Seattle Times: Hidden Big Business Behind Your Dr's Diagnosis

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The hidden big business behind your doctor's diagnosis

By Susan Kelleher and Duff Wilson · Seattle Times staff reporters

 

http://seattletimes.nwsource.com/html/health/sickintro.html

 

 

You walk into your doctor's office for a physical exam and step on

the scale. Last year, the doctor said you were overweight. Now he

says you are obese — at the same weight.

 

A nurse takes your blood pressure. You have hypertension — with the

same previously healthy reading you've had for years.

 

The doctor scans your wrist bone. You have a condition

called " osteopenia " — with the same bone density that was fine last

time you were measured.

 

You mention you are not enjoying sex as much as you used to.

Diagnosis: a new kind of sexual dysfunction.

 

You leave the office with a head full of worry and a fistful of new

prescriptions, joining more than 40 percent of Americans who take one

or more prescribed drugs daily in the effort to stave off more

serious trouble.

 

You are suddenly sick, simply because the definitions of disease have

changed. And behind those changes, a Seattle Times examination has

found, are the companies that make all those newly prescribed pills.

 

The Times found that:

 

• Pharmaceutical firms have commandeered the process by which

diseases are defined. Many decision makers at the World Health

Organization, the U.S. National Institutes of Health and some of

America's most prestigious medical societies take money from the drug

companies and then promote the industry's agenda.

 

• Some diseases have been radically redefined without a strong basis

in medical evidence.

 

• The drug industry has bolstered its position by marketing directly

to the health-conscious consumer, leading younger and healthier

people to consider themselves at risk and to start taking medications.

 

Every time the boundary of a disease is expanded — the hypertension

threshold is lowered by 10 blood-pressure points, the guideline for

obesity is lowered by 5 pounds — the market for drugs expands by

millions of consumers and billions of dollars.

 

The result? Skyrocketing sales of prescription drugs. Soaring health-

care costs. Escalating patient anxiety. Worst of all, millions of

people taking drugs that may carry a greater risk than the underlying

condition. The treatment, in fact, may make them sick or even kill

them.

 

Dartmouth Medical School researchers estimate that during the 1990s,

tens of millions more Americans were classified as having

hypertension, high cholesterol, diabetes or obesity simply because

the definitions of those diseases were changed.

 

Today, three of every four Americans technically have at least one of

those diseases. But millions of them are not truly sick and may never

be, even without medication. The Dartmouth researchers said it was

unknown whether those people would benefit from early detection and

treatment, while it is " an open question " whether branding them

diseased and feeding them drugs may be causing significant physical

or psychological harm.

 

The medical profession's term for these people is " the worried well. "

They are otherwise healthy people who have risk factors, such as high

blood pressure or high cholesterol, but may never suffer a heart

attack or stroke.

 

Dr. Alfred Berg, chairman of family medicine at the University of

Washington and a past chairman of a federal task force that fights

drug-industry influence on disease and treatment guidelines, said the

best advice for many people at risk of so-called " lifestyle diseases "

is to simply change their lifestyles.

 

" Diet and exercise and righteous living — but nobody wants to hear

that, " Berg said.

 

Instead, he says, a " commercial prevention " industry has emerged,

focused on selling drugs to people who don't really need them but who

can pay for them.

 

" We have a system that nobody but Big Pharma is happy with, " says Dr.

John Kitzhaber of The Foundation for Medical Excellence in Portland,

who was Oregon's governor from 1995 to 2003.

 

But the drug companies can't do it alone. They need, and receive,

support from much of the world's medical establishment.

 

Treatment guidelines established by international and national health

organizations instruct physicians on diagnosis and treatment of

disease and are meant to be scientifically pristine. But many of

those groups lack any process for preventing or disclosing conflicts

of interest.

 

The Times found that for a broad spectrum of diseases, the experts

writing the treatment guidelines had drug-company ties ranging from

research contracts to consultancies to stock ownership.

 

Berg's group, the U.S. Preventive Services Task Force, flatly

prohibits any conflicts of interest, either in money or previous

research. As a result, it is consistently more conservative in its

recommendations than other medicalguideline-writing groups and pushes

fewer drugs.

 

Dr. H. Gilbert Welch, a Dartmouth medical professor and editor of

Effective Clinical Practice, a journal of the American College of

Physicians, agrees that his profession shares the blame for what he

sees as an overdose of preventive medicine.

 

The problem begins, he said, with the expanding definitions of

disease.

 

" You can't tell me that three-quarters of my population is sick

before I start, " he said. " That just doesn't pass the laugh test.

 

" Our business is in a hard place right now, " Welch said. " A lot of

docs know it's not right. "

 

Duff Wilson reported and co-wrote this story while working for The

Seattle Times. He now reports for The New York Times. Send comments

to suddenlysick or call Susan Kelleher: 206-464-2508

 

 

HARLEY SOLTES / THE SEATTLE TIMES

 

Dr. Robert Saunders checks the blood pressure of Seattle City

Councilwoman Jean Godden, who had a close call with a hypertension

drug. Saunders expresses concern about company-backed research behind

some medicines. " I think the days of getting unbiased information are

gone, " he says.

 

 

 

AP

 

" We have a system that nobody but Big Pharma is happy with, " says ex-

Oregon Gov. John Kitzhaber, a doctor with The Foundation for Medical

Excellence.