Designer Disease : “I am Wrong”.

NPR news of 10^th November 2010 cited the findings of Centre for Disease Control (CDC) survey : “1 In 10 Kids Has ADHD (Attention Deficit Hyperactivity Disorder)”. The numbers are startling to say the least. They amount to 23% increase over the numbers released in a 2003 survey and add about 1 million children into the ranks of those diagnosed with ADHD. While scientists are not clear about the underlying causes of the rise, partly they hold – greater awareness and stepped-up screening efforts – as responsible. “More parents than before are saying their children have ADHD” – reports the same survey. This agrees with earlier statement. Greater awareness means more parents reporting, and more parents reporting means greater awareness. But this is tautology. It neither explains nor suggests the way forward. Director of ADH & Behaviour Disorders, NYU, weighed in that there is “no blood test or brain-imaging exam for the condition” & cited other reports, which put the rate of ADHD prevalence at about 5%. Diagnosis is a matter therefore of expert opinion, and experts seem to differ here widely. Since “Opinion” is also informed by “Awareness”, it may explain the highly significant divergence among experts. It would be interesting to investigate what instigates this awareness. Remarkably, two-thirds of those diagnosed with ADHD are on drugs. Now Drugs are made by pharmaceutical companies, and more positive diagnoses simply imply more revenues and more profits.

Awareness is a function of information availability, and though the readership of printed material and newspapers may have dropped significantly, that of TV and internet has shot up. Developmental, behavioural or most other psychological disorders are what they call spectrum disorders. That means there is a wide variability in the intensity with which the behavioural responses of such people are altered from what is judged as the norm. Another difficulty is that norms are prescriptive and therefore subjective. What would be considered a perfectly normative behaviour in one culture may be treated as an unacceptable aberration in another. One has to recognize that both the yardstick and the deviations that are measured against it have a significant element of “subjective judgement”, which goes under the name of “Opinion”. Such being the case, the usual marketing and advertising tools could easily be used to shape the opinion of both the laity and the learned. This is the sense one gets when one sees the high powered advertising by pharmaceutical majors targeted unabashedly at “Consumers” and “Practitioners” alike. Is such targeted advertising shaping the outcomes of expert opinions & parental expectations? Only a sweeping study would be able to assess the exact impact of various methods (e.g. Controversial celebrity endorsements) mega corporations use to drive up revenues, but some intuitive conclusions are not beyond our reach. Incidentally, USA & New Zealand are the only two countries where advertising of prescription drugs is permitted.

To begin with US-FDA takes a very ambivalent attitude towards highly aggressive and targeted advertising. Its guide for consumers (see the irony, even patients – often with serious conditions – are looked upon as “consumers of drugs”) says this on the website : “Your healthcare provider is the best source of information about the right medicines for you. Prescription drug advertisements can provide useful information for consumers to work with their health care providers to make wise decisions about treatment”. Once the healthcare provider is proclaimed as the best source of information, the FDA is free to assert that advertisements can provide useful information to consumers. Isn’t this a classic case of running with the hares and hunting with the hounds. Camouflaged by the laudable objective of “informed decision” by the “consumer” lies the insidious asymmetry of information, influence, and power between the consumers and producers. A consumer-patient, already compromised by his health issues, is a soft target of advertisements that are out there to sell, not to educate. Selling “novel drugs”, not unlike selling “sophisticated investment instruments”, very subtly exaggerates the advantages while diminishing the risks – the risks are often there in small print added as an after thought. Like the cigarette adverts of the yesteryears, drug ads focus on lifestyle enhancements that evoke the feel good factor, which makes the drugs a desirable commodity. The following advert of drug Ritalin for example emphasises convenience (& desirable obscurity of the medical condition which medicating in school would likely compromise).

Among the benefits of adverts, one argument claims how they help generate acceptance, “Prescription drug advertisements lessen the stigma associated with many health conditions and thus make it easier for patients to acknowledge their potential health issues”. While this may have some substance, the flip side is they may make it fashionable – any disease is nothing to be ashamed about, but nor is it anything to be proud of. There is an interesting chart of Pros & Cons of prescription drugs advertising that is worth perusing. It says that every dollar spent on adverts fetches dollars four in profits, and among the pros lists an argument that drug companies like any other must legitimately pursue profits (even super profits). When health of most becomes the business of others (see these adverts) the interests of both groups could hardly be convergent. Often, these adverts tempt the consumer-patients by incentivising them with freebies, like in this Abilify advert.

 

Inventiveness of drug companies doesn’t end with peddling formulations for known diseases, but spreads over into characterizing new diseases like RLS. Everyone needs legs to take them around, but what happens when legs refuse to stop – Boom!, then one has Restless Legs Syndrome (wait, what’s that?). But, don’t worry, there is a cure – taaraa laaraa lee….

As if all this propaganda is not enough, a well regarded magazine Time in its 1^st November issue carried an extensive article on “Kids & Mental Health”.

 

It had some good observations.

• “Parents worried about the most common childhood-onset disorders — phobias, generalized anxiety, OCD, depression, bipolar disorder, attention-deficit/hyperactivity disorder, autism—rarely know exactly what to look for or what to do if they spot something. Is a child obsessive or just fastidious? Depressed or ruminative? Hyperactive or high-spirited? ”.
• “American parents are scared out of their wits about autism these days — partly with cause, partly because of media hysteria and myths about the perils of vaccines”.
• “In psychiatry, if you don’t ask the questions, you’re not going to get the diagnosis. A lot of things that were labelled as conduct problems may be bipolar. But once doctors and parents began looking for bipolar disorder, they started finding it everywhere — even when it wasn’t there. In 2002 researchers reported that within a single generation, the average age of onset of the disorder had fallen from the early 30s to the late teens. Few conditions change their nature so suddenly, and many of those bipolar cases were surely misdiagnoses“.

But it also had this to say.

• “All of us, in many ways, are born insane. Our emotions are unregulated; our moods are explosive; we are consumed by irrational fears, erupt into manic happiness, dissolve into inexplicable tears. It takes years — decades really — for an internal emotional governor to come fully online, and in that time, young minds can be prey to all manner of disorders and pathologies”.
• “About one in five children in the U.S. suffers from some sort of emotional or behavioral condition, according to a new study led by the National Academy of Sciences (NAS)”.
• “Childhood is a canary-in-the-coal-mine time. If early signs of mental-health problems aren’t correctly managed, they may stay with kids for life“.

On the balance, the tone of the article generates a fear psychosis in readers, who are numbed into meekly accepting the clever sales-pitch unleahsed by the drug companies (the article was generously interspersed with drug adverts). Situation is not unlike the WMD hysteria unleashed by Bush administration prior to attacking Iraq. The power & clout of the coprorations is so huge that most doctors, scientists, & researchers either actively serve or fall in line with the “official position”; and often emerging evidence, such as the possible ill effects of vaccines, is simply brushed aside or trashed as “mythical” or “delusional”. Defeat Autism Now (DAN/ ARI) is a movement of mainstream modern medicine practitioners/ doctors, who largely were drawn into its fold when someone they loved were diagnosed with the condition. They were thus compelled to take a close look at the disorder out of personal reasons. Apart from overload of vaccinations, DAN doctors have identified heavy metal poisoning, immune system disorders, food allergies, etc. as other significant causes. The solutions they advocate do not necessarily add profits to the coffers of pharmaceutical industry, and may in fact adversely affect their bottom line. Therein lies the rub. The whole sphere of health issues is so fundamentally shaped and controlled that drugs become the first & sole choice of treatment to the complete exclusion of even considering other available options & alternative therapies.

Post second world war the US industry faced the problem of what to do with the huge production capacity that was built to service the massive war effort. Mass production required mass consumption. Consumption not only had to grow fast and reach a critical mass to keep the wheels of industry moving incessantly, but had to keep growing ceaselessly. Consumption was turned into the Creed of US citizens, and Growth, the Mantra of its military-industrial complex. That was the birth of Consumerism. But for all this to happen, the traditional values of thrift & living within one’s means had to be broken and moderation in lifestyles had to be severed permanently. That is where advancements in psychology informed and aided the fields of marketing and advertising. Clever messages are delivered to make people unhappy with what they have or the way they are. The way out of this unsatisfactory situation, these messages then suggest, is to buy this, buy that, and buy whenever one can or even can’t – the latter led to massive household debt – to match the humongous public debt – over the years (but that is another story). After 9/11, the president of USA urged citizens, not to grieve or pray or reflect or volunteer to help, but to go out and shop. Drug industry too wants people to go out and shop. That’s why it is telling people – “You are wrong”.

O O O O O O O O O O O O