Sunday, June 12, 2011

New concept of the day: Disease Branding

Until about a half an hour ago, I had never heard of "disease branding." I can tell you this, I sure have seen enough evidence of it, and so have you.

Here's an example: Overactive bladder. You may have seen an ad about this condition where a woman in a car needs to pee too often. Later on, we see her happily ensconced in the same car with her hubby, both happy, for now she's less of a pain in the rear end. Less rest stops for the both of them. They can get to their vacation destination quicker. She had overactive bladder syndrome, and now it's stopped, because she told her doctor, and she's got a new medication to take care of that once never talked about but oh-so common ailment.

There is no such thing as overactive bladder or overactive bladder syndrome. There are other reasons why one may need to urinate frequently, or be unable to hold it in, but none of them is an overactive bladder.

One may have a urinary tract or bladder infection, and it's painful to hold it in. For that, one needs antibiotics.

There's stress incontinence, which occurs when the muscles in one's pelvic floor cannot hold tight against the stresses one's body creates when sneezing, coughing, laughing, etc. This is most commonly due to low estrogen levels, which weakens the muscles around the urethra. It's common in pregnant women, and in those who are "grossly obese." The best treatment for this is strengthening these muscles by doing Kegel exercises, and weight loss.

There's overflow incontinence, which is basically what it sounds like. One's bladder is full, and the overflow dribbles out. The causes of this are varied. One is very simple: holding it in too long. In other words, the woman in the car on the road should stop at a rest stop.

Lastly, there's urge incontinence, which is also due to many factors. It is defined an an uncontrollable or unpredictable urge to urinate. Sometimes it is due to nerve or neurological damage. Sometimes it is psychological in nature. Sometimes one does have what is called a spastic bladder - one that has spasms, and an anti-spasmodic drug is needed.

Writing about this makes me think I need to pee. I don't. Perhaps I've got overactive imagination syndrome.

But overactive bladder syndrome? It's a public relations invention, a reframing of incontinence in palatable marketable language. It's disease branding.

To brand a disease, according to bioethicist Carl Elliott, is to "shape its perception in order to make it more palatable to potential patients."

Elliott says thereare  two kinds of conditions that are particularly good candidates for disease branding. One is "a condition that can be plausibly portrayed as common yet underdiagnosed." The other is a "shameful condition that can be destigmatized."

Hmm. Even though I started writing about needing to pee too much (because I presume you're sick of hearing about mental health), I'm starting to see why mental health issues are so easily disease branded.

Ever hear of Detrol? Or Detrol LA? I don't watch much television, so I didn't remember the name of the drug, but I obviously did remember the commercial for this drug, the one I mentioned above.

In 2002, Neil Wolf, the vice-president of Pharmacia, the company that manufactures Detrol, gave a presentation called "Positioning Detrol: Marketing a Disease." All forms of incontinence were folded into one new syndrome, unsupported by any research or doctors, but by public relations firms, and the company's own analysts. The drug (so far) was found to be not harmful enough to prevent people from taking it who might, say, just pee a bit more than they'd like to, so instead of simply marketing this new drug to the small "niche market" of those suffering from incontinence, a new syndrome was born.

The vice-president of Pharmacia, in his presentation, called this a "mass marketing opportunity to triple the treatable population of potential patients." One year after that presentation was made, the drug had $757 million dollars in sales.

Of course, one can't just simply make up a new disease. Doctors do have to say it exists, but there are cases, and this is one of them, where marketers came up with the suggestion to re-frame pre-existing conditions in a new, more palatable and expanded way.

Many drugs are invented with a specific disease entity in mind, but many more drugs are developed by drug company scientists with a wide range of physiological effects. Marketers then identify and promote the disease for the drug.

I will write what I wrote once again, more simply, so you can absorb it. Marketers identify and promote the disease for the drug. It is not that marketers are promoting a drug for a disease. Market the disease and then people will believe they might want to ask their doctors about a drug. If it's the drug one manufactures, all the better.

I don't know how many more people now than in 2003 believe they are suffering from overactive bladder syndrome. But, again, in 2003, three times more people believed they did than in 2002. One might argue that these people were simply in the dark about their conditions previous to 2002. Their syndrome was going undiagnosed. Haven't you heard an awful lot of that lately?

This idea has been promoted for so many illnesses and syndromes that it has become absurd. Pharmaceutical companies hire medical and psychiatric anthropologists (yes, there are such people) to study other cultures so as to understand how to convince them that there are indeed diseases that had previously not been recognized.

In "Crazy Like Us: The Globalization of the American Psyche," journalist Mark Watters analyzes four major instances where drug companies targeted entire countries for importation of psychiatric conditions that were considered rare. The words "undiagnosed" and "underdiagnosed" were used a lot. They are today. Just go to any health website and start noticing how many times you encounter those words. It's staggering.

I wonder when they're going to find a new name for the disease called This Human Life.

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