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Published: Sunday, 8/10/2003

Not every problem should be a disease

There's a lot of money to be made from telling healthy people they're sick."

Strange words, indeed, to lead an article in the esteemed British Medical Journal, published by the British Medical Association since 1840. And this was an entire edition (April 13, 2002) devoted to the "medicalization" of society.

That involves putting a special spin on life's natural processes and problems so they become diseases requiring treatment.

"Disease mongering" is how BMJ described this pill-for-every ill mindset.

And the supposed mongers have had no shortage of topics, supposedly:

  • Turning menopause into a disease that led millions of women to long-term hormone replacement therapy that has been discredited.

  • Promoting pills, injections, and surgery for baldness, wrinkles, sags, and flab.

  • Putting adults who are naturally shy on pills for "social anxietyā€¯ and high-spirited kids on Ritalin.

  • Trying to redefine who should be on antidepressants to include individuals who are simply unhappy.

    "The ordinary processes or ailments in life are classified as medical problems," the article stated. "Mild symptoms are portrayed as portents of a serious disease; personal or social problems seen as medical ones; risks conceptualized as diseases; and disease prevalence (the number of people affected) estimates framed to maximize the size of a medical problem."

    It termed some "public awareness" campaigns as disease mongering-in-disguise.

    BMJ said the campaigns involve alliances among consumer groups, drug companies, and doctors enlisted by drug companies as "experts." The theme: A disease is more common, more serious, more under-treated than once believed. The solution invariably is drug treatment. Consumer groups benefit with a higher profile. Drug companies increase sales.

    The problem, of course, is deciding where to draw the lines between disease and normal, between treating a problem and letting it be.

    Decisions will get tougher, as genetics research uncovers the biological roots of problems that reduce the enjoyment of life. Many of life's little nuisances may become treatable "diseases."

    Medicalization critics often ignore evidence that more people could benefit from medication. Under-medication may be as big a problem as over-medication. Many treatable conditions go untreated, and millions die early and suffer physically and mentally.

    That once was the rule with clinical depression. People thought it was a personal weakness. "Just pull yourself together." All-too-often, however, the lives of those affected fell apart.

    Researchers discovered drugs that restore normal brain chemistry in people with severe feelings of hopelessness and despair. Gradually, the use of antidepressants expanded to include some individuals with milder symptoms.

    Do advertising and public awareness campaigns for drugs like Prozac, Paxil, and Zoloft medicalize everyday worry, disappointment, and irritation -- as critics claim? Or do they educate people about treatable depression and anxiety disorders?

    Those are fill-in-the-blank questions. Ask them for other drugs and conditions, including "Viagra" and "male impotence."

    Maybe the medicalization critics have gone off the deep end. Maybe there should be a pill for every ill, available at prices more people could afford.



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