Searching for Syndromes

In a previous post, I talked about “perverse incentives,” that is, market incentives that encourage companies to do the wrong thing, like not drill for oil when there is a shortage. Another, and perhaps more pernicious example comes from the drug dealers. Now, there is no question that both individuals and societies suffer from the use of illegal drugs. However, there may be even more damage from legal drugs.

Drug companies like to justify their obscene markups for drugs on the grounds that research is so expensive. Actually, research isn't the biggest cost in a drug, marketing is, and the profits are so high that the expense is worth it. At least to the drug companies. Whether it is good for patients is another question. Indeed, the real question is who is a real “patient”? A patient used to be someone with an illness, that is someone with a clearly defined pathological disorder. But in such a healthy country as ours, that is simply too small a market. The new strategy is not a search for “diseases,” but for “syndromes,” and the difference is crucial. As an article on the Minyanville website puts it:

In “The Art of Branding a Condition,” an article that appeared in Medical Marketing & Media, Vince Parry, a marketing executive, discussed how pharmaceutical companies are “fostering the creation of a condition and aligning it with a product.”...

Since syndromes are defined by symptoms rather than pathological processes, the old “reverse-placebo effect” can stimulate sales almost immediately. Consumers hear a roll call of symptoms and become convinced they’ve got them, whatever they are. That’s why, these days, RLS “affects” nearly 12 million people in the United States alone. So if your legs are restless, ask your doctor about Requip. And try not to pay too much attention to the excessive sexual urges, hallucinations and compulsive gambling it’s been shown to cause....

Steven Woloshin and Lisa M. Schwartz of the Dartmouth Medical School had this to say on the matter:

“Helping sick people get treatment is a good thing. Convincing healthy people that they are sick is not. Sick people stand to benefit from treatment, but healthy people may only get hurt: they get labeled “sick,” may become anxious about their condition, and, if they are treated, may experience side effects that overwhelm any potential benefit.”
Big Pharma’s tactics are likewise being criticized across the pond. Dr. Maureen Baker of the Royal College of General Practitioners opined:
“It is very much in the interest of the pharmaceutical industry to draw a line that includes as large a population as possible within the ‘ill’ category. The bigger this group is, the more drugs they can sell.”
Some of these “syndromes” turn out to be surprisingly common. There's RLS (Restless Leg Syndrome) selling Requip, Teenage Rebelliousness (Oppositional Defiance Disorder selling Risperdal, Clozaril, Abilify and Seroquel ), Road Rage (Intermittent Explosive Disorder) selling anti-epileptic drugs, Excessive Sleepiness selling Provigil, etc.. Indeed, everybody's got some syndrome or other, hence everybody needs a pill. In the interest of full disclosure, I have “RLS,” which means that occasionally I have to get up and walk it off. Getting rid of this inconvenience is hardly worth taking a daily dose of some toxic and poorly understood substance. And the other ploy is to convince us to take a daily dose of some chemical on the chance that we might suffer some disease. So puff some Nasonex up your nose in case you might get the sniffles, or fill your stomach with Pepcid in case you might get some heartburn.

Aside from any other damage these toxic substances, they certainly divert research funds from real diseases into less well-defined but more marketable channels. However large the portion of the population with cancer, it is infinitesimal compared with that portion that has a “syndrome,” which is pretty much everybody. Thus, there is a perverse incentive to abandon research into real diseases and concentrate on mere syndromes. This is not to say that at least some of the syndromes point to real or even to serious problems. But even here, the research seems to concentrate on mere palliatives rather than real cures.

There is no doubt that illegal drugs can cause great damage to society. But than a large part of the damage arises merely from the fact that they are illegal. Certainly, a large percentage of the young Black population is in prison. Does marijuana have more side effects that Ritalin? I don't know. But I have often suspected that we have the wrong drug pushers in jail.


Anonymous,  Thursday, August 14, 2008 at 1:38:00 PM CDT  

John, I won't disagree that pharma is benefiting from opportunities. But, I'm certain, at least in the case of RLS, that it's not something made up, recent, or that doesn't need attention.

My grandmother started having it in 1940, the year my mother was born. Ekbom, a doctor, wrote about RLS about that same time. The earliest reference in medical literature is in the 1600's, if I remember correctly.

It's been there. It just wasn't like cancer (big deal, you couldn't sleep) and no one could find a cause, so it was ignored. It's not ignored now, thankfully, and the pharma companies are capitalizing on that. In that case, I'm glad.

The incidence, in the largest study of its kind called REST, is 10-15%. But, that's all cases. The study you cite, only includes those with moderate to severe RLS. And, those are usually the only ones who need treatment. Are you suggesting that 2-3% of the population should not sleep so have difficulties concentrating, doing their work, and driving? That it's OK for them to have marital problems (you try sleeping with someone who is kicking you all night)?

Please, do a little more research to find out about RLS. It's not what you think it is.

Anonymous,  Friday, August 15, 2008 at 3:30:00 AM CDT  

John, I commend you for not taking any medicine for RLS because there is a common problem with pharmacies right now (as I have a sister who had to deal with ADHD and the amount of medicines that she was given as a child; and also that I have dealt with clinical depression myself.) At times medicine might do things for these "syndromes" but most of the time I believe that prayer, training and patience helps one to live with these difficulties. If one does not need medicine one should not take medicine (as medicine does have nasty side effects.)
I am happy that someone has written on this topic because in the economy I feel like many pharmacists do take advantage of the fear in our culture and make lots of money off it. Sadly, until people center themselves on something besides themselves, people will suffer from not being able to see past fear. So props to you.


John Médaille Thursday, August 21, 2008 at 11:02:00 AM CDT  

Anon, I am not saying, or I did not mean to say, that there are no syndromes that can benefit from palliative care. I am saying that the cases were this is so are smaller than the marketing would lead one to think.

In general, we should avoid taking poorly understood medicines. There are cases where we have no choice, were it is the best of a bad lot. But money spent on palliatives might be better spent understanding the pathologies.

Anonymous,  Wednesday, December 10, 2008 at 2:28:00 AM CST  

My name is Richard Elmore and i would like to show you my personal experience with Seroquel.

I am 17 years old. Have been on Seroquel for 1.5 years now. I am currently trying to come off it, but my anexiety has been through the roof, and even 2mg of extended release xanax isnt working

I have experienced some of these side effects-
the biggest one is weight gain, i have to take at least 600mg at bed time for it to work.

I hope this information will be useful to others,
Richard Elmore

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