Selling Sickness

April 15th, 2006 by Ben Goldacre in alternative medicine, bad science, mail, medicalisation, nutritionists, patrick holford | 71 Comments »

Ben Goldacre
Saturday April 15, 2006
The Guardian

It’s not every day that you wake up to find that a favourite bête noir is making headline news, but this week, to my amazement, the media collectively decided to pick up on an obscure report and conference on “medicalisation” in Australia. “Drug companies are inventing diseases to sell more of their products, it has been claimed,” said the Daily Mail.

“Scientists have accused major pharmaceutical firms of ‘medicalising’ problems like high cholesterol or the symptoms of the menopause in a bid to increase profits … exaggerating conditions and turning them into something more serious. Female sexual dysfunction, attention deficit hyperactivity disorder (ADHD) and ‘restless legs’ syndrome have all been promoted by the pharmaceutical industry in the hope of selling more drugs, they say.”

Now, this is an incredibly interesting set of ideas, but what is even more fascinating is how medicalisation was consistently presented as something that is done to us, as passive recipients, by powerful drug companies. This seems particularly odd since just months ago the Daily Mail, for example, was telling us that “Night Eating Syndrome affects an estimated 1 million people in the UK.” More than that, for 30% of sufferers “their symptoms were wiped out” with Sertraline.

The article was based on a study funded by Pfizer, and that won’t have broken the bank since it had 17 subjects, wasn’t blinded, and didn’t have a placebo control group, for the simple reason that it didn’t have any control group at all. Pfizer did not work hard to get their story out there.

But of course, medicalisation of our problems isn’t just something that drug companies and the media are selling, it’s something we are buying. Looking at food intolerance alone, more than 40% of people are estimated to suffer from food intolerance, according to Allergy UK, a popular charity and pressure group (and founding publishers of Allergy, a lifestyle magazine). That’s 25 million people.

Meanwhile the front cover of the new book by Patrick Holford, ubiquitous and bestselling author, reads: “One in two people suffers from a hidden food allergy. Find out if you are one of them.” Half the population is a very big market if you can persuade them all, and if he can, Holford is also recommending and endorsing vitamin pills to treat this condition. Its “classic symptoms” include, to take Holford’s own list, “weight gain, strong food cravings, bloating, abdominal pain, irritable bowel, diarrhoea, constipation, fatigue, depression, hyperactivity and bedwetting in children, rhinitis, eczema, itches, rashes, asthma, sinus problems, ear infections, mouth ulcers, headaches and migraines, joint aches and pains.” I believe I may have had some of those.

Meanwhile, there are pseudoscientific diagnostic tests to measure intolerance to specific foods, ranging from Vega testing, an exotic machine that measures electromagnetic field in response to holding samples of foods in containers, to a vast market in dubious allergy blood tests. It would be madness to deny that people have unpleasant symptoms, and for some they may be related to certain foods: the question is, what do we add by giving it a biomedical label, rolling out the diagnosis to include half the population, “diagnosing” it with dubious tests, or treating it with unproven interventions?

More importantly, why should we feel the need to give all distress and discomfort a sciencey label, if that label is tenuous? How do we gain from that? Is the distress and discomfort not enough in itself? If drug companies, the media, alternative therapists, and shops are all selling medicalisation, that’s only half the story: much more interesting is the fact that we are buying it.

We have collectively got to a point where distress and discomfort are only legitimate when they have an objective biomedical diagnosis, and we’re all players in that game. To pretend that medicalisation is something that is done to us – by evil, powerful outside influences – only plays up to a dangerous sense of passivity.

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71 Responses

  1. kim said,

    April 21, 2006 at 7:00 pm

    PV: two points. One, a study in the Lancet last year claimed that men, too, suffer from postnatal depression. Two, of course I’m not trivialising the problem. My question is: if people’s unhappiness is caused by the particular situation they find themselves in, to what extent can it be called an illness? Despite your glib comments, this is actually a pretty serious and complex question.

    PND is diagnosed simply through use of a self-administered questionnaire – not the most precise of diagnostic tools. Is PND caused by a hormonal imbalance in the body or by the stresses and difficulties involved in looking after a small baby? Or is it caused by hormonal imbalance in some cases, but not in others – in which case, how useful is it to use the same label for all cases?

  2. Melissa said,

    April 22, 2006 at 6:53 am

    Kim, I see what you’re saying, and please correct me if I’m wrong, but isn’t the treatment the same no matter what you call it? I was under the impression that one gets prescribed antidepressants whether it’s PND or just plain depression (whatever the cause).

  3. pv said,

    April 24, 2006 at 9:51 am

    Kim, let’s call it coincidence then. Baby is born and mother displays symptoms of depression – from day 1, not after weeks of sleep deprivation. Another coincidence would be that post-natal depression isn’t that uncommon following late term miscarriages. No sleep deprivation or screaming infants to care for there.
    Having been treated for depresion myself when I was younger, and having a wife who suffered post-natal depression for more than a year I don’t think I’m being glib at all. I also have a friend who’s husband is a manic depressive; another ghastly beast entirely. So, I am fully aware of the seriousness and complexity of depression. What is trivialising is equating depression, which if left untreated can become chronic, with “unhappiness”. Am I to take it that you think depression, as opposed to manic depression, is nothing more than feeling a bit out of sorts with the world?
    With regard to men becoming depressed following the introduction of a new family member, I think it’s quite likely, though I wouldn’t put it down to lack of sleep and I wouldn’t call it “post-natal” depression. That people can become depressed following catastrophic changes in their lives is pretty well established isn’t it. But I also think the causes of post-natal depression are different, even if the symptoms and results are the same. The fact that the mechanism isn’t entirely understood doesn’t invalidate the diagnosis of depression. As Melissa has pointed out, one is prescribed the same medication irrespective of the cause – it’s still depression (as opposed to “unhappiness”).

  4. kim said,

    April 24, 2006 at 6:36 pm

    Hi PV and Melissa

    To answer questions first: Melissa, yes, the treatment is the same for both postnatal and ordinary depression. PV: No, I don’t think that depression is “nothing more than feeling a bit out of sorts with the world.” In fact, I think that depression is an immensely serious problem, as you do; the misery that women with new babies experience is absolutely genuine, as are the other kinds of depression that people suffer.

    The point I come back to again, though, is whether depression is an illness. Now I don’t pretend to have a simple answer to that but I do think it’s a question worth asking. And the answer isn’t necessarily “yes” or “no”; it could be “sometimes”.

    To expand a bit further. Last year I interviewed an academic psychiatrist about postnatal depression for an article I was writing. He said that the rates of depression among women who had just had a baby were about the same as in the population at large, ie about 10-15 percent. In that sense, he said, “postnatal depression” wasn’t a useful term. But he added that for a minority of women, there did seem to be something about giving birth that actually triggered the depression.

    For the same article I interviewed women who’d had PND. I was struck in particular by one woman who seemed to match his description: her baby hadn’t been especially demanding or difficult (as is often the case when women have PND), but it sounded as if something had “flipped” after she’d had the baby; she really did experience a dramatic change in personality and became seriously depressed. She was convinced that there was a physical cause behind it.

    But I also think that it’s very hard to say where unhappiness ends and depression begins. It seems to me, based on the evidence of friends and acquaintances, including some diagnosed with PND, that it doesn’t take much to get a GP to prescribe anti-depressants. After all, somebody goes along to their GP and says they’re feeling depressed: who is the GP to say, “No, you’re just unhappy?” And what expertise do GPs have in the area anyway?

    I come back to the question of whether it’s an illness. Somebody loses his entire family in a car crash: understandably he enters a deep depression. Does that mean he’s suffering from an illness? Or is he experiencing a normal human emotion? You might argue that it doesn’t matter what we call it: if it can be made better by medication, why worry? But it makes me uneasy.

    And it brings me back to Ben’s original article, which was about pharmaceutical companies medicalising ordinary problems. It suits pharmaceutical companies if lots of people are diagnosed with depression because they get to sell their SSRIs. Perhaps the pharmaceutical companies are right – the fact that they have a special interest in getting their drugs prescribed doesn’t of itself mean that they’re wrong. But I think we ought to ask the question.


  5. pv said,

    April 25, 2006 at 8:59 pm

    Kim, it all seems to hang on how you define “illness”.

  6. owen said,

    April 26, 2006 at 10:21 am

    I agree with pv.

    Does anyone remember Thomas Szasz whose book “The Myth of Mental Illness” was popular once upon a time. Here is a quotation from an article “Mental Disorders are not Diseases” writen in 2000:

    “Psychiatrists and their allies have succeeded in persuading the scientific community, courts, media, and general public that mental illnesses are phenomena independent of human motivation or will.

    THE CORE CONCEPT of mental illness–to which the vast majority of psychiatrists and the public adhere–is that diseases of the mind are diseases of the brain. The equation of the mind with the brain and of mental disease with brain disease, supported by the authority of a large body of neuroscience literature, is used to render rational the drug treatment of mental illness and justify the demand for parity in insurance coverage for medical and mental disorders.

    Reflecting the influence of these ideas, on Sept. 26, 1997, Pres. Clinton signed the Mental Health Parity Act of 1996, which took effect on Jan. 1, 1998. “This landmark law,” according to the National Alliance for the Mentally Ill, “begins the process of ending the long-held practice of providing less insurance coverage for mental illnesses, or brain disorders, than is provided for equally serious physical disorders.” Contrary to these views, I maintain that the mind is not the brain, that mental functions are not reducible to brain functions, and that mental diseases are not brain diseases–indeed, that mental diseases are not diseases at all.

    When I assert the latter, I do not imply that distressing personal experiences and deviant behaviors do not exist. Anxiety, depression, and conflict do exist–in fact, are intrinsic to the human condition–but they are not diseases in the pathological sense.”

    You can find the complete article here:


  7. kim said,

    April 26, 2006 at 2:28 pm

    Agreed entirely – it does depend on how you define illness. And I think the evidence on conditions like schizophrenia seems to suggest (I’m deliberately being tentative here!) that it’s the result of something physically going wrong in the brain rather than the result of particular social conditions, which is what RD Laing and Thomas Szasz argued.

    But depression? I’m not so sure. And I think we should tread carefully with drug treatments. There was an interesting article by Susan Greenfield in yesterday’s Guardian (,,1760103,00.html). She says,

    “Already there are reports of an alarming increase in the use of prescribed and black market drugs medicating the classroom, whether it be Ritalin for enhancing concentration, Prozac for enhancing mood or Pro-vigil for extending alert wakefulness.

    The problem with these drugs is that they do not target a single trait, such as mood, or concentration, or wakefulness – partly because we do not yet understand how these functions are generated as a cohesive operation in the brain. Rather, drugs manipulate, in a very broad way, the chemicals in the brain. And that, in turn, could have widespread and long-lasting effects.”

  8. Teek said,

    April 28, 2006 at 8:26 am

    does anyone have the link to the PLoS article referred to here:,,1763199,00.html

    putting this on the agenda is top work again Ben, i tend to agree that every twinge, niggle, i’m-feeling-a-bit-down, headache etc must be given a label and a pill to go with it – i like the analogy of placebo diagnosis, this sort of thing does indeed placate those of us who need reassurance that something really is wrong wen in actual fact we just need to go for a walk/drink some water/have some chocolate or sex/eat properly etc.

    still, i think there’s a danger in making genuine conditions (true clinical depression, post-natal or not) into a trivial matter, when these things are often really serious and have a basis in the biochemistry of the brain.

  9. kim said,

    April 28, 2006 at 11:09 am

    PV – I think that’s true, external conditions can lead to physical disorders in the brain. But the question that follows naturally is whether you then treat the physical disorder or whether you change the external conditions. Surely it’s better to address the problem of sleep deprivation, for example, than to administer drugs.

    Was also interested in the link posted by Teek and the Glaxo comment about restless legs syndrome. A relative of mine has suffered from restless legs for about 50 years – long before the medical profession even gave it a name (his doctor refused to acknowledge the problem for years), let alone found a drug to treat it. It’s only in the past few years that he’s been given medication for it and it has made a huge difference to his life. So I think what Teek says is right: it’s easy to trivialise a complaint (which, in the case of RLS, has a silly-sounding name) that can actually make people’s lives a misery.

  10. Teek said,

    April 28, 2006 at 11:55 am

    errr, hang on a minute Kim…!!

    i posted the Glaxo article to point out what a big defence the pharma giant had launhced, not to legitimise RLS. what i said in terms of trivialising real conditions applied to depression, not restless leg syndrome – i have utter confidence in saying that, even tho i have a habit of moving my leg up and down if i’ve sat down for ages or i’m concentrating, i would never label it as a syndrome and take drugs for it – just get up and stretch your legs!!!!

    let me make myself clear. i think RLS is the perfect example of medicalisation of something trivial, whereas depression is seen as trivial but is in many cases a genuine, often serious medical disorder that needs treatment.

    please don’t misunderstand my intentions, therefore, in posting the above article!!

  11. pv said,

    April 28, 2006 at 12:58 pm

    Kim, physical events such as being pregnant and giving birth cause huge changes in the body and body chemistry; e.g. lactation, pain tolerance… Post-pregnancy is another enormous adjustment for the body to deal with. Since the brain controls bodily function it’s hardly surprising that chemical abnormalities/imbalances (whatever they’re called) in that particular organ might develop, thus predisposing the onset of a condition such as depression.
    With regard to external or social conditions that might cause depression, it could very well be (probably, usually is) that the conditions are chronic or have already passed. Removal or alleviation of these conditions isn’t usually an option. What’s left is the disorder which might, or might not, right itself. Even if it rights itself – at what cost elsewhere?
    I think there’s no doubt that drug interventions for depression are by and large successful and have even saved people’s lives; both metaphorically and literally. That the mechanisms aren’t properly understood is beside the point. I suspect it’s the subject of many researchers. In any case, all the medical practitioners I’ve come across in recent years regard depression as an illness.

  12. Melissa said,

    April 28, 2006 at 5:04 pm

    But Teek, isn’t RLS a side effect of sleep disorders? That makes it rather different from just moving your legs when bored or in need of a stretch. I admit it has a stupid name, which opens the door for misunderstanding.

  13. Melissa said,

    April 28, 2006 at 5:07 pm

    I agree with pv that it is useful to classify depression as an illness, chiefly because it destigmatizes it and makes a sufferer more likely to seek treatment instead of just suffering in silence and possibly blaming themselves for not being strong enough to “snap out of it.”

  14. kim said,

    April 28, 2006 at 6:04 pm

    Melissa – your point about RLS is well-made. My relative used to lie awake with restless legs and did exactly what Teek suggests, ie he used to get up and walk about. Sometimes he would stick his feet in the fridge! Then he would go back to bed and get restless legs again. The results was hours of lost sleep every night. As has been pointed out elsewhere, lack of sleep can lead to depression, and depression can lead to suicide. RLS isn’t trivial if you’re the person suffering from it.

    But I feel Teek is suffering from a bad case of “irregular verb syndrome”, conjugated this:

    I have a really bad case of the ‘flu
    You have a mild cold
    He or she is a malingerer…

  15. ronanos said,

    May 11, 2006 at 3:24 pm

    I assume that I have RLS, I’ve had it as long as I can remember (I can remember having difficulty travelling in cars from 15 years ago and more) – far longer than knowing it was “medicalised”.

    I am not on any medication, but would like to point out that it’s not a simple “urge to move your legs” like you get if you need a stretch, but a horrible feeling that doesn’t correspond to any other sensation I have ever had. At times, the “urge” leads to involuntary leg twitching, sometimes of a highly visible nature (stamping and kicking). It tends to happen when sitting for long periods of time (used to travel by car around mainland europe), and pretty much every night before I fall asleep.

    It may not be a “disease”, but it’s annoying to have people laugh at it, when I find it affects my life in a negative way.

  16. DrGlenn said,

    October 20, 2006 at 6:24 pm

    Teek said….let me make myself clear. i think RLS is the perfect example of medicalisation of something trivial, whereas depression is seen as trivial but is in many cases a genuine, often serious medical disorder that needs treatment…oh

    I had this for several years while I was on dialysis and even though this was caused by the toxins affecting my nervous system it wasn’t taken seriously then by the medics in charge of my case. What a hoot it was, having to walk all night long for two years trying to calm them down just to sleep and then being told it really wasn’t that bad by my medics then. Thank God it is taken more seriously today and there is a treatment. The attitude displayed by some here reinforces my opinion that there medics out there who are unable to listen, really listen openly. I’ve dealt with the serious illness professionaly and in my personal life and I really wish some doctors mental thought processes could be medicalised and treated too.

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