The excerpt of the documentary Big Bucks, Big Pharma: Marketing Disease and Pushing Drugs opens with accusations that experts, influenced by the pharmaceutical industry, are re-defining sickness. In response to Thursday’s post on this subject a commenter said “In my understanding, the accusations disease-mongering usually apply to primary prevention i.e. labeling people who were considered ‘healthy’ yesterday as ‘sick’ today because of the lowered guidelines and thus increasing the number of people who are considered to have a disease.” That’s a widespread misconception. The video does accuse industry of redefining sickness through direct to consumer ads and influence on guideline writers, but where’s the evidence to back up that assertion?
Let’s look at cholesterol recommendations. The current guideline and a frequent target for accusations of disease-mongering is the NCEP Adult Treatment Panel-3. What are its recommendations for healthy persons? For individuals with no history of atherosclerosis and 0-1 risk factors it calls for consideration of drug treatment for patients with an LDL cholesterol of 190. This is hardly an aggressive target, and hardly a level a reasonable person would regard as healthy. But note the word consideration. That means that, as explained in the text of the full report, drug therapy should be recommended for such patients only after documented failure of a trial of hygienic measures such as diet and exercise.
It is only for patients with atherosclerosis, diabetes or a constellation of conditions defining very high risk that the guidelines recommend aggressive treatment to low targets. But that isn’t disease mongering. Such patients, especially those with atherosclerosis, already are sick.