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Complete Health Reporting: Steer Clear of Disease-Mongering Quicksand
June 06, 2012
There are two criticisms that make a reporter's blood boil.
The first, which Antidote explored earlier, is saying a news story sounds too much like a press release. The second is saying that the story engages in disease mongering.
Writer Ray Moynihan and pharmacology professor David Henry described disease mongering quite well in PLoS Medicine in 2006:
In our view, disease mongering is the selling of sickness that widens the boundaries of illness and grows the markets for those who sell and deliver treatments. It is exemplified most explicitly by many pharmaceutical industry–funded disease-awareness campaigns-more often designed to sell drugs than to illuminate or to inform or educate about the prevention of illness or the maintenance of health.
One could slice disease mongering quite finely, I suppose, but I would argue that it comes in four main strains. I will explore the first two today and two more in an upcoming post. Avoid them all, and your audience will be better served.
1. Making everyday life a medical condition.
In the book Selling Sickness, Moynihan and Alan Cassels describe how pharmaceutical companies and company-funded researchers take the regular complaints we all have about our lives and turn them into conditions that must be treated, preferably with a highly priced drug:
The ups and downs of daily life have become mental disorders, common complaints are transformed into frightening conditions, and more and more ordinary people are turned into patients. With promotional campaigns that exploit our deepest fears of death, decay and disease, the $500 billion pharmaceutical industry is literally changing what it means to be human.
What can a health writer do about it?
Explain how certain groups are targeted for this kind of marketing. Middle-aged women are particularly popular among marketers. Premenstrual dysphoric disorder, vaginal atrophy, female sexual dysfunction, overactive bladder, and, of course, menopause all started as normal facets of growing older that were then dressed up in the frightening masks of diseases that needed to be treated. Susan Kelleher at The Seattle Times exposed the shaky science behind female sexual dysfunction in 2005:
If a woman isn't as interested in sex as she used to be, is she sick? According to some experts, the answer is yes - as long as the woman's decline in desire bothers her. Those experts, backed by drug companies, for years have been pushing the medical establishment to incorporate that sort of standard into a new definition for a condition called "female sexual dysfunction," or FSD. Today, FSD has all the trappings of a well-established disease: spokespeople, alarming statistics, a political lobby, a medical specialty and an academic journal. Drug companies are developing a mountain of medicines to serve the new market.
2. Inflating the scope of an illness.
When a talk at the American Thoracic Society conference indicated that sleep apnea may be linked to cancer, media outlets around the country reported that 28 million Americans suffer from it. That would mean nearly one of every 10 people.
A quick look at PubMed shows that most estimates of sleep apnea are somewhere between 15 million and 18 million. I could find no reference to 28 million Americans suffering from the disorder. By making the problem sound more pervasive, it heightens people's fears about it. "I'm not sleeping well. Do I have that? Am I going to get cancer? Do I need to start using a device or taking a drug?" It also helps drive demand for research and development in an area that may not deserve it as much as others.
What can a health writer do about it?
Question prevalence estimates. Who says 28 million people have this disorder? How did they arrive at that figure?
Genevra Pittman at Reuters Health did a nice job in a piece on statins being used to lower prostate cancer risk. She defined the scope of the problem in clear terms and with a reliable source, showing that, even though prostate cancer diagnoses are common, deaths are far less common:
According to the American Cancer Society, about one in every six men will be diagnosed with prostate cancer at some point, and one in every 36 men will die of the disease.
Then she made it clear that the evidence that statins would actually lower a man's prostate cancer risk was murky, at best:
Researchers agreed that until there's clearer evidence for benefit, men with healthy hearts shouldn't seek out statin prescriptions for the purpose of lowering their prostate cancer risks. But Freedland said that other strategies for lowering cholesterol -- such as eating better and exercising regularly -- are ways almost everyone can lower their disease risks in the meantime.
Next: Exaggerating the effects of an illness and making risk factors the disease.