# "Drug firms 'inventing diseases'" **URL:** \ **Category:** Great Debates\ **Created:** [April 14, 2006, 5:18am UTC](https://boards.straightdope.com/t/drug-firms-inventing-diseases/352628 "2006-04-14T05:18:14Z")\ **Posts on this page:** 20\ **Page:** 3
**Author:** ![Snickers](https://avatars.discourse-cdn.com/v4/letter/s/5daacb/32.png) [@Snickers](https://boards.straightdope.com/u/Snickers)\ **Post date:** [April 20, 2006, 1:20pm UTC](https://boards.straightdope.com/t/drug-firms-inventing-diseases/352628/41 "2006-04-20T13:20:25Z")
> [@DoctorJ](#): > > I hear people talk about all these “kickbacks”, but I never seem to get on the good end of it. All I get are crappy pens and note pads and the occasional nice dinner (for me only–not my wife), consumed while listening to a really dull talk… DoctorJ, my dad’s a family practitioner in a small town in Western Wisconsin and he gets much the same. Although his drug reps do bring in lunch for everyone in the office, meaning that his nurses and receptionists get treated to lobster (or whatever the plate of the day is) every now and again. In the 20 years he’s worked in his WI office, the biggest gift he’s ever gotten was to watch the Vikings play in one of the Metrodome’s fancy-schmancy boxes. This was with a whole bunch of other doctors and reps and such, and he said he would’ve had more fun watching it with us in our cheap seats (my parents have been season ticket holders for years). That’s not to say there isn’t a problem here - according to Dad, the problem is the sheer number of drug reps itself. Dad said that 20 years ago, he’d be visited by like 4 reps a year. Now he probably sees 4 - 6 reps a month. He says that the increase in their numbers is just incredible. Undoubtedly this adds enormously to costs. ---
**Author:** ![Trunk](https://avatars.discourse-cdn.com/v4/letter/t/87869e/32.png) [@Trunk](https://boards.straightdope.com/u/Trunk)\ **Post date:** [April 20, 2006, 2:31pm UTC](https://boards.straightdope.com/t/drug-firms-inventing-diseases/352628/42 "2006-04-20T14:31:13Z")
> [@Oy!](#): > > If people choose to medicate rather than change lifestyle, why should that “make you sick?” Disagree with their choices, by all means, but why disgust you? Why is it a moral issue at all? > > And congratulations on the magnificence that makes you so able to change your life so readily, and so willing to do so rather than to pollute your body. Does that make you a more self-disciplined person than most? Maybe (or maybe a very healthy lifestyle is simply more to your taste anyway). But your vehemence on the topic makes you someone I personally would never want to meet! I’ll take the unself-disciplined over the mightily self-righteous any day! For starters, the problem that I have with people choosing to medicate instead of attempting to change their lifestyle is that the costs of their medication are spread out to all of the people in their health plan. When I see a [website](http://www.wellbutrin-xl.com/undiagnosed/symptoms_of_depression.html) that lists the symptom, “decreased ability to concentrate or make decisions” and then says to talk to your doctor about Wellbutrin if you have ANY of the listed symptoms, well. . .I tend to fell a little of that “irritability” that they list, myself. Start making people pay cash for those pills when they’re feeling “tension” and see just how unself-discplined they are. ---
**Author:** ![Loopydude](https://avatars.discourse-cdn.com/v4/letter/l/e56c9b/32.png) [@Loopydude](https://boards.straightdope.com/u/Loopydude)\ **Post date:** [April 20, 2006, 2:51pm UTC](https://boards.straightdope.com/t/drug-firms-inventing-diseases/352628/43 "2006-04-20T14:51:47Z")
I think simply banning the advertising will go a long way, but there are some almost inexorable market-related issues that require some serious discipline on the part of the potential patient pool to overcome. Obesity and TII diabetes drugs are probably going to be the next Prozac, if not bigger. Presently the current crop of newer, patent-protected medications (like sibutramine and rosiglitazone) have far too many liabilities to achieve widespread use. The minute somebody comes up with a new FDA-approved pill that is well-tolerated and makes even a marginal difference in insulin resistance and BMI in the absense of lifestyle change, you’re talking blockbuster. People will want this like they want vitamins or Advil. So: Eat less, limit what you eat to whole foods with low caloric content, and exercise religiously. Or, take a pill. What will most people do? ---
**Author:** ![Loopydude](https://avatars.discourse-cdn.com/v4/letter/l/e56c9b/32.png) [@Loopydude](https://boards.straightdope.com/u/Loopydude)\ **Post date:** [April 20, 2006, 3:05pm UTC](https://boards.straightdope.com/t/drug-firms-inventing-diseases/352628/44 "2006-04-20T15:05:12Z")
> [@Snickers](#): > > That’s not to say there isn’t a problem here - according to Dad, the problem is the sheer number of drug reps itself. It must be different in different specialties, I dunno. It’s fairly well understood these days that the freebies have just taken on a new form, in that they usually have to have something educational attached to them. But the influence peddling is alive and well, and it works. Yeah, maybe you have to attend a seminar, but it’s still a free dinner, and there are no shortage of specialists I’ve seen who, again, fall in line right out the door for it. Videos, textbooks, educational software, anatomical models and posters, all these can cost hundreds a pop and big pharma throws those around like confetti. The most egregious examples are the all-expense-paid CME programs, sometimes held in expensive resorts. These can cost the pharm companies tens-of-thousands a person, yet they gladly pay it. Why? Out of the goodness of their hearts? I think not. ---
**Author:** ![Squink](https://avatars.discourse-cdn.com/v4/letter/s/b5e925/32.png) [@Squink](https://boards.straightdope.com/u/Squink)\ **Post date:** [April 20, 2006, 3:14pm UTC](https://boards.straightdope.com/t/drug-firms-inventing-diseases/352628/45 "2006-04-20T15:14:46Z")
[More than half the psychiatrists who took part in developing a widely used diagnostic manual for mental disorders had financial ties to drug companies before or after the manual was published, public health researchers reported yesterday.](http://www.nytimes.com/2006/04/20/health/20psych.html) ---
**Author:** ![DoctorJ](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/doctorj/32/2904_2.png) [@DoctorJ](https://boards.straightdope.com/u/DoctorJ)\ **Post date:** [April 20, 2006, 10:00pm UTC](https://boards.straightdope.com/t/drug-firms-inventing-diseases/352628/46 "2006-04-20T22:00:04Z")
> [@](#): > > Not a cardiologist? I just say that because I go to the meetings, and the lines for free stuff (textbooks, dinners, product samples, models, posters, and, yes, occasionally junkets) go way out the door. It all seems to be big pharma doling out the goodies, and a terrible waste, IMO, but I don’t see a lot of restriction on inducements, and it hasn’t changed in the seven or so years I’ve been in this sphere. If anything, it’s gotten worse. They try to give out a lot of textbooks, but I use online sources exclusively these days, so I don’t take them up. As for the models, posters, dinners, etc.–is this really that much worse than it is in any other industry? I went to Austin last month for SXSW, the big music industry shindig, and I came back with piles and piles of swag. I also ate and drank heavily on the dimes of various record labels and publications. I’d say in most trades, it is customary for the makers of a product to wine, dine, and give stuff to the middlemen who ultimately get the product to the end user. Should the drug companies be any different? (Note: I’m being a bit of a devil’s advocate here.) As for the junkets, there’s no doubt that drug companies will put some money in on big educational meetings, but I don’t think they’re paying travel or hotel expenses or anything like that for docs anymore. I could be wrong; maybe we lowly GPs just aren’t important enough. And though you may not have noticed it, the rules have changed. About 4-5 years ago the industry adopted completely new guidelines for drug rep functions. Among other things, the guidelines tightened up the definition of what an educational program has to offer, and prohibited family members who aren’t health care personnel from attending. > [@](#): > > Dad said that 20 years ago, he’d be visited by like 4 reps a year. Now he probably sees 4 - 6 reps a month. 4-6 a month? We probably have 4-6 a day. Of course, we’re a big clinic with seven full-time providers. Most of them know by now that I will catch them between patients, listen to what they have to say for about thirty seconds, and sign for their samples (which are a huge help for indigent patients, and are the only reason I listen at all). This is what happens when you have so many competing drugs for the same conditions. Sure, we’d be better off if the money that drug companies have spent to develop six or seven pills for acid reflux and to push their respective pills had been spent developing new drugs for other conditions instead, but I don’t know how to get there from here. ---
**Author:** ![Loopydude](https://avatars.discourse-cdn.com/v4/letter/l/e56c9b/32.png) [@Loopydude](https://boards.straightdope.com/u/Loopydude)\ **Post date:** [April 20, 2006, 10:18pm UTC](https://boards.straightdope.com/t/drug-firms-inventing-diseases/352628/47 "2006-04-20T22:18:25Z")
Hmm. Looks like if some folks get their way the CME “grants” might dry up altogether. [Cite](http://www.ama-assn.org/amednews/site/free/prsd0306.htm). > [@](#): > > Harry A. Gallis, MD, president of Alliance for CME said some Alliance members were concerned drug companies would respond to these proposals by taking their marketing dollars out of CME and redirecting them into **research** or advertising. Bolding mine. Obviously the pharmas still regard this as a marketing exercise. The proposed changes are scrupulously ethical, though, and appear to be in line with what the irate public wants, namely that more of the profits going into R&D. Nix the advertising, too, and drug companies will be flush with cash, right? Well probably not, as they rely on all those marketing efforts to get the big profits. If the potential patients do a better job of taking care of themselves while they paint everyone from the caregivers to the manufacturers to the insurers as rapacious profiteers, they won’t miss the new-fangled drugs they won’t get. ---
**Author:** ![Loopydude](https://avatars.discourse-cdn.com/v4/letter/l/e56c9b/32.png) [@Loopydude](https://boards.straightdope.com/u/Loopydude)\ **Post date:** [April 20, 2006, 10:28pm UTC](https://boards.straightdope.com/t/drug-firms-inventing-diseases/352628/48 "2006-04-20T22:28:49Z")
> [@Squink](#): > > [More than half the psychiatrists who took part in developing a widely used diagnostic manual for mental disorders had financial ties to drug companies before or after the manual was published, public health researchers reported yesterday.](http://www.nytimes.com/2006/04/20/health/20psych.html) That is disturbing. It would be more disturbing if one could use the DSM-IV to determine what drug, exactly, one ought to prescribe, but it’s not proven terribly useful for that. I think it’s well established at this point that results depend on who funds the study. I think recently some fairly rigorous scientific analysis has demonstrated that sad fact with a satisfying degree of rigor. Obviously something’s gotta give in the whole drug business. The present situation is untenable. I say this knowing full well it could cost me my job, though I’m not in the pill business, per se. Whatever happens, it’s clear sustained growth in the current system isn’t possible in the long run, excessive pathologizing being just one symptom of the economic disease. Another symptom is, to my increasing chagrin as I become more cognizant of it, the corruption of the science by omission, as we’ve seen in the Merck Vioxx fiasco. They probably deserve every lawsuit they get nailed with, but the results will likely be chilling on the industry as a whole. Mass-marketed drugs draw mass liability to suit if something goes wrong. And something always goes wrong. ---
**Author:** ![Zoe](https://avatars.discourse-cdn.com/v4/letter/z/a4c791/32.png) [@Zoe](https://boards.straightdope.com/u/Zoe)\ **Post date:** [April 20, 2006, 11:20pm UTC](https://boards.straightdope.com/t/drug-firms-inventing-diseases/352628/49 "2006-04-20T23:20:06Z")
First, my apolgies for a mistake. I confused Irritable Bowel Syndrome with diverticulosis when I made my comments. I don’t know anything about IBS. > [@](#): > > **Squink** : (from a link) More than half the psychiatrists who took part in developing a widely used diagnostic manual for mental disorders had financial ties to drug companies before or after the manual was published, public health researchers reported yesterday. I’m no fan of how the drug companies are screwing people over, but this report is not as grim as the headlines suggest: The statistics included psychiatrists who had financial ties _after_ the DSM was published and includes anyone over a period of fifteen years! The most frequent tie involved money _for research_ – not for personal gain. The authors were not able to establish how many of the psychiatrists were receiving money from drug companies while the manual was actually being compiled. (The manual was published in 1994, but they were still counting psychiatrists who received research money ten years later!) > [@](#): > > **Trunk** : When I see a website that lists the symptom, “decreased ability to concentrate or make decisions” and then says to talk to your doctor about Wellbutrin if you have ANY of the listed symptoms, well. . .I tend to fell a little of that “irritability” that they list, myself. Actually, that website lists several symptoms and then says: > [@](#): > > If you are experiencing _any or several_ of these symptoms, you should talk to your doctor… In my own circumstance, it is the inability to concentrate which is the most disabling aspect of my illness. Nothing soaks in. Such a lack of concentration is indeed a reason to see a physician. But when that symptom is put in the context of the other symptoms, it becomes more meaningful. A doctor would not diagnose depression based on one symptom alone and you do have a point. ---
**Author:** ![Oy](https://avatars.discourse-cdn.com/v4/letter/o/bc8723/32.png) [@Oy](https://boards.straightdope.com/u/Oy)\ **Post date:** [April 21, 2006, 1:50am UTC](https://boards.straightdope.com/t/drug-firms-inventing-diseases/352628/50 "2006-04-21T01:50:34Z")
> [@Trunk](#): > > For starters, the problem that I have with people choosing to medicate instead of attempting to change their lifestyle is that the costs of their medication are spread out to all of the people in their health plan. > > When I see a [website](http://www.wellbutrin-xl.com/undiagnosed/symptoms_of_depression.html) that lists the symptom, “decreased ability to concentrate or make decisions” and then says to talk to your doctor about Wellbutrin if you have ANY of the listed symptoms, well. . .I tend to fell a little of that “irritability” that they list, myself. > > Start making people pay cash for those pills when they’re feeling “tension” and see just how unself-discplined they are. The chances are good that you produce more garbage, or use more hot water, or drive more miles than a taker of drugs for conditions you consider treatable by lifestyle changes alone. Setting aside the issue of just how difficult it can be to change one’s lifestyle, do the people who have more trash or shower twice a day or drive 50 miles each way to work disgust you? There are precious few people who _don’t_ do \*something \* that contributes to what you might call societal cost. Why is it that the self-medicators are the ones who merit your scorn, if not your disgust? My WAG is that you consider it a despicable weakness, and therefore worthy of your sneers. But that’s judging entirely based on _your_ priorities. Other people may not find it a minor change to alter their lifestyle to the healthiest available. Some folks may even have downright compulsions to overeat or smoke or whatever, and find that changing their lifestyle is simply something they cannot do. There may be economic or other external reasons - the least expensive food, for example, is frequently the least healthy and most caloric. I guess what I’d like to understand is why this particular form of (by your standards) unnecessary societal cost merits more of what comes across as a moral scorn than other forms. I personally wish that SUVs could be entirely eliminated from the road, but the fact is, for some folks, SUVs, if not essential, are highly important within the structure their lives. While I \*do \* have some scorn for the people who drive SUVs purely because it’s the fashion, I certainly don’t for those who find SUVs an extremely useful tool, and I doubt you do either. Yet those SUVs may end up costing society a hell of a lot more than the meds, between oil prices and pollution! ---
**Author:** ![whiterabbit](https://avatars.discourse-cdn.com/v4/letter/w/cab0a1/32.png) [@whiterabbit](https://boards.straightdope.com/u/whiterabbit)\ **Post date:** [April 21, 2006, 3:23am UTC](https://boards.straightdope.com/t/drug-firms-inventing-diseases/352628/51 "2006-04-21T03:23:54Z")
> [@Trunk](#): > > For starters, the problem that I have with people choosing to medicate instead of attempting to change their lifestyle is that the costs of their medication are spread out to all of the people in their health plan. > > Start making people pay cash for those pills when they’re feeling “tension” and see just how unself-discplined they are. Not everybody has insurance, you know. I have no prescription coverage at all. I also have an understanding doc who has gotten me piles of Lexapro samples. And I definitely needed it. “Tension” my ass. Unself-disciplined, my ass. ---
**Author:** ![Guinastasia](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/guinastasia/32/5751_2.png) [@Guinastasia](https://boards.straightdope.com/u/Guinastasia)\ **Post date:** [April 21, 2006, 3:31am UTC](https://boards.straightdope.com/t/drug-firms-inventing-diseases/352628/52 "2006-04-21T03:31:01Z")
Not to mention, sometimes lifestyle changes aren’t enough. Certain conditions, hell, just getting older, can make it impossible to keep your blood pressure down by diet and exercise alone, I would imagine. Think about diabetics-diet alone won’t always do it, you need insulin as well. Certain mental illnesses SOMETIMES need medication. Every case is different. ---
**Author:** ![Trunk](https://avatars.discourse-cdn.com/v4/letter/t/87869e/32.png) [@Trunk](https://boards.straightdope.com/u/Trunk)\ **Post date:** [April 21, 2006, 12:16pm UTC](https://boards.straightdope.com/t/drug-firms-inventing-diseases/352628/53 "2006-04-21T12:16:49Z")
> [@Zoe](#): > > Actually, that website lists several symptoms and then says: Yes, it says “ANY” or “SEVERAL”. Notice the “any” part. That means if you are experiencing ANY of those symptoms. As in, “pick one off this list”. Let’s also notice that the top of that page says, “The symptoms that help a doctor make a diagnosis of depression include:”. Not, “these may be the symptoms of depression and you should see your doctor”, but rather “the symptoms that help a doctor make a diagnosis of depression”. That is to say, “if you’ve already disagnosed yourself with depression, this is what you need to tell your doctor.” That is what is has become. I don’t doubt that some people are genuinely depressed and helped by these drugs. I’d like to think that someone in that condition is symptomatic enough that they go to see a doctor and get the help they need. What I don’t think we need is entire marketing drives centered around trying to get people who have a “decreased ability to concentrate” to figure out what they need to tell their doctor to get their happy pills. **Oy!** , I’m not responding to your “wild ass guesses”, your suppositions about how much garbage I produce compared to a taker of drugs, or your declarations about the pecking order of my “scorn”. > [@whiterabbit](#): > > Not everybody has insurance, you know. I have no prescription coverage at all. I also have an understanding doc who has gotten me piles of Lexapro samples. And I definitely needed it. “Tension” my ass. Unself-disciplined, my ass. In other words, “nothing I said actually refers to you.” ---
**Author:** ![Oy](https://avatars.discourse-cdn.com/v4/letter/o/bc8723/32.png) [@Oy](https://boards.straightdope.com/u/Oy)\ **Post date:** [April 21, 2006, 12:24pm UTC](https://boards.straightdope.com/t/drug-firms-inventing-diseases/352628/54 "2006-04-21T12:24:58Z")
[QUOTE=Trunk] **Oy!** , I’m not responding to your “wild ass guesses”, your suppositions about how much garbage I produce compared to a taker of drugs, or your declarations about the pecking order of my “scorn”. [QUOTE] Well, I guess that showed _me_! ---
**Author:** ![Trunk](https://avatars.discourse-cdn.com/v4/letter/t/87869e/32.png) [@Trunk](https://boards.straightdope.com/u/Trunk)\ **Post date:** [April 21, 2006, 12:34pm UTC](https://boards.straightdope.com/t/drug-firms-inventing-diseases/352628/55 "2006-04-21T12:34:47Z")
**Oy!** , just a WAG here, but I bet you’re a child molester who takes his Wellbutrin to keep the feelings of guilt away. When you’re tired of directing your scorn at SUV drivers, and garbage producers, you’re busy scouring the internet for kids and anti-depressants. Oh, and why are we talking about the SUV drivers. Aren’t you so angry that the Yankees can just BUY a division title every year? Yes, yes. . .let’s play the WAG game and “change the subject” all day long. That’ll be fun. ---
**Author:** ![Oy](https://avatars.discourse-cdn.com/v4/letter/o/bc8723/32.png) [@Oy](https://boards.straightdope.com/u/Oy)\ **Post date:** [April 21, 2006, 1:16pm UTC](https://boards.straightdope.com/t/drug-firms-inventing-diseases/352628/56 "2006-04-21T13:16:22Z")
> [@Trunk](#): > > **Oy!** , just a WAG here, but I bet you’re a child molester who takes his Wellbutrin to keep the feelings of guilt away. When you’re tired of directing your scorn at SUV drivers, and garbage producers, you’re busy scouring the internet for kids and anti-depressants. > > Oh, and why are we talking about the SUV drivers. Aren’t you so angry that the Yankees can just BUY a division title every year? > > Yes, yes. . .let’s play the WAG game and “change the subject” all day long. That’ll be fun. You specifically stated above that a reason for being irritated at medicators of conditions you consider treatable by lifestyle change was that they caused a cost to society at large in the form of higher insurance and/or prices for medicines. It’s a perfectly legitimate question to ask why it appears that you are more annoyed at these folks than other people who \*also \* cost society more than “their share” in various different ways. I don’t think that that is “changing the subject,” and I don’t think it was out of line. The only reason I could think of was the one I presented as a WAG, so that I could address it in the same post. Gee, how incredibly offensive of me to try to anticipate! ---
**Author:** ![Loopydude](https://avatars.discourse-cdn.com/v4/letter/l/e56c9b/32.png) [@Loopydude](https://boards.straightdope.com/u/Loopydude)\ **Post date:** [April 21, 2006, 1:56pm UTC](https://boards.straightdope.com/t/drug-firms-inventing-diseases/352628/57 "2006-04-21T13:56:12Z")
> [@Guinastasia](#): > > Think about diabetics-diet alone won’t always do it, you need insulin as well. If you’re talking about Type I, there’s not a damn thing the patient can do about getting the disease. If you’re talking about Type II, however, the usual progression is this: You become increasingly insulin resistant. Your pancreas works overtime to churn out more insulin to keep your serum glucose down. Eventually your beta cells crap out, and now you need insulin injections, to which, again, you are becoming increasingly refractory. By this time you’re probably also on a small coctail of drugs, some with some nasty potential side-effects (like lactic acidosis for metaformin, or congestive heart failure for rosiglitazone…less severe but troubling side effects are far more common with both), _and_ your doctor is leaning on you pretty heavily to clean up your act, e.g., eat right, and exercise if you still can. Chances are very, very good that if you’d eaten right and exercised in the first place, you wouldn’t be in that pickle. ---
**Author:** ![Loopydude](https://avatars.discourse-cdn.com/v4/letter/l/e56c9b/32.png) [@Loopydude](https://boards.straightdope.com/u/Loopydude)\ **Post date:** [April 21, 2006, 3:13pm UTC](https://boards.straightdope.com/t/drug-firms-inventing-diseases/352628/58 "2006-04-21T15:13:18Z")
Sorry, metformin, not “metaformin”… ---
**Author:** ![Gaudere](https://avatars.discourse-cdn.com/v4/letter/g/e495f1/32.png) [@Gaudere](https://boards.straightdope.com/u/Gaudere)\ **Post date:** [April 21, 2006, 4:27pm UTC](https://boards.straightdope.com/t/drug-firms-inventing-diseases/352628/59 "2006-04-21T16:27:24Z")
**Trunk** : > [@](#): > > Oy!, just a WAG here, but I bet you’re a child molester who takes his Wellbutrin to keep the feelings of guilt away. When you’re tired of directing your scorn at SUV drivers, and garbage producers, you’re busy scouring the internet for kids and anti-depressants. [Moderator Hat ON] NOT funny, Trunk. Please leave accusations of child molestation OFF this board. [Moderator Hat OFF] ---
**Author:** ![Trunk](https://avatars.discourse-cdn.com/v4/letter/t/87869e/32.png) [@Trunk](https://boards.straightdope.com/u/Trunk)\ **Post date:** [April 21, 2006, 4:51pm UTC](https://boards.straightdope.com/t/drug-firms-inventing-diseases/352628/60 "2006-04-21T16:51:20Z")
> [@Gaudere](#): > > **Trunk** : > [Moderator Hat ON] > > NOT funny, Trunk. Please leave accusations of child molestation OFF this board. > > [Moderator Hat OFF] I wasn’t trying to be funny. I was responding to this: > [@](#): > > My WAG is that you consider it a despicable weakness, and therefore worthy of your sneers. But that’s judging entirely based on your priorities. by pointing out the absurdity of his post by using a more extreme example. Anyone who actually thought that was an accusation of child molestation. . .well, instead of reporting the post to mommy, they might want to ask mommy to explain it to them. [Previous page](https://boards.straightdope.com/t/drug-firms-inventing-diseases/352628.md?page=2) [Next page](https://boards.straightdope.com/t/drug-firms-inventing-diseases/352628.md?page=4)