http://www.reutershealth.com/archive/2002/04/12/eline/links/20020412elin005.html

Are everyday problems being dubbed 'disease'?

By Amy Norton

NEW YORK, Apr 12 (Reuters Health) - Recent medical advances and the accompanying flood of new drugs for a range of ills threaten to "medicalize" every human condition and behavior, according to some experts.

And, they say, the advent of genetic screening could eventually mean that apparently healthy people will be labeled "sick" decades before an actual diagnosis.

In an issue of the British Medical Journal dedicated to the topic of "medicalization," international researchers look at the pros and cons of screening for disease-related genes, direct-to-consumer drug advertising and what some see as the modern-day phenomenon of treating everyday problems--from balding heads to unremarkable performance in the bedroom--as medical conditions in need of treatment.

As part of the special issue, the journal polled readers on what they thought were the top current "non-diseases." Among the most popular were baldness, freckles, cellulite, penis envy and road rage. The number-one vote-getter was "aging."

Some call it "disease mongering." In one article, Ray Moynihan, a journalist with Australian Financial Review, and co-authors describe what they see as "informal alliances" among drug companies and some doctors and consumer groups. They argue that drug companies provide medical experts and patient groups offer "victims" to attest to a given condition's severity and draw attention to a new "breakthrough" treatment.

The authors also point to several examples--such as hair loss and excessive shyness--of what can be regarded as normal human conditions that have been made medical conditions because there is a pill available for them.

In another article, Barbara Mintzes of the University of British Columbia in Vancouver, Canada, argues that prescription-drug advertising to consumers--currently allowed only in the US and New Zealand--is helping to medicalize "normal human experience."

"Relatively healthy people are targeted," she writes, "because of the need for adequate returns on costly advertising campaigns."

Many of these advertising dollars, according to Mintzes, are spent on relatively new, expensive drugs intended for long-term use in large groups of people, such as medications for cholesterol, impotence and anxiety.

And while studies prove these drugs work, the ads for them tend to target a wider audience than the evidence supports, Mintzes said in an interview with Reuters Health.

She cited cholesterol-lowering drugs as an example, saying that the evidence that they cut heart disease death risk is "much better" for patients with existing heart disease. But ads, Mintzes noted, are targeted at a much broader population.

In a counterpoint to Mintzes' article, officials with the Whitehouse Station, New Jersey-based drug company Merck argue that consumer advertising helps the public make informed choices about their health and treatment.

And evidence shows there is under-diagnosis of many major diseases and disease risk factors for which treatment exists, according to Silvia Bonaccorso and Jeffrey Sturchio.

But Mintzes argued that advertisers and public health experts often have different views on what ailments need "awareness raising."

Others say that as medicine has forayed into advertising, it has also gotten deeply involved in people's sex lives. When it was launched in 1998, the impotence drug Viagra "became the world's most popular medicinal drug ever," write Graham Hart and Kaye Wellings.

And while many men with erectile dysfunction are thankful for the little blue pill, they add, using an "overly medical" approach to sex threatens to ignore the relationship dynamics and other factors that go into sexual behavior.

The UK public health experts note that forms of gynecological surgery aimed at enhancing sexual pleasure have recently emerged. And in the US, about one third of men and even more women now say they've had sexual dysfunction--a sign, Hart and Wellings say, of a new obsession with sexual gratification and feelings of inadequacy.

Hart, of the University of Glasgow, told Reuters Health that his concern is that the term "sexual dysfunction" is being used to cover a range of behaviors or feelings that may be natural for some people--such as a libido that's lower than it used to be.

"If people are in happy, loving relationships in which, over time, sex plays a less important part, this should not be seen as problematic or dysfunctional," he said.

Looking a bit into the future, UK genetics researchers say that genetic tests "could drive a new wave" of medicalization. With the exception of a relatively small number of medical conditions directly caused by a single defective gene, genetic screening cannot predict whether a person will develop a disease, note David Melzer, of the University of Cambridge, and Ron Zimmern, of Strangeways Research Laboratory in Cambridge.

With diseases with multiple underlying factors--including major killers like heart disease and cancer--screening for disease-related gene variations can only give people information on their statistical risks, Melzer and Zimmern write.

"Genetic tests for markers that may not result in symptoms for half a century or more could be new examples of a process of premature medicalization--of attaching the 'disease' label before it has been established that prevention or treatment is clearly beneficial," they argue.

Genetic technologies, the authors write, could be a "major benefit to society, but their introduction must be measured...and, most importantly, based on best evidence."

SOURCE: British Medical Journal 2002;324:863-864, 883-885, 886-891, 896-900, 908-911.

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