I started Medical School about 35 year ago. To put things in medical perspective, AIDS had not been named, nor had the virus been found. Ulcer treatment had just seen its first breakthrough in Tagamet (Cimetidine) a true H2 blocker. Restless Leg Syndrome, Overactive Bladder and Erectile Dysfunction did not exist, at least not in text books.
As we progressed through classes and clinics we saw patients with complaints that involved frequent voiding, but we were trained to look for a cause of the problem and treat that. Patients were amazed that if they reduced intake of stimulants like caffeine and nicotine and avoided large quantities of liquid before a long car trip or bed time how much improved their symptoms were. For some we prescribed an exercise program that put emphasis on the strengthening pelvic muscles. The occasional patient had a non-specific urethritis that was treated with an antibiotic.
We did not have a magic bullet drug for this symptom, nor did we need one. Drugs were rarely advertised on television (of course we only had a handful of channels then) or print and we did not have the Internet or an In Box full of junk mail.
A lot has changed. A few channels of television have moved to hundreds of cable selections and the content which was “G” is now closer to “R”. Ads include women looking for bathrooms supposedly because of their overactive bladders and couples sitting in bathtubs with big smiles overlooking the ocean seeming pleased with recent use of an Erectile Dysfunction medication.
Medical journals are tools that physicians use to communicate results of research and this science becomes part of our practice in what we call evidence based medicine. I read a lot of medical journals, but I have not found the land mark articles published when Overactive Bladder (OAB), Restless Leg Syndrome (RLS) and Erectile Dysfunction (ED) were discovered. In one way or another, these symptoms have existed for a long time.
There are frequently underlying causes for these symptoms that should be addressed and treated. But when a drug is found to act on a specific symptom they are then referred to as a disease by the owners of the drugs, the pharmaceutical companies. Thus the birth of a new disease. This disease was not discovered; it was created or, better yet, mongered by the pharmaceutical companies who hold the patents.
One such class of drugs has the ability to block the nerve receptors that go to the bladder. A few studies show that the numbers of urinations per day are reduced by this drug. Then the real research begins; the marketing research. The drug is packaged as a cure for Overactive Bladder (OAB). The marketing blast includes innovative commercials and web based content that allows you to create a step wise plan to cure your OAB.
That plan, of course, includes some instructions on watching what you drink, some basic pelvic exercises and to take their magic bullet pill every day. There punch line is always something like, ‘tell your doctor you want our magic bullet to treat your OAB’.
Disease Mongering means billions of dollars to pharmaceutical companies. Once they find a class of drug that has a unique property they create derivatives (drugs that structurally are similar to the original compound), test them and if they show the same effect, maybe stronger, maybe fewer side effects or maybe cheaper to synthesize. When the initial patent runs out, they simply roll out the newer, better drug and the money continues to flow.
Research and development (R&D) for new classes of drugs, so called New Molecular Entities (NME) is very expensive and only rarely yields a new compound that has potential. It then needs to progress through the various phases of testing before FDA approval and sales can begin.
The process of using derivatives of Known Molecular Entities (KME) is cheaper and faster. The most creative part of this approach turns out to be the marketing. Sadly, pharmaceutical companies spend huge sums of money on the marketing and advertising of these “new” drugs.
Many of these new drugs do not have any long term testing prior to the market push. What does long term blockage of bladder muscle contraction do to the bladder muscle itself? Will there be muscle weakness after long term use? Will men with enlarged prostate glands have a risk of urine blockage?
Is Disease Mongering wrong? There’s an inherent lack of honesty in the marketing that touts a pill as a fix for a problem that is then packaged with a ‘plan’. A real study would be to follow the same plan with and without the magic bullet and see what percentage of patients actually have a reduction in their OAB. Are patients just looking for a pill so they can continue their current habits?
New drugs are not without risks and many of those are not fully understood when the drug is released. Risks of side effects must be weighed against the benefits. What you are actually weighing is the risk of side effects against the unwillingness to make these lifestyle modifications, but that’s another topic.
What’s the next new disease to be mongered? Are you Tired In the Morning? You must have TIM. More on the pharmaceutical advances for TIM in my next blog.
Please send email responses to Dr. Brooks at firstname.lastname@example.org