Wednesday, May 28, 2008

Fake drugs, fake diseases

This week's news included two trends in drug promotion and sales, both of which are detrimental to health worldwide: the advertizing and selling pharmaceutical drugs for phony diseases, and the selling of fake drugs for real diseases.

The corporate-sponsored creation of disease, or at least the widening of the boundaries of disease for marketing purposes, is called 'disease mongering.' From a purely business point of view, it would be a pity if human beings suffered from a finite number of well-defined diseases. It is far better, in terms of pursuing profits, if new diseases would crop up regularly that would create new patient populations willing to purchase new medical treatments. So there is a standing motivation for pharmaceutical companies invent new health conditions or medicalize mildly negative aspects of life that -- while annoying -- were never thought to be in need of drug treatment: such as 'restless leg syndrome', 'female sexual dysfunction' or 'irritable bowel syndrome.' PLoS Medicine put out a series of articles in 2006, and this week has followed up with an opinion piece that reports on the increasing media and academic attention to the phenomenon of disease mongering. Disease mongering must be real: it has its own Wikipedia entry.

What's wrong about disease mongering? The ethics of disease mongering are still a work in progress, but some things come to mind. It does involve exploitation of people's anxieties and fears about their bodies, needlessly making persons into patients, and in this way contributing to human misery -- though misery-creation is not unique to disease mongering. But the greatest harm in disease mongering may come from its distortion of public health priorities: while attention and money is drawn to new treatments for the diseases du jour, other more serious (but less marketable) diseases and essential medicines may be neglected, and this corporate-driven distraction could negatively impact on individual and population health. The problem is not at all restricted to the richer countries, inundated as they are by erectile dysfunction commercials and spam. Asia, in particular, is a vast new opportunity to get people to pay for medications to treat all sorts of newly constructed ailments.

The market in fake drugs, for real and serious diseases, has been a concern for some time. Malaria is not like 'restless leg syndrome': its credentials as an actual disease are clear, and millions die from it every year. In PLoS One, a study has been published that offers a few disheartening numbers. Researchers visited pharmacies in urban and peri-urban areas of six African cities, bought anti-malarial drugs, and tested their quality. The result: 35% failed tests whose purpose was to detect the appropriate active ingredient, and 33% of the drugs were artemisinin monotherapies, i.e. the kind of anti-malarial drug that the World Health Organization thinks should be withdrawn from the market because they create drug resistance. Here is a situation that seriously threatens patient safety and public health, particularly in developing countries. And malaria is just one disease targetted by the counterfeit drug trade: HIV and tuberculosis are others. Counterfeit drug makers and suppliers should be condemned, because they prey cruelly on the poor. Like corporate disease mongers, they are driven by the profit motive, come what may. But unlike them, they at least seem to have a sense of the pressing health needs of communities. Not that this does those communities much good.

Access to real medicines for real diseases: is this really too much to ask?


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