Disease mongering

Disease mongering is a pejorative term for the practice of widening the diagnostic boundaries of illnesses and aggressively promoting their public awareness in order to expand the markets for treatment.

Among the entities benefiting from selling and delivering treatments are pharmaceutical companies, physicians, alternative practitioners and other professional or consumer organizations. It is distinct from the promulgation of bogus or unrecognised diagnoses.

One of the earliest examples of disease mongering is Listerine, a chemical product formulated in 1879 and used as an antiseptic, even a floor cleaner, before its marketing to dentists for in-office oral care.  Then Listerine's creators started selling it directly to consumers by inventing a disease that their product “cured”: halitosis, a term borrowed from antiquated medical texts and is nothing but bad breath. Halitosis was paraded as a disease that could have dire consequences for your personal and professional life. By taking advantage of people’s insecurities, and through the creation of manipulative soap-opera-like commercials, Listerine turned into a sought-after remedy for a previously non-existent malady.

The disease osteoporosis was developed at a WHO conference in 1992.  Prior to the conference, osteoporosis was a term to describe normal loss of bone mass with ageing, like wrinkles and grey hair, not a disease to be "cured" by prescription of drugs  At the conference, it was decided that “normal” bone density was that of a 30-year-old woman, the age at which bone mass typically peaks. It’s normal for a 50-year-old’s density to be less than a 30-year-old’s, and it’s ridiculous to measure the bone density of a 70-year-old against that of someone four decades younger.  But at the conference, it was decided that anything below this peak density number was “abnormal” and in need of treatment.

The actual T-score number was decided in an even more irresponsible way. Researchers resorted to a single analysis of women in a small geographic area (Rochester, Minnesota) and applied that research to every woman in the United States. According to the Rochester study, 16% of post-menopausal Rochester women would fracture their hip.

So the WHO looked at the bone density scores of this 16%, and came up with the average of -2.5 or below as the threshold. From this moment on, any T-score of -2.5 or below was considered “abnormal.”

Amazingly, the WHO arbitrarily decided that T-scores between -1 and -2.5 were the threshold of another condition that had never existed before: osteopenia.

Suddenly, there were two thresholds that opened the door for osteoporosis drugs! Doctors could prescribe sooner and send women as young as 45 out the door with a prescription for a drug that would “build bone” and “prevent osteoporosis.”

Merck – the very name makes Savers cringe – introduced Fosamax in 1995, just 3 years after the pivotal conference. Now their drug could be prescribed for women were told that they had a disease (osteoporosis), or at the very least, in a precursor of a disease (osteopenia).

Incredibly, Mr. Allen persuaded Merck to simply create the Bone Measurement Institute (BMI), a not-for-profit subsidiary whose goal was to expand as much as possible the use of bone density measuring machines.

Under this official-sounding corporate name, Mr. Allen set about to find a cheap, easy way for doctors to measure bone density – and he found it: peripheral machines.

These small units measured bone density in the wrist or heel, not the spine. So there was no need for a pelvic and spinal density scan.

But Manufacturers Of The Small, Inexpensive Scan Machines Resisted

Why? Wasn’t there money to be made? Actually, many manufacturers refused to get on board with Allen’s plan to place their products in doctors’ offices because it was either not profitable or, as one manufacturing giant put it, their machines were not good diagnostic tools.

The problem is that measuring the bone density of someone’s forearm is a poor predictor of their risk for fracture in the hip and spine.

Yet Merck wanted those machines in doctors’ offices. So…

Merck Partnered With The FDA To Appeal Directly To Doctors

Merck helped fund clinical trials and submissions through the FDA, and the Fosamax sales task force distributed pamphlets to doctors. And they didn’t stop there. Merck’s goal of fundamentally changing the osteoporosis drug market meant getting Medicare to reimburse for bone scans.

A Key Piece Of Legislation: The Bone Mass Measurement Act Of 1997

This was an incredibly important piece of legislation that changed the very rules of Medicare reimbursement. Thanks to the lobbying of BMI and other organizations with an interest in drug sales, millions of people could now afford to have their bone density scanned right there in their doctor’s office.

In a nutshell, after that law was passed, doctors would get paid for doing bone scans.

Ease And Profitability Of Scanning + The Invention Of Osteopenia = Huge Profits For Merck

Think about it. Now bone scans were quick, easy, accessible, and cheap. And the diagnostic line had been drawn so as to include osteopenia so doctors could scan, diagnose, and prescribe all at once.

No wonder that Fosamax sales totaled $3 billion in 2007, one year before its patent ran out.

Fosamax Is A Dangerous Drug

It’s bad enough that millions of women are taking a drug for a disease that does not exist. But it gets worse, because the side effects and dangers of Fosamax (and its generic alendronate) are legion. These are the known risks and side-effects of this toxic drug:

Increased risk of femur fractures (yes, you read that right)

Osteonecrosis of the jaw

Hair loss (alopecia)

Upper GI irritation/heartburn

Esophageal ulcers and cancer

Low blood calcium

Skin rashes

Joint and muscle pain

Swelling of the hands and feet

Dizziness

Headache

Chest pain

Difficulty swallowing

Flu-like symptoms

Thigh and hip pain

Nausea

Vomiting

…the list goes on.

It is sad and shameful to think that so many women are risking and experiencing these side effects because they’ve been led to believe they have a “disease.” Drug companies like Merck capitalize on this fear, leading doctors and patients alike to believe that osteoporosis drugs are the answer.