Prologue
Selling sickness
by Ray Moynihan and Alan Cassels
Thirty years ago the head of one of the world’s best-known drug companies made some very candid comments. Close to retirement at the time, Merck’s aggressive chief executive Henry Gadsden told Fortune magazine of his distress that the company’s potential markets had been limited to sick people. Suggesting he’d rather Merck to be morelike chewing gum maker Wrigley’s, Gadsen said it had long been his dream to make drugs for healthy people. Because then, Merck would be able to « sell to everyone. » 1 Three decades on, the late Henry Gadsden’s dream has come true.
The marketing strategies of the world’s biggest drug companies now aggressively target the healthy and the well. The ups and downs of daily life have become mentaldisorders, common complaints are transformed into frightening conditions, and more and more ordinary people are turned into patients. With promotional campaigns that exploit our deepest fears of death, decay, and disease, the $500 billion pharmaceutical industry is literally changing what it means to be human. Rightly rewarded for saving life and reducing suffering, the global drug giants are nolonger content selling medicines only to the ill. Because as Wall Street knows well, there’s a lot of money to be made telling healthy people they’re sick.
At a time when many of us are leading longer, healthier, and more vital lives than our ancestors, saturation advertising and slick « awareness-raising » campaigns are turning the worried well into the worried sick. 2 Mild problems are painted asserious disease, so shyness becomes a sign of social anxiety disorder and premenstrual tension a mental illness called premenstrual dysphoric disorder. Everyday sexual difficulties are seen as sexual dysfunctions, the natural change of life is a disease of hormone deficiency called menopause, and distracted office workers now have adult ADD. Just being « at risk » of an illness has become a « disease »in its own right, so healthy middle-aged women now have a silent bone disease called osteoporosis, and fit middle-aged men a lifelong condition called high cholesterol.
With many health problems, there are people at the severe end of the spectrum suffering genuine illness, or at very high risk of it, who may benefit greatly from a medical label and a powerful medication. Yet for the relativelyhealthy people who are spread across the rest of the spectrum, a label and a drug may bring great inconvenience, enormous costs, and the very real danger of sometimes deadly side effects. This vast terrain has become the new global marketplace of potential patients – tens of millions of people – a key target of the drug industry’s multibillion-dollar promotional budgets.
The epicenter of thisselling is of course the United States, home to many of the world’s largest pharmaceutical companies, and the stage on which most of the action in this book takes place. With less than 5 percent of the world’s population, the U.S. already makes up almost 50 percent of the global market in prescription drugs. 3 Yet spending in the U.S. continues to rise more rapidly than anywhere else, increasing byalmost 100 percent in just six years – not only because of steep increases in the price of drugs, but because doctors are simply prescribing more and more of them. 4
Prescriptions for the most promoted categories, like heart medicines or antidepressants, have soared astronomically in the U.S., with the amount spent on these drugs doubling in less than five years. 5 In many other nations the trendis also up. Young Australians took ten times more antidepressants in 2000 than they did in 1990. 6 Canadian consumption of the new cholesterol-lowering drugs jumped by a staggering 300 percent over a similar time period. 7 Many of those prescriptions enhanced or extended life. But there is a growing sense that too many of them are driven by the unhealthy influences of misleading marketing rather…