or anti-drug would be a gross error. The great power of Payer's thesis is this: resources wasted on expensive and needless tests or therapies for the healthy are resources that could have been available to ameliorate or prevent the suffering of the genuinely ill. Yes, deciding where to draw the line between what is healthy and what is legitimately treatable pathology is not always easy. But as Payer has helped us to understand, to continue to allow those with vested interests to have such a strong influence over those decisions is plainly unhealthy.

Ray Moynihan, journalist. 

ray_128@hotmail.com

© BMJ 2002
 

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