When profit leads the way to diagnosis: doctors and profit-mongers

Here are some excerpts from Borch-Jacobsen’s review of David Healy’s new book on bi-polar disorder. Healy’s findings are deeply troubling, since they sketch out a pattern of pharmaceuticals influencing the deep structure of how medical knowledge is formed, and therefore the way doctors’ diagnoses are generated. If profit motive, even unconsciously, reigns supreme over how the medical field produces knowledge, then patients become as exploitable as infomercial consumers: whether the patient and doctor are aware of it or not, if the knowledge itself is formulated primarily in the interests of profit, then their relationship is primarily one of profit-generation, and not of healing. Shamans used to heal us. Healers used to heal us. Today’s doctors don’t heal us, they prescribe things that we consume.

Which came first, the condition or the drug?

by Mikkel Borch-Jacobsen


A Short History of Bipolar Disorder by David Healy
Johns Hopkins, 296 pp, £16.50, May 2008, ISBN 978 0 8018 8822 9


One now speaks of a ‘bipolar spectrum’, which includes, along with bipolar disorders I and II, cyclothymia (a mild form of bipolar II) and bipolar disorder ‘not otherwise specified’ (an all-purpose category in which practically any affective instability can be placed). The spectrum also includes bipolar disorders II1⁄2, III, III1⁄2, IV, V, VI, and even a very accommodating ‘subthreshold bipolar disorder’.

The category has expanded so much that it would be difficult to find anyone who couldn’t be described as ‘bipolar’, especially now that the diagnosis is liberally applied to people of all ages. Conventional wisdom once had it that manic depression burns out with age, but geriatric bipolar disorder is now the talk of psychiatric congresses. Elderly people who are depressed or agitated find themselves diagnosed with bipolar disorder for the first time in their lives and are prescribed antipsychotics or anticonvulsants that have the potential to drastically shorten their life expectancy: according to David Graham, an expert from the Food and Drug Administration, these psycho-tropic medications are responsible for the deaths of some 15,000 elderly people each year in the United States.

In August 2002, a cover of Time magazine read: ‘Young and Bipolar – Once called manic depression, the disorder afflicted adults. Now it’s striking kids. Why?’ The article listed a series of ‘warning signs’ for parents: ‘poor handwriting’, ‘complains of being bored’, ‘is very creative’, ‘intolerant of delays’, ‘curses viciously in anger’, ‘elated or silly, giddy mood states’.

Healy has another, more cynical explanation: the never-ending expansion of the category of bipolar disorder benefits large pharmaceutical companies eager to sell medications marketed with the disorder in mind.

Behind the psychiatrists’ constant redrawing of the map of mental illness in a sincere effort at better understanding, there are enormous financial and industrial interests that steer research in one direction rather than another.

For researchers, mental illnesses are realities whose contours they attempt to define; for pharmaceutical companies, they are markets that can be redefined, divided up and extended in order to make them ever more lucrative.

As Vince Parry, the president of an advertising agency and author of professional articles on pharmaceutical marketing, puts it, ‘No therapeutic category is more accepting of condition branding than the field of anxiety and depression, where illness is rarely based on measurable physical symptoms and, therefore, open to conceptual definition.’

conceptual gerrymandering

But the reality of the contemporary medical-industrial complex is that their hypothesis would not have survived, let alone prospered, had it not been ‘recruited’ at a particular moment by the pharmaceutical industry and thrust on the public with the help of the most sophisticated marketing and advertising techniques.

By subsidising one research programme instead of another, one conference or symposium, one journal, one publication, one learned society etc, the pharmaceutical industry makes precious allies among the ‘key opinion leaders’ of the medical establishment, and gains a very efficient means to steer academic discussion towards the illnesses that interest it at any given moment.

Healy tells the story of the launch of bipolar disorder at the end of the 1990s. A specialised journal, Bipolar Disorder, was established, along with the International Society for Bipolar Disorders and the European Bipolar Forum; conferences were inundated with papers commissioned by the industry; a swarm of publications appeared, many of them signed by important names in the psychiatric field but actually ghost-written by PR agencies. Once the medical elites were bought and sold on the new disease, armies of industry representatives descended on clinicians, to ‘educate’ them and teach them how to recognise the symptoms of bipolar disorder. Bipolar patient advocacy groups sprang up, generously supported by pharmaceutical companies; freelance journalists were hired to write magazine articles on the latest advances in psychiatric science; websites were created, such as IsItReallyDepression.com (sponsored by AstraZeneca), where you can fill out a ‘mood assessment questionnaire’ at the end of which you’ll inevitably be dispatched to the nearest doctor. As a British blogger noticed recently, the Wikipedia entries ‘Bipolar Disorder’ and ‘Bipolar Spectrum’ were edited from a computer belonging to AstraZeneca, ensuring that everyone is on the same diagnostic page as the industry.

After this marketing blitz, it was no longer possible to ignore bipolar disorder. A new reality emerged, constructed by scientific articles, patient testimonials, rating scales, statistics, epidemiological surveys, clinical guidelines, everyday language (‘I’m bipolar’), vague fears and reassuring medications.

Pharmaceutical companies today launch diseases in the way that fashion companies launch new brands of jeans, creating needs that align with industrial strategies and the duration of patents.

Pasted from <http://www.lrb.co.uk/v32/n19/mikkel-borch-jacobsen/which-came-first-the-condition-or-the-drug>



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