Buyer beware: How Big Pharma uses fear to boost sales

Long before the Internet and direct to consumer advertising, the medical profession tried to reassure people about their health concerns. Sure fatigue and headaches could be a symptom of a brain tumor; sure a cough could be a symptom of lung cancer--but most doctors tried to assuage not sow fear. Remember "take two aspirins and call me in the morning"?

Flash forward to today's online "symptom checkers," quizzes to see if you have a certain disease and exhortations to see your doctor even though you feel fine. Once Pharma discovered that health fears and even hypochondria sell drugs, there seems to be no end to the new diseases, symptoms and risks people need to worry about.

Selling symptoms to suggestible people has been a gold mine for Big Pharma since it started advertising directly to the consumer around the late 1990s. Thanks to such marketing which actually "sells" diseases to build demand, millions of people who were once fine now have depression, insomnia, season allergies, GERD and assorted attention, pain and spectrum disorders. Worse, they these afflictions because the medications that treat them have been made so glamorous.

In fact the public's embrace of prescription drugs is best expressed in the T shirt that says "I take aspirin for the headache caused by the Zyrtec I take for the hayfever I got from Relenza for the uneasy stomach from the Ritalin I take for the short attention span caused by the Scopoderm I take for the motion sickness I got from the Lomotil I take for the diarrhea caused by the Xenical for the uncontrolled weight gain from the Paxil I take for the anxiety from Zocor I take for my high cholesterol because exercise, a good diet and regular chiropractic care are just too much trouble." (Of course the shirt cannot be worn by a small person.)

Here are some of the ways Pharma uses fear to keep the public buying drugs.

Fear of Aging and Losing Sex Appeal

Hormone replacement therapy which millions of women took until about ten years ago was officially marketed to stop hot flashes and keep their bones strong. But unofficially it was marketed as a way of staying young and sexy. Early HRT ads told women they had "outlived their ovaries" and not kept up with their husbands who wanted younger looking women. When HRT was found to increase the risk of heart attacks and cancer (sorry about that), bone drugs took up Pharma's "don't get old" message to women, pushed by former show host Meredith Vieira, former Charlie's Angel Cheryl Ladd and actress Sally Field. Now Pharma is telling men they also need hormone replacement therapy for their "Low T" and to retain their sexiness. Male HRT doesn't look safer than women's.

Fear of Symptoms That Seem Benign

Once upon a time people with heartburn took Tums, Alka Seltzer, Bromo Seltzer or Maalox and vowed not to eat so much. They did not worry they really had Gastroesophageal reflux disease (GERD), were on their way to cancer of the esophagus and take proton pump inhibitors for the rest of their lives. Similarly, while depression certainly exists, people who have the blues over real things like their marriage, finances or even the loss of a loved one now go running to the doctors for "happy pills" for their "depression." Of course Pharma's biggest success in creating fear around benign symptoms is convincing parents and teachers that healthy energetic kids are suffering from ADHD. Ka-ching.

Fear of New Diseases

Who remembers Restless Legs Syndrome? Who remembers Shift Work Sleep Disorder and Non-24-hour Sleep Wake Disorder for people who probably did not get enough sleep? Obscure diseases Pharma "raises awareness" about are not made up--but they are so rare they would never be advertised unless Pharma were trying to create "demand" for expensive drugs-- especially since there is usually no confirming lab or blood test for a diagnosis. Recently North Chicago-based AbbVie rolled out two high budget drug campaigns to convince people with sore backs that they have ankylosing spondylitis and people with diarrhea that they have exocrine pancreatic insufficiency, replete with web sites helping them discern that they have the disease by their symptoms. Do people with symptoms or diseases really need Pharma to tell them when to go to the doctor and what they have?

Fear that Your Child Is Not Normal

ADHD is not the only way Pharma has medicalized and monetized childhood. Temper tantrums are now called "Disruptive Mood Disregulation Disorder." Thanks to "pediatric psychopharmacology" children are increasingly diagnosed with oppositional defiant disorders, mixed manias, social phobias, bipolar disorders, conduct disorders, depression and "spectrum" disorders. Why does Pharma like kids? Children are compliant patients who will do what they parents, teachers and doctors tell them says former Pharma rep Gwen Olsen, author of Confessions of an Rx Drug Pusher. They are the "ideal patient-type because they represent refilled prescription compliance and 'longevity.' In other words, they will be lifelong patients and repeat customers for Pharma." No kidding. And, once on the heavy and unnecessary drugs, many kids will exhibit reactions are be given more drugs for the side effects.

Fear That Your Drug Isn't Working

Once Pharma discovered how easily it could add drugs on to an original drug, whether in children or people with mental illness, the era of "add-on" drugs and "treatment resistant" conditions began. Your drug may not work said new ad campaigns for Abilify or Seroquel--because you lack a second drug to activate your first drug and make it work better. Of course patients would never know if they need the first drug to begin with but would be afraid to stop, a great sales tactic. The reframing of depression to sell drugs was especially sneaky. Depression was originally considered a self-limiting condition which, though, unpleasant, would go away. But pharma-funded doctors reclassified depression as a life long condition requiring life long drugs. And there was more! With little or no medical evidence, depression was also termed "progressive" which of course upped its fear quotient. "As the number of major depressive episodes increase, the risk for subsequent episodes is predicted," hawked an article on the physician web site Medscape called "Neurobiology of Depression: Major Depressive Disorder as a Progressive Illness" and flanked by ads for the antidepressant Pristiq.

Fear of Silent Diseases

What if you have no symptoms and feel fine? That doesn't mean you aren't suffering from silent conditions that could be threatening your health or life without you knowing it. No pill in the history of the world has been as successful as the statin Lipitor with its "Know Your Numbers" TV ad campaign and manipulation of the growing national fear of cholesterol-linked heart attacks. Millions take statins to protect against the fear of silent heart disease even though recently dietary cholesterol was vindicated as a strong risk factor in heart disease. (Good thing Lipitor's patent ran out.) Pharma campaigns that scare women about silent bone loss have also sold anti-osteoporosis drugs like Fosamax, Boniva and Prolia, convincing women that one day with little or no warning, their weakening bones will break. The prediction was true but it had a twist: some of the women whose bones snapped were actually taking the anti-osteoporosis drugs themselves whose side effects turned out to include fractures!