Disease mongering is a pejorative term for the practice of widening the diagnostic boundaries of illnesses, and promoting public awareness of such, in order to expand the markets for those who sell and deliver treatments, which may include pharmaceutical companies, physicians, and other professional or consumer organizations.
The term “war mongering”, referring to the inherent conflict of interest of the arms industry and military–industrial complex in which encouraging human conflict may be profitable, had long been part of the public consciousness when the term “disease mongering” was first used in 1992 by health writer Lynn Payer, who applied it to the Listerine mouthwash campaign against the disease halitosis. Payer defined disease mongering as a treatment which includes the following practices:
- stating that normal human experiences are abnormal and in need of treatment
- recognizing suffering which is not present
- defining a disease such that a large number of people have it
- defining a disease's cause as some ambiguous deficiency or hormonal imbalance
- associating a disease with a public relations spin campaign
- directing the framing of public discussion of a disease
- intentionally misusing statistics to exaggerate treatment benefits
- setting a dubious clinical endpoint in research
- advertising a treatment as without side effect
- advertising a common symptom as a serious disease
While it is clear that marketing leads to medicalization of conditions not previously defined as illness, the overall effect of such medicalization is difficult to scientifically assess, owing to the inherently social and political nature of the definition of what constitutes a disease, and what aspects of the human condition should be managed according to a medical model. For example halitosis, the condition which prompted Payer to coin the phrase "disease mongering", is recognized by the Scientific Council of the American Dental Assocation as "a recognizable condition which deserves professional attention".
Instances of disease mongering and spectrum of agreement
Ray Moynihan has argued that the pharmaceutical industry engages in disease mongering to enlarge its profits, and that it harms patients. His use of osteoporosis as an example of a "made up" disease in this article prompted an angry retort from the president of the British National Osteoporosis Society, stating that the article was insulting to people with osteoporosis and vastly understated the risk of disabling fractures associated with the disorder. Moynihan published a satire of disease mongering in the 2006 April Fool's day issue of BMJ titled "Scientists find new disease: motivational deficiency disorder".
Other conditions which have been cited as examples of disease mongering include restless leg syndrome, testosterone deficiency, erectile dysfunction, hypoactive sexual desire disorder. Some of these conditions are recognized as medical disorders by professional medical societies and the National Institute of Health and Clinical Excellence. In 2014 an FDA advisory committee voted to limit the use of testosterone replacement therapy products due to potentially increased cardiovascular risk associated with their use.
- Dossey, L (2006). "Listerine's long shadow: Disease mongering and the selling of sickness". Explore 2 (5): 379–85. doi:10.1016/j.explore.2006.06.005. PMID 16979097., citing
- Frosch DL, Grande D, Tarn DM, Kravitz RL (January 2010). "A decade of controversy: balancing policy with evidence in the regulation of prescription drug advertising". Am J Public Health 100 (1): 24–32. doi:10.2105/AJPH.2008.153767. PMC 2791253. PMID 19910354.
- Moynihan R, Heath I, Henry D (2002). "Selling sickness: the pharmaceutical industry and disease mongering". BMJ 324 (7342): 886–91. doi:10.1136/bmj.324.7342.886. PMC 1122833. PMID 11950740.
- Edw ards L (July 2002). "The pharmaceutical industry and disease mongering. Article was insulting to people with osteoporosis". BMJ 325 (7357): 216; author reply 216. PMID 12143857.
- Moynihan R (2006). "Scientists find new disease: motivational deficiency disorder". BMJ 332 (7544): p. 745. doi:10.1136/bmj.332.7544.745-a. "[Neurologist Leth Argos and a team...] at the University of Newcastle in Australia say that in severe cases motivational deficiency disorder can be fatal, because the condition reduces the motivation to breathe."
- Moynihan R, Henry D (April 2006). "The fight against disease mongering: generating knowledge for action". PLoS Med. 3 (4): e191. doi:10.1371/journal.pmed.0030191. PMC 1434508. PMID 16597180.
- Vitry AI, Mintzes B (June 2012). "Disease mongering and low testosterone in men: the tale of two regulatory failures". Med. J. Aust. 196 (10): 619–21. PMID 22676868.
- Moynihan R, Heath I, Henry D (April 2002). "Selling sickness: the pharmaceutical industry and disease mongering". BMJ 324 (7342): 886–91. PMC 1122833. PMID 11950740.
- Tiefer L (April 2006). "Female sexual dysfunction: a case study of disease mongering and activist resistance". PLoS Med. 3 (4): e178. doi:10.1371/journal.pmed.0030178. PMC 1434501. PMID 16597176.
- Hatzimouratidis K, Amar E, Eardley I, et al. (May 2010). "Guidelines on male sexual dysfunction: erectile dysfunction and premature ejaculation". Eur. Urol. 57 (5): 804–14. doi:10.1016/j.eururo.2010.02.020. PMID 20189712.
- "FDA Panel: Limit Testosterone Drug Use – WebMD".
- Moynihan R, Henry D (eds). "A Collection of Articles on Disease Mongering.". PLoS medicine, 2006. Retrieved 2007-06-12.
- Moynihan, Ray; Henry, David (2006). "The Fight against Disease Mongering: Generating Knowledge for Action". PLoS Medicine 3 (4): e191. doi:10.1371/journal.pmed.0030191. PMC 1434508. PMID 16597180.
- Peter Conrad (2007), The Medicalization of Society: On the Transformation of Human Conditions into Treatable Disorders, Baltimore: Johns Hopkins University Press.