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. interbreeding said,

    April 15, 2006 at 4:57 am

    sorry Ben, where are these examples of medicalisation being something which drug companies do to unwitting victims? Secondly, I think this stuff about people’s complicity in medicalisation is a bit rich, or better, a bit trivial. Yes, people have the theoretical capacity to resist these messages, but most of them have neither the education, nor the energy, nor the inclination.

  2. Aliera said,

    April 15, 2006 at 6:10 am

    Very nicely said! I wouldn’t limit it to just medical companies exaggerrating their drugs and the conditions they’re meant to cure though. I mean, commercials these days are full of “scientific breakthroughs” to keep your teeth clean, give you a good night’s sleep and all that… Anyway, good stuff in this entry!

  3. RS said,

    April 15, 2006 at 11:36 am

    “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”

    The problem with this position is that you can also take it too far the other way; I know a lot of doctors that basically dismiss IBS, depression and other conditions where the pathophysiology is unclear – that is not a healthy attitude.

    I’m curious as to how something like lactose intolerance fits into your schema – “what do we add by giving it a biomedical label, rolling out the diagnosis to include half the population”? Well we stop telling people that there is nothing wrong with them and that they should just drink their milk and stop complaining!

  4. NelC said,

    April 15, 2006 at 12:09 pm

    Interbreeding, where do you think those lazy arses at the Daily Mail got their story about Sertraline? Did they make it up out of whole cloth, or do you think they might have just copied a Pfizer press release nearly word for word?

    And a medical study with only 17 subjects and no control group? I mean, that’s just taking the piss. It shows a depth of cynicism at Pfizer that astounds me. It’s quackery, plain and simple. Isn’t there someone who can fine Pfizer for this rubbish?

  5. Pedantica said,

    April 15, 2006 at 12:20 pm

    There seems to be an interesting change of attitudes with respect to disease that has probably been going on for some time. There was a time when many people were very reluctant to admit to medical conditions particularly where they are on the margins of what one might consider being a medical condition versus simply being slightly off centre in terms of overal human variation. Recently this position appears to have completely reverse such that there seems to be a general tendancy to want to own up to medical conditions in such marginal situations or even where there is no medical condition at all.

    Once parents would have prefered it if their child was just a bit slow at reading and perhaps been horrified by the idea that little Timmy had a medical condition. Now being a bit slow at learning to read is unacceptable, little Timmy must have dyslexia. I don’t want to suggest that there is no medical basis for dyslexia, I’m just using it as an example, perhaps one of many, where there does appear to have been a signficant change over the years.

    I can think of a few possible reasons for this and I’m sure there are many more.

    Firstly there is a set of positive reasons. We may simply be getting better at recognizing diseases and medical conditions, and more scientifically literate in categorizing them both among the medical profession and in society more generally; we are today better informed about the health of ourselves and our families than in the past. At the same time we may be losing some uninformed stigma attached to many diseases which may have led to people being reluctant to admit them in the past. Again this would be a good thing. And thirdly it may be that we now see disease as something generally curable, so recognizing the existence of a disease is seen as a good thing because it is the first step to finding a cure.

    These might broadly be categorized as things which help reduce underdiagnosis.

    Then there are a number of perhaps more negative or worrying things that may be contributing to the phenomenon. It may be a sort of victim mentality or the desire to have an excuse. If little Timmy has dyslexia then it’s a medical condition and perhaps his parents could not do much about it. If he’s a bit slow at reading then either it can be seen as either his fault, or his parents fault, rightly or wrongly. A disagnosis has the effect of pointing the finger of blame at an abstract concept, a disease, rather than the individuals involved. In addition as you say, where there is a disease there is a market for cures, whether or not they work, and accordingly whether or not there is a real disease at all.

    These might broadly be categorized as things which help increase overdiagnosis.

  6. RS said,

    April 15, 2006 at 12:22 pm

    I think there are very practical reasons for wanting a dyselxia diagnosis – extra help and extra time in exams – very middle class aspirations.

  7. Michael Harman said,

    April 15, 2006 at 1:58 pm

    www.timesonline.co.uk/article/0,,3-2128371.html
    www.timesonline.co.uk/article/0,,8123-2133725.html

    Snap!

  8. jimyojimbo said,

    April 15, 2006 at 3:22 pm

    RS – the thing is, extra time in exams etc isn’t really proposed as a treatment for dyslexia, more of a recognition and an allowance for the condition.

    Surely there are two things here: Firstly there is diagnosis of a problem. This is recognition of the problem, and basically just gives the individual the knowledge that they have a particular condition, disease etc. And secondly there is the treatment of a condition. It is in the latter situation where the credulous can be exploited by cynical means.

    For example (this is based on my limited knowledge): Gluten intolerance is a medical diagnosis, (Coeliac disease, I think). The only “treatment” is a gluten free diet. Now, saying the phrase “don’t eat foods containing gluten” isn’t going to turn out very profitable for you. It’s more that if you are diagnosed as such, you are therefore made aware that you should try and avoid certain foods.

    On the other hand, cynically selling a pill that “treats gluten intolerance” with no evidence for its worth is a cynical exploitation of the treatment phase, not the diagnosis phase.

  9. Pedantica said,

    April 15, 2006 at 4:06 pm

    “RS – the thing is, extra time in exams etc isn’t really proposed as a treatment for dyslexia, more of a recognition and an allowance for the condition.”

    Just to play devils advocate, surely a poor reading speed due to other mental faculties apart from dyslexia can also be considered a condition. Couldn’t we propose to recognise it by giving less intelligent children more time in exams across the board.

  10. imagineyoung said,

    April 15, 2006 at 9:47 pm

    And then we could take the length of time an exam was completed in into account when marking it.

  11. tomh said,

    April 15, 2006 at 10:15 pm

    “Just to play devils advocate, surely a poor reading speed due to other mental faculties apart from dyslexia can also be considered a condition. Couldn’t we propose to recognise it by giving less intelligent children more time in exams across the board.”

    So I guess the new question shouldn’t be: “What grade did you get at gcse/alevel”, rather: “how much extra time did it take to get your A*”

    I always thought I was a bit (tiny bit) of a fraud when I had extra time in maths exams, sinse i dont have any problems in ansering those questions (espesialy comparied to the essay questions you get in english)

  12. raygirvan said,

    April 16, 2006 at 1:54 am

    Let’s not forget extra time for hand-writing slowly. I get writer’s cramp very quickly – always used to hate people who rapidly wrote huge screeds in exams (I consoled myself with the thought that it was probably regurgitated rubbish).

  13. Darth_Tater said,

    April 16, 2006 at 11:08 am

    Moving slightly further off-topic, it’s not just extra time in exams. You can also get a reader or an amenuensis to help with exams if you meet particular criteria. Now this is all very well but with the exam boards being somewhat less than trusting souls you have to have an invigilator in the room with the reader and the candidate. That’s two adults to one pupil. The reader is usually a teaching assistant who is thus unavailable to the class they would normally be with. The teachers’ workload agreement says no invigilation of external exams so the invigilator is paid for over and above the normel complement of invigilators needed in the main exam hall.The staffing and financial considerations for a school with a significant proportion of pupils on the SEN register can be considerable.

  14. blakestacey said,

    April 16, 2006 at 5:00 pm

    More or less on-topic, see also the special in PLoS Medicine on “disease mongering”:

    collections.plos.org/diseasemongering-2006.php

  15. David Mingay said,

    April 16, 2006 at 7:08 pm

    From my experience as a teacher, it’s the intelligent and problem-free students who should get extra time, since they’ve got more, and more interesting, things to say.

  16. David Mingay said,

    April 16, 2006 at 7:14 pm

    Restless Leg Syndrome is a hoot. If you go to GlaxoSmithKline’s website for Requip, the drug they sell to deal with this hideous problem which now affects “up to 25 million Americans”, there’s a handy self-diagnosis questionnaire with items such as:

    Do you sometimes have a compelling urge to move your legs, often accompanied by uncomfortable leg sensations?
    Does moving your legs provide temporary relief?

    Clearly, if you answer “yes” to these questions, the response should be that you get up off your fat arse, move away from the computer, and go for a walk. But where’s the profit in that?

  17. DrSteve said,

    April 16, 2006 at 10:08 pm

    I think that a wider phenomenon that is fuelling the medicalisation of common problems – the increasing democracy of health information (for which we can thank the internet and the popular media).The lay public believes itself increasingly well-informed and as such the the doctor-patient encounter is becoming more fraught. Patients are challenging diagnoses or prescribed treatment – Doctor doesn’t know best in many patients eye’s these days. As such many people are taking control of their own treament of real or perceived health problems in all sorts of ways (ie complentary therapy, holistic medicine etc) if they feel misunderstood, hard done-by or not taken seriously. The medicalisation of common ailments with the promise of some kind of palliative is a predictably rational market-orientated response to what the modern public demands – some feeling of personal control over their health.

  18. Darth_Tater said,

    April 17, 2006 at 9:05 am

    Restless leg syndrome: surely a session of Brain Gym will sort it out?

  19. Moganero said,

    April 17, 2006 at 4:04 pm

    “It’s Brain, Gym, but not as we know it.”

    Perhaps I should try some of this Brain Gym – perhaps it’s the cure for my CFS that I have been waiting for all these years!

    Is it cheaper than all the medical methods that don’t work?

  20. potsy700 said,

    April 17, 2006 at 9:51 pm

    It is a bit rich for my favourite paper that I love to hate, The Daily Mail, to complain about medicalisation given the amount of medical pseudo-science they peddle on a daily basis. Every bloody thing they mention is a ‘wonder drug’ or ‘miracle cure,’ as long as, in reality, it isn’t. When someone actually came up with a treatment that does have remarkable efficacy xperimentally, i.e. the cervical cancer vaccine, they slagged it off for being immoral.

    As for the Pfizer study….so what? As a doctor, if someone came to me and asked for sertraline for night eating syndrome, my response would be: a) What the fuck is night eating syndrome??? b) Where’s the evidence that sertraline can help? and c) stop reading the Daily Mail, you wanker.
    In this country at least, I have faith in most of my medical colleagues in that they won’t just prescribe something because their patient wants it and it was mentioned in the Daily Mail. That’s the reason that some drugs are classified as prescription-only. Okay, we’ve all given in to pressure to prescribe antiobiotics inappropriately at some point, but mostly we’re pretty good at saying ‘no.’

    What worries me more is the medicalisation of things and the promotion of ‘treatments’ that the public can freely get access to, often at great expense. This whole thing at the moment about ‘ food doesn’t have the corrcet amount of nutrients in it anymore ‘ is fuelling an entire industry, and the fact that so-called ‘celebrities’ like Heather Mills McCartney promote this shit does not help. Firstly it makes the public think there is something wrong with them when there isn’t, secondly it encourages them to spend a fortune on stuff they don’t need and which doesn’t work, and thirdly it promotes distrust in science and fuels the ‘medical establishment conspiracy’ theory. I’ve got a copy of Patrick Holford’s ‘Optimum Nutrition Bible’ and in it he claims to be able to cure all sorts of things with vitamins. Get real. If there was any evidence, don’t you think the drug companies and the NHS would have latched onto this by now? No one doubts that a healthy diet is a good thing, but as Ben Goldacre has said on more than one occasion, diet isn’t complicated; there are two rules: don’t overeat and eat your greens.
    I’m afraid that it’s all symptomatic of a distrust in all science in our society. Religion in it’s traditional form may be on the decline, but science is too difficult for a lot of people, so they’ve compromised with pseudo-science – a kind of religion that uses vaguely understood scientific terms. So more people are interested in astrology than astronomy; in the power of pyramids to sharpen blunt razor blades rather than the engineering or mathematics of pyramids; in ‘crystal therapy’ rather than crystal chemistry.
    Over Easter, my own mother asked me ‘if evolution is correct, why are there still monkeys?’ This despite the fact that I have explained natural selection and evolution to her AGAIN and AGAIN over the years. She can understand it; she just doesn’t want to accept it. And that, in a nutshell, is the problem with our society. When David Copperfield flies like Superman across the stage, we want to believe. When Derren Brown controls someone’s behaviour apparently on a whim, we want to believe. The truth is usually far more boring than the fiction to most people. We all ant to believe in miracles.

  21. potsy700 said,

    April 17, 2006 at 10:08 pm

    As a quick addition to my post above, a good example was today’s “Deal or No deal” on channel 4. This programme must be quite fascinating for psychologists. I remember one contestant who had the following conversation with Noel Edmonds, without any evidence that they realised they were completely contradicting themselves:

    Contestant: I believe in destiny. Everything’s planned out to bring you to a certain place at the right time.
    Noel edmonds: But do you believe you can create your own luck?
    Contestant: Absolutley. That’s why I’m here today.

    Now, I have lost count of the number of people who’ve been on this programme with good luck charms, with ‘fate on my side’, who have ‘good vibes about this box’ etc etc and they always push their luck, bet their money against the odds and usually lose and make a fool of themselves. But I’m concious that it would take only ONE instance of someone’s intuition, fate, good luck charm, astrology reading etc, to coincide with a win to convince so mnay people…… So today, the contestant hit the £250,000 box on the first round. So Noel Edmonds wrote a “cosmic order” on a piece of paper, asking the cosmos to make sure that the woman did not hit the boxes containing the next four biggest numbers. Thank God she did. (Irony noted). But she then went on to say that a tarot card reader had once told her that ’10’ was her lucky number. She left box number 10 until last, and eventually gambloed that it had £20,000 inside. It didn’t. And she was heard to say “so much for tarot reading.” Hurray. It won’t stop people making a fortune from it though. And this is the kind of shit we scientists have to deal with. You can work out odds, probabilites and strategy, but it’s muchy easier to go with your tarot cards at the end of the day. Science can only answer so muchy, and is (or should be) honest about that. Mystics appear to offer certainty, and no matte rhow often this is disproved, people still ant to believe.

    So a Doctor can say “we can investigate your problem by doing a prostate biopsy” and folks will screw up their noses. Gillian McKeith and Patrick Holford can say “we can deal with your problem by shoving a coffee enema and a butternut squash up your arse” and people will flock to it; and probably enjoy the sensation.

    Very sad, but very true.
    How do we deal with it? Fuck knows.

  22. le canard noir said,

    April 17, 2006 at 10:26 pm

    I find it amazing how some of my more woo-woo friends cannot see how viciously commercialised the whole alt med scene is.

    – Dr & Herbs on the High Street rubs shoulders with Dixons (and Dixons is forced out).
    – There is three times more shelf-space for ‘Mind, Body and Spirit’ than Popular Science in my local Waterstones. I think the shelf for ‘Angel Healing’ (whatever that is) is bigger than the space on evolution.
    – Our Sunday supplements have more ‘holistic doctor’s’ than real PhDs and Doctors.
    – My boss at work (very smart in the business world) has an anti-EMF crystal glued to the back of her phone and she paid good money for it.
    – Vitamins and Minerals, and other things I can’t recognise, outnumber the tubs of paracetamol, plasters and sterile dresings in most peoples medicine cabinets.
    – Detox is now how you sell any yoghurt-based drink or smoothie.

    …and so on.

    And yet, it is the ‘big pharma’ who are involved in countless twisted conspiracies to keep us ill. Our doctors are blind and ignorant and only want to hide symptoms and not treat underlying causes. The government cannot be relied upon to give us good food advice and our food is vastly depleted in goodness due to supermarket practices.

    Point out the obvious, like:

    – it is only vitamin sellers who want us to eat vitamins
    – forced drinking of 8 glasses of water a day is only really good for Evian
    – sugar is not an adictive drug like heroin
    – Patrick Holford awarded himself that Diploma

    and they look at you as if you are mad…

    Depressed. Anyway, quite pleased that Dixons has gone. useless bunch of tw*ts.

  23. Raging Potato said,

    April 18, 2006 at 4:33 am

    True Stories:

    My girlf was working as a registrar in the allergy unit in a very big children’s hospital. Most of her patients were kids that were legitimately getting treatment for allergies to various things, but the unit used to get quite a few referals from private ‘allergy specialists’ who, at best, were unfamiliar with the literature (or, to interpret it another way, quacks successfully plundering the anxiety of middle class patients, but I digress). These specialists were all medically trained; they were real doctors.

    Two classic examples:
    EXAMPLE 1: Patient sees specialist, tests positive for peanut allergy. Specialist writes letter to child’s school informing head teacher that child has potentially lethal allergy that could be triggered by any exposure to peanuts, including inhaling peanut particles. Recommends school-wide ban on any peanut products in case somebody breaths snickers onto child and triggers anaphylaxis. At clinic doctors assess child’s allergy; has the weakest reaction to peanuts that can still qualify as an allergy. Could safely eat peanuts without fear of dropping dead. No case in which a patient has inhaled allergen-laced breath and suffered a response has ever been recorded.

    EXAMPLE 2: Two sisters have been examined by a specialist . The specialist had diagnosed severe food allergies; put them on a restricted diet that excluded most foods and put the fear of god into them. Seven years later, the parents took one of the daughters to the GP, worried that she still hadn’t hit puberty at ~15 years old. GP took one look at the kid, arranged immediate consultation at the hospital for her and her sister. The poor kids have been malnourished as a direct result of the restricted diet they’d been put on. Damage may be permanent. No food allergies detected in subsequent examinations.

  24. Dr* T said,

    April 18, 2006 at 8:17 am

    From my cynical standpoint, many medicalisations are adopted by a certain personality type who would like to a) appear more interesting than they inevitably are, or b) ensure people have to go to extra efforts just to make them feel special.

    e.g. I have a terribly nut allergy and couldn’t possibly eat anything that’s been near a peanut – you should hear me cough after eating a snickers…..

    or the oldest chestnut,

    I’m a strict vegetarian, but I do eat fish, small amounts of chicken and a little pork.

    Hmmm… seem to have woken up extra cynical this morning…. :)

  25. Big Al said,

    April 18, 2006 at 8:43 am

    I’m a hardcore skeptic, but I think there’s ample evidence for “medicalisation”. For example, ADHD / ADD. This would suggest that, rather than a continuum of kids’ behaviour ranging from one who’s dull and unresponsive to an absoulte hell-raiser, we now have a disorder. This suggests a line, with every kid to the left perfectly normal and every kid to the right with a recognisable syndrrome.

    Yet I believe that Ritalin and its allies are prescribed just because a parent says their kid is problematical.

    Then there’s Seasonal Affective Disorder: so some people get fed up in winter and are happier in summer: what sort of disease is that? Yet there are all sorts of drugs to “cure it”.

    I’m no believer in “Big Pharma” trying to suppress the marvellous efficacy of woo-woo treatments, but I think they do invent cures for diseases that don’t exist.

  26. Hanne said,

    April 18, 2006 at 10:56 am

    With respect to S.A.D- I thought all we needed was more sunlight? Didn’t know that it was available on prescription…

    Dr*T- have you heard of this one:

    I’m a strict vegetarian. I don’t believe animals should suffer at all. I don’t eat any meat- except roadkill.

  27. Adam said,

    April 18, 2006 at 12:07 pm

    If anyone is interested about the relationship between Doctors and patients, I would refer them to the wonderful book “One-Upmanship” by Stephen Potter, which has sadly been out of print for about 50 years.

    Potter advises Doctors who seek to redress the balance in the patient-Doctor relationship to either:

    1) Make the patient believe that they might potentially be quite ill (ask seriously and quietly for full descriptions of symptoms, make copious notes, refer ostentatiously to books entitled “Vetinary Science”, intake breath sharply from time to time).

    2) Talk to the patient as if they are a child (“Your heart is like a kind of pump, it goes ‘squeezee, squeezee’, and your blood is actually full of little soldiers called corpuscles”).

  28. pv said,

    April 18, 2006 at 12:20 pm

    I’m not so sure the pharmaceutical industries are at the root of the medicalisation problem. Well, not alone at any rate. I think this is being driven more by the medical profession in the US (who make the diagnoses) along with the lawyers. Pharmaceutical companies are probably quite keen to provide whatever their clients in the medical profession want. Of course, if it can’t be cured, the next best thing is to hire a lawyer to find someone to blame for the “sickness” and sue them for an obscene amount. America – the land of the free (lunch), and the home of the brave (entrepreneurial scumbags otherwise known as doctors and lawyers)!
    Of course, as every cynical Brit knows, Britain has to slavishly follow, or have its own version of, every “next big thing” coming out of the US (no matter how good, bad, comic or tragic). “Britain’s answer to…”, you choose – Elvis, 9/11, Brain Gym, shopping malls, diet fads, eating habits, exercise regimes, ADHD, obesity, political correctness, language fads, gurus (charlatans), religions, celebrity worship, news presentation, Restless Leg Syndrome and so on.

  29. Ben Goldacre said,

    April 18, 2006 at 12:26 pm

    i think it’s incredibly interesting how resistant people are to taking responsibility for this themselves. there’s so clearly a deep rooted cultural desire to label all pain, distress, or aberration as a disease, and we’re all driving that, perhaps because we want the illusion of an explanation, or authoritative admission into the sick role, or because admission to the sick role can only be obtained with a diagnosis, not with symptoms alone.

    it’s an important question to ask: if there isn’t a legitimate diagnosis that fits, why do we still want one? what does it add? what are it’s dangers?

  30. Fi said,

    April 18, 2006 at 1:04 pm

    “From my cynical standpoint, many medicalisations are adopted by a certain personality type who would like to a) appear more interesting than they inevitably are, or b) ensure people have to go to extra efforts just to make them feel special.

    e.g. I have a terribly nut allergy and couldn’t possibly eat anything that’s been near a peanut – you should hear me cough after eating a snickers…..”

    Ah Dr*T you’ve hit my favourite personality type right on the head.
    The trouble is they make life really shit for people like me with real food allergies (proper patch tests from a real doctor and I have the paper in my medical records to prove it).

    Life has now lurched from no one understands the concept (my childhood spent within easy reach of antihistamines) to actually being able to buy stuff like Soya milk in supermarkets which is good but far too many people assume you’re just making it up for attention or are actually just a fussy eater / McKeith wannabe.

    Though it does give you an alternative rating system for restaurants.
    Q1. Can I eat anything on the menu?
    Q2. How pissed off does the waiter look when you ask them to clarify ingredients?

  31. superburger said,

    April 18, 2006 at 1:39 pm

    obesity has to one of the examples of the ‘medicalisation’ problem. Every other day there is a story about the genetic / environmental causes of obesity and how medicine (real or alternative) can ‘cure ‘ it. People can’t / won’t take responsibility for their fat arses and eat a bit less exercise a bit more, and there is an industry devoted to taking money out of the pocket of people. And it gives Ms McKeith airtime which is a crime beyond all comprehension. …..

  32. Robert Carnegie said,

    April 18, 2006 at 1:45 pm

    If we interpret “medicalisation” not as “selling pills, potions and gadgets”, but “analyzing implications of your lifestyle for personal health”, I think the latter is valid if it genuinely improves your quality of life. Whether it should be funded from the public purse is a different question, but I think I prefer a public body with a sceptical attitude to therapies to be buying treatments of marginal but real value, to being sold them in supermarkets. Even losing weight, taking exercise, and eating fruit, if medicalisation are what those take, are worthwhile. Dental and eye care too – these rarely bring up life-threatening illnesses, but they’re a valid part of the NHS, bolshie dentists notwithstanding.

    Of course being medicalised increases everyone’s stress a little, but most of us are already worried well.

    Then, too, I remember one of Ronnie Barker’s television addresses – “If you wake up every morning feeling something terrible, get a divorce!” …

  33. guthrie said,

    April 18, 2006 at 2:20 pm

    [quote]
    i think it’s incredibly interesting how resistant people are to taking responsibility for this themselves. there’s so clearly a deep rooted cultural desire to label all pain, distress, or aberration as a disease, and we’re all driving that, perhaps because we want the illusion of an explanation, or authoritative admission into the sick role, or because admission to the sick role can only be obtained with a diagnosis, not with symptoms alone. [/quote]

    I suggest its not so much about responsibility, but about control. If you feel there is something wrong, or dont fit in, or have some trouble with something, but can’t seem to do anything about it, then having it labelled a disease means that you now have aname for it, can control it more since it is named, and can then use the placebo effect to be cured.
    Also, if you do have a real (I mean a real physiological change) disease, then its not your fault that you cant hold down a job or something. Look at how long it has taken various problems like ME to be recognised. Or fibromyalgia.

  34. Des said,

    April 18, 2006 at 3:59 pm

    The comments by potsy700 are spot on. Someone recently told me about some guy in America who is ‘allergic’ to the colour red! What happens if he cuts himself, does he come out in a rash and wouldn’t that just lead into a viscious circle? As she claims to have a wide variety of ‘allergies’ so I guess this American geezer is something for her to aim for.

  35. Delster said,

    April 19, 2006 at 7:43 am

    a lot of people are saying things like being overweight are genetic. Whilst genetics can give people a predisposition towards that at the end of the day there are things that people can do to avoid it.

    For instance i only became overweight when i took a desk job and didn’t compensate with exercise and reduced calorific intake. This was my own fault and nothing to do with a disease or condition or “glands”. Unfortunatly a lot of people won’t take that responsability and would rather the state they have gotten themselves into was seen as a problem outside their control as it exonerates them from responsability.

    Yes i realise there are things that are genuine medical conditions (i have hayfever) but a lot of things are just people being people.

  36. superburger said,

    April 19, 2006 at 8:30 am

    precisley delster!

    Human nature being what it is, it should be no suprise that there are also there to pander to people’s delusions and offer medical cures for obesity that don’t involve changes to lifestlyle. Why blame yourself for your solitary greed when it’s clearly glandular…

    I’m sure there is a scheme where GPs are ‘prescribing’ exercise classes to people who are overweight or suffering from mild depression as it is effective in treating both, and people take the exercise classes because someone they trust (a GP) has given the advice, possibly on a bit of paper with the NHS logo on.

  37. Delster said,

    April 19, 2006 at 10:35 am

    :-) i’ve often thought that a good use for the military would be to put over weight people throught the basic training program…. it’s amazing how it shapes you up!

  38. luvaduck said,

    April 19, 2006 at 2:54 pm

    A 100 years ago, medical knowledge came mostly from your mother/grandmother and your local doctor (“lets have a look at your tongue… no, there’s nothing wrong with you – off you go to school”).

    Now we are bombarded with stuff through TV, newspapers, magazines, internet, etc. People haveaccess to too much information but are not given the training to filter it properly.

  39. superburger said,

    April 19, 2006 at 3:58 pm

    Luvaduck, don’t underestimate the power of tongue inspection!

    after buying a ‘PhD’ off the internet you can learn the secrets of how to diagnose all manner of illnesses just by looking at the tongue. You could probably get a C4 show and a publishing deal too.

    Makes you wonder why anyone bothers going to medical school any more.

  40. kim said,

    April 19, 2006 at 5:59 pm

    So, big pharma have a role in the medicalisation of ordinary problems, and we all know of people who medicalise their own problems too – who doesn’ t know someone who claims to have an intolerance to some kind of food?

    But what about the role of doctors? I know an astonishing number of women who have been diagnosed as having postnatal depression and been given pills to deal with it. Is depression always a medical problem? Isn’t feeling miserable when you’re not getting any sleep and you have to look after a yowling baby 24 hours a day, seven days a week, enough to make anyone depressed? And then there are people who are having a bit of a bad time at work and get their GP to write them a note saying they’re suffering from “stress”. Is “stress” a genuine medical complaint?

    I only ask.

  41. Dr* T said,

    April 19, 2006 at 10:02 pm

    I *assume* most people believe stress to be a genuine medical complaint, but I would similarly assume a lot people who go off on the sick for stress are merely frustrated/annoyed/irritated.

    I worked for a while in an NHS environment for a manager who couldn’t manage her way out of a wet paper bag. As I was only a temp, she filled me in on all the politics, but finished off by saying “I’m going off for stress and then see how they cope”, she did and everything worked as well as before.

    Ooops…Complaints about stress-wavers and NHS middle management in the same rant. Must be the Merlot……:)

  42. Melissa said,

    April 20, 2006 at 12:15 am

    ” I know an astonishing number of women who have been diagnosed as having postnatal depression and been given pills to deal with it. Is depression always a medical problem? Isn’t feeling miserable when you’re not getting any sleep and you have to look after a yowling baby 24 hours a day, seven days a week, enough to make anyone depressed?”

    Yes, but think of it this way– I can control what pills I take, but I cannot control how much or how little sleep I get when I have a baby to care for. I’d far rather pop my daily Paxil than, say, fly into a lack-of-sleep-induced rage and hit my child. To my mind, yes, medicate me, please!

  43. Pro-reason said,

    April 20, 2006 at 4:08 am

    It’s ‘bête noire’ with an ‘e’ on the end.

  44. JQH said,

    April 20, 2006 at 10:24 am

    Inventing syndromes for which you just happen to have a cure available is a game both “big pharma” and the alternative therapy brigade like to play. While it is true that we should accept responsibility for our actions, when the press and television are full of stories, adverts and adverts disguised as reports about various new ailments I’m not surprised that people start to believe them.

    We need vigourous application of the Trades Descriptions Act to drug & therapy peddlers, better science education and more qualified scientists writing columns in the press and presenting TV programmes. Maybe then more of the population will see through the disease peddlers and stop buying their rubbish.

  45. RS said,

    April 20, 2006 at 12:31 pm

    “Is depression always a medical problem? Isn’t feeling miserable when you’re not getting any sleep and you have to look after a yowling baby 24 hours a day, seven days a week, enough to make anyone depressed?”

    And how is telling someone that you’re not surprised they’re depressed going to help them? If the pills help them why not prescribe them? Normally you try to address any underlying issues that give rise to depression (or at least, you should) but if you can’t do anything about them, then medication can often be better than doing nothing.

  46. Stu said,

    April 20, 2006 at 8:30 pm

    “And how is telling someone that you’re not surprised they’re depressed going to help them? If the pills help them why not prescribe them? Normally you try to address any underlying issues that give rise to depression (or at least, you should) but if you can’t do anything about them, then medication can often be better than doing nothing.”

    Sounds like an argument for homeopathy.

  47. pinguin said,

    April 20, 2006 at 10:22 pm

    “Sounds like an argument for homeopathy.”

    Homeopathy doesn’t do anything though. Antidepressants make you feel less depressed. Like RS says, it’s better to deal with the underlying problem but at least the medication will stop people from climbing the walls.

    Anyway… about the article

    It might be that people medicalise their lifestye problems so everyone will pat them on the head and buy them grapes, but pharma companies do it because if you make something with a pharmacologcal effect you need to get it past the FDA or the EMEA and they only approve stuff for actual illnesses.

    I think this is a mistake. Why not create a new category for recreational and lifestyle drugs? Things to make you look younger, lose weight, have better sex, get off your face etc etc that have been properly tested? Sure, there might be a bit of an ethics issue on the tox testing but I don’t know – one of my colleagues does drug trials and I think he’d quite enjoy getting something a bit more interesting than yet another arthritis drug.

  48. Ben Goldacre said,

    April 20, 2006 at 10:45 pm

    is there not a sense in which some of these novel medicalised variants will become “placebo diagnoses”, giving the reassurance of a diagnosis, and the social status (entry into the sick role)? the only danger i can foresee is that entering the sick role can itself be a backwards step sometimes, in some circumstances, for some people.

  49. Kira said,

    April 21, 2006 at 9:19 am

    I am not sure that people are actually as willing to accept the diagnoses of mental illnesses such as postnatal depression and stress quite so willinging – there is still a lot of stigma attached to mental illness that is not attached to other illnesses (i won’t call them physical as mental illness can have physical effects).

    Postnatal depression is much more than just feeling down because you are tired and struggling with a baby, and if left untreated can lead to the mother being able to look after her baby, or even worse, harming it or herself, so I think that being given anitdepressants is much better than telling her to pull herself together or whatever the alternative might be.

    Real stress is more than just having a bad time at work, although I imagine that there are some people that can look up the symptoms on the internet and tell their doctor they have these symptoms in order to get signed off work for a while.

  50. pv said,

    April 21, 2006 at 12:43 pm

    “I know an astonishing number of women who have been diagnosed as having postnatal depression and been given pills to deal with it. Is depression always a medical problem? Isn’t feeling miserable when you’re not getting any sleep and you have to look after a yowling baby 24 hours a day, seven days a week, enough to make anyone depressed?”

    I must say that is a gross trivialisation of what is a serious problem for the sufferer and whoever lives with them. If a diagnosis of post-natal depression were confined to these symptoms then I’d have to ask why men are never diagnosed.

  51. 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?

  52. 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).

  53. 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”).

  54. 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.

    Kim

  55. pv said,

    April 25, 2006 at 8:59 pm

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

  56. 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:
    www.szasz.com/usatoday.html

    Owen

  57. 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 (education.guardian.co.uk/egweekly/story/0,,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.”

  58. Teek said,

    April 28, 2006 at 8:26 am

    does anyone have the link to the PLoS article referred to here:

    business.guardian.co.uk/story/0,,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.

  59. 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.

  60. 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!!

  61. 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.

  62. 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.

  63. 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.”

  64. 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…

  65. 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.

  66. 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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