Thursday, March 01, 2007

More bogus allegations of disease-mongering

As I was researching for my recent posts on medicalization and disease-mongering I ran across an item from the Seattle Times. Though a little dated (published June 2005) it’s illustrative of misinformation being put out by the media. The six part series, cleverly titled Suddenly Sick, is full of distortions.

The hypertension section, largely off topic with its focus on an anecdote about a former Seattle Times reporter who was placed on an ACE inhibitor and experienced a frightening episode of angioedema, accused the JNC-7 panel of designating a systolic blood pressure of 120 as “unsafe”. Although the panel cited evidence that with lower and lower blood pressures there is a continuum of decreasing cardiovascular risk down to 115/75 there was no statement that 120 was “unsafe”. In fact, the panel’s recommendation for a blood pressure of 120/80, the lowest reading in the prehypertension category, was “no antihypertensive drug indicated.”

Several paragraphs later the article states “More people visit doctors for hypertension than for any condition other than the common cold. And no wonder, as the threshold for hypertension has dropped from 160/100 to 140/90 and now, with prehypertension, to 120/80.” Well, not exactly. The threshold for JNC-7’s designation of hypertension is indeed 140/90, but not 120/80. And who in their right mind thinks 160/100 is an acceptable target? The article even mentions the old saw that “100 plus your age” is an acceptable systolic blood pressure. That went out 30 years ago. Disease mongering?

The section on deep vein thrombosis (DVT) profiles an ad campaign by Aventis, the maker of Lovenox, to raise awareness about DVT and encourage prevention. When anticoagulant drugs such as Lovenox are used for DVT prevention the typical duration of treatment is a matter of days and in unusual circumstances a few weeks. But the article makes this statement about the campaign (italics mine): “It was powerful marketing, tapping primal fears of death and disease, targeting the healthy for life-long use of blood thinners.” Well, wrong. What the campaign actually did was suggest that patients who are laid up with injury, surgery or illness ask their doctors about DVT prophylaxis. Maybe that’s not such a bad idea since research has repeatedly shown that this evidence based, potentially life saving treatment is underutilized.

There’s been a lot of screaming about disease mongering and medicalization, little of which is evidence based.


Anonymous said...

You are right here, but what about other deseases, like ADHD? Are all kids diagnosed with it really sick? Half of the kids in summer camps are on one drug or other. There was also a recent case of a 4-year old diagnosed with a bi-polar disorder. Isn't this desease-mongering?

Also, you agreed in another thread that there is not much evidence for statins for primary prevention in women. Yet it didn't prevent AHA on coming with guidelines for women that included statins.

Lily said...

All these DTC ads are pushing new drugs when the old drugs or the generics are much, much less expensive. I’ve seen ads on TV for Caduet. It has two ingredients. One is Amlodipine and the other is Atorvastatin. With my RxDrugCard I can get 30 tablets of Amlodipine for $9 and 30 tablets of Simvastatin for $9. I’ll bet they are charging more than $18 for this new drug! The unthinking public is going to pressure their doctors into giving them something just because it’s new, when something old or generic would do the job for cheaper.