Effect Measure

Disease mongering

The National Post recently had an interesting article on “disease mongering,” an article I largely agreed with. The major point was that fostering a fear of “germs,” promoting the idea that following medical advice, especially advice involving “taking your pills,” and the very definition of who is diseased and who is not has a suspiciously commercial aspect.

Consider the marketing of hand sanitizers, a subject of interest to the flu obsessed:

The slogan of Purell — a hand sanitizer manufactured by Pfizer — is “Imagine a Touchable World.” It’s hard to miss the implication that the world in its current state is untouchable, a message underscored on Purell’s Web site, which includes a handy list of “99 Places Where Germs Are Likely To Lurk — 99 Reasons to Use Purell Instant Hand Sanitizer.” Number 6: subway seats and poles. Number 18: calculator keypads. Number 58: thermostats. Number 67: shopping cart handles. Number 83: library books. While there is solid evidence that the reasonable use of hand sanitizers in settings such as classrooms and daycares is beneficial, Pfizer portrays virtually any object touched by humans as a potential threat and any contact with any such object as a crisis that calls for a squirt of Purell. Welcome to the world of Howard Hughes. (Dan Gardner, National Post [Canada])

Gardner does not mention, although it is consistent with his theme, that data indicates the long residence time on inanimate surfaces for influenza virus still capable of infecting host cells is not matched by their survivability on human hands, which may be only on the order of minutes. This may seem counterintuitive, but human skin is a highly active biological tissue with its own complement of host defenses. Still, washing hands isn’t a bad thing. Some of his other examples are considerably more egregious:

A television ad for Brita, the German manufacturer of water-filtration systems, starts with a close-up of a glass of water on a kitchen table. The sound of a flushing toilet is heard. A woman opens a door, enters the kitchen, sits at the table and drinks the water. The water in your toilet and the water in your faucet “come from the same source,” the commercial concludes. Sharp-eyed viewers will also see a disclaimer at the start of the ad printed in tiny, white letters: “Municipal water is treated for consumption.” This is effectively an admission that the shared origin of the water in the glass and the toilet is irrelevant and so the commercial makes no sense — at least not on a rational level.

From these specific examples Gardner moves on to a more global perspective, this time targeting Big Pharma:

It is not in the economic interests of a corporation selling pills to unhealthy people for people to actually be healthy, or rather — to be more precise — for them to perceive themselves to be healthy. Their actual physical state is irrelevant. What matters is whether someone believes there is something wrong that can be cured with a pill. If so, the corporation has a potential customer. If not, no sale. It doesn’t take an MBA to figure out what pharmaceutical companies need to do to expand their markets and boost sales.

[snip]

This is much bigger than advertising. It is about nothing less than shifting the line between healthy and diseased, both in consumers’ perceptions and in medical practice itself.

Steven Woloshin and Lisa Schwartz, doctors and researchers at the Dartmouth Medical School, were among the first to analyze this process. In 1999, they published a paper examining proposals by various professional associations to change the thresholds for diagnosis of high blood pressure, diabetes, high cholesterol and obesity. In every case, the new thresholds made it easier for people to be qualified as having these conditions. They then calculated that if all the new standards were put in place, 87.5 million otherwise healthy Americans would suddenly be deemed to have at least one chronic condition– and three-quarters of all Americans would be considered “diseased.”

As I said, I tend to agree with the overall thrust of this very long piece (I’ve only pulled quotes from a portion. There’s a lot more interesting material there. Follow the link.) It is wise to remember, though, that as the old cliche observes, even paranoids have enemies. We continue to learn our modern world has many dangers it would be prudent to take measures to avoid. We should be suspicious of easy fixes, whether they are a magic pill to lower cholesterol or a magic foot pad to remove toxins from our bodies. There is rarely an easy technological fix for problems that are themselves caused by technology, other than banning or avoiding the technology. If a radiation source is a danger, we are better of eliminating the source than taking a radiation resistance pill.

We should also become more sensitive to the many ways corporations and people use to market their products. That’s why it was somewhat disconcerting to read at the end of this long and interesting article the following acknowledgment:

From Risk: The Science and Politics of Fear by Dan Gardner. In stores Saturday, April 19. Published by McClelland & Stewart Ltd. Reprinted by permission.

Comments

  1. #1 DDeden
    April 20, 2008

    Dan or Dam?

  2. #2 revere
    April 20, 2008

    Dan. I thought I corrected it. Guess not. Thanks.

  3. #3 Lea
    April 20, 2008

    Especially like the term ‘condition branding.’ But hey, there are people who want to led around by the nose and told exactly how to feel and think and be.

    Since my husband works with the public, oh dear, he uses Purell hand sanitizer. And he doesn’t leave the office at the end of the day without washing his hands first.

  4. #4 Gindy
    April 21, 2008

    My daughter is the only one on her college dorm floor who hasn’t been sick. She religiously washes her hands and uses hand gel when she can’t. My husband is an airline pilot who uses hand gel and washes his hands a lot. During his early career he didn’t wash or use the gel and was sick with a cold or flu several times a year, bringing it back for all of us to enjoy.
    I know it’s anecdotal.
    I know it isn’t scientific.
    But it works for us.
    And the blood pressure, diabetes thing? Just a boondoggle for the drug companies as far as I am concerned. They get millions more people labeled as having something and now they can push more drugs on them.

  5. #5 Crudely Wrott
    April 21, 2008

    FWIW, I’ve been remarkably resistant to disease and infection throughout my adult life. I spent my childhood in an agrarian environment in which exposure to “dirt” (soil, humus, compost and lots of various manures) was a daily occurrence. My mother promoted organic gardening and we grew lots of vegetables and raised chickens, cows, pigs and horses. My sibs and I didn’t miss school unless we were running a fever and/or had been diagnosed with a communicable disease. We all received the standard vaccinations of the day (early 50s through early 70s). To this day none of us have had to battle any sort of chronic conditions.

    With what little I know of immune system functions I have always thought that our relative robustness was at least partly due to a greater than usual (in clean America) exposure to a wide variety of microorganisms, many of which may have been potentially dangerous. Of course, eating fresh, healthy food must surely have had a beneficial influence.

    Not that we didn’t get sick at all. I had a bout with scarlet fever at about nine and actually got sick with both measles and mumps twice! But over all, the incidence of infection by bacterial agents seems to be quite low. I did get an “incipient infection” in my foot after a slight abrasion suffered in the pool at an apartment complex I once lived in at about age thirty. About once every nine to fifteen months I’ll come down with a “cold” or the “flu” or some such and feel poorly for three to five days but I don’t “suffer” as the actors in commercials do. I refer to such bouts as “immune system tune ups.” At work (carpenter, general jack of diverse trades) I frequently get cuts and splinters that fail miserably in developing anything other than some short lived swelling and redness.

    I have always thought that my exposure as a child to a multitude of “germs” gave my system an enhanced ability to resist those little rascals and I am very thankful for the fact, if it is so. And, I’m a soap and water guy. I will use an anti-bacterial hand wash if that’s all that is available, but I do not purchase them or use them at home.

    So, Doc(s). Does that make me a throwback and object of medical curiosity or am I just a normal, healthy human? And what are your thoughts concerning the long term, daily use of anti-bacterial washes by the general population? Might they see an increase in infection? Might useful, symbiotic bacteria be adversely affected?

  6. #6 g36
    April 22, 2008

    Everything in moderation. I use alcohol gel hand sanitizers when I need to eat in the field and there’s no access to soap & water.

    Other than that it’s wash hands with soap & water at the usual times: after using the toilet, before eating, and upon getting home from field items at the end of the day. I rarely get sick though I got a variation on the doozy that was going around in February.

    When I was a kid, we played outside, including in the nice dark dirt, and the swamps where there were frogs, and in the trees. That was healthy dirt, and to see kids today cooped up in front of video games is just plain wrong.

  7. #7 Susan Och
    April 22, 2008

    I hate to let this topic go by without mentioning the possibility of preschoolers eating enough hand sanitizer to get drunk. I’ve also heard stories about teenagers drinking hand sanitizer. Since I wrote about this, I’ve gotten quite a few hits from Google searches of “How much Purell will get me drunk?”

  8. #8 Marissa
    April 23, 2008

    Here’s a downside to huge use of antibacterial wipes: you end up with a much more agressive population of bugs in the environment since you can’t kill all the bugs. Probably a contributory factor to the rise of problems like MRSA I shouldn’t wonder.

  9. #9 Dan
    June 5, 2008

    Published on http://www.brainblogger.com

    Your Television as you doctor?

    Often, usually on television, one viewing will often at times see an advertisement for some type of medication- usually one involved in a large market disease state and the commercial is sponsored usually by a big pharmaceutical company for a particular network. This is called direct to consumer advertising, and doctors would prefer they did not exist.
    Since 1997, when the FDA relaxed regulations regarding this form of advertising, the popularity of the creation of such commercials has greatly increased. The pharmaceutical industry spends around 5 billion annually on this media source now. Normally, the creation of such a commercial becomes visible to the consumer within a year of the drug’s approval, which raises safety concerns. And involves money spent that could be applied to greater uses, according t many, but we are dealing with a corporation here.
    The purpose of DTC ads is not education, in my opinion, as others have claimed. Any advertising of any type shares the same objective, which is to increase sales and grow their market and, in this case, for a particular perceived medical condition or disease state. The intent of DTC advertising is to generate an emotional response from the viewer, such as fear or concern, believing upon research that the viewer will then question as to whether they need to seek treatment for what may be an unconfirmed medical condition. Furthermore, the FDA has admitted that they are ignorant as far as the content of such DTC ads, in relation to their accuracy and clarity, as well as their effect on the health care system.
    DTC advertising is also a catalyst for and similar to disease mongering.
    Disease mongering is the creation of what some believe to be medical flaws, and illustrated by the creators through exaggeration and embellishments through media sources as an avenue for suc propaganda, as is often seen with DTC advertising. Yet the flaws may not be medical, but corporate creations of these questionable human ailments that do not require treatment, possibly, and may be an attempt to develop a particular medical condition to acquire profit. One of my favorite DTCs is the new indication for the use of an anti-depressant for a social disorder. This used to be called introversion, a term created by Dr. Carl Yung. And it is a personality trait, not a medical disease. There are other questionable medical conditions claimed in the contents of DTC commercials, as the creators wish to grow the market for a particular, and possibly fictional, disease state. Then there is baldness treatments advertised, as another example. Lifestyle meds are not treatment meds for illnesses, and should not be portrayed as such.
    Also, DTC ads discuss only one treatment option normally, so it seems, when likely several treatment options exist for authentic medical disorders. This should be left to the discretion of the doctor, as they assess your health, not your television or another media source. That’s why most of the world does not conduct DTC advertising, with the exception of our country and New Zealand.
    Finally, DTC advertising and its ability to influence viewers to make their own assessment instead of a medical professional remains largely unregulated, yet apparently effective for the DTC creators. People are prone to believe what they see and hear, regardless of whether or not it is actually true. Many, after viewing a DTC ad, seek out a doctor visit and request whatever product that was advertised, which makes things cumbersome for the doctor chosen for such a visit. So the doctor and patient relationship is altered in a negative way, because most DTC ads require a prescription.
    Medical information and claims of suggested health ailments should come from those in the medical field instead of the corporate world. Perhaps this will save some over-prescribing, which will benefit everyone in the long term. And the Health Care System can regain control of their purpose, which is far from financial prosperity.

    “Do every act of your life as if it were your last.” —- Marcus Aurelius

    Dan Abshear

  10. #10 MB
    June 21, 2008

    I agree with the gentleman about exposure. A drainage ditch was behind our home when I was growing up. In fact We used to catch frogs and fish, was well as skateboard on the cement areas. For some odd reason I’ve gone at least four years with so much as a cold. I never get flu shots and Im never down for more than two or three days, if at all. I also agree with the woman on medical hype. Not any different than lowering the standards for our education because most kids don’t want to learn and we had to make them look smart somehow. Last but not least, If I remember correctly, wasn’t it Gramma who keep harping on me to wash my hands and keep them clean, as well as clean those ears young man!!!

    Get some germs on ya….its healthy!!!