German Ethics Council discusses disease mongering
Starting point for a targeted therapy is the reliable diagnostic of diseases. In their own interest, patients should only be given care when an illness or disorder actually exists and there are therapies that can prevent or heal the disease, or alleviate the symptoms. But what is considered and treated as a disease does not always depend only on medical facts. Cultural and economic factors may also play a role. As a result, some illnesses even come into fashion.
The history of Western medicine is full of fashionable diseases that were readily accepted not only by doctors, but also by the general public. Michael Stolberg from Julius Maximilian University of Würzburg gave a vivid presentation of diagnosis and disease fads over the past centuries. These trends indicate that our perception, interpretation, and experience of illnesses is always necessarily also shaped by our respective historical and cultural contexts.
Gisela Schott from the Drug Commission of the German Medical Association took on "disease mongering" in her presentation. She criticized the way in which normal life processes are redefined as medical problems and new clinical diagnoses are virtually invented through advertising, while minor symptoms are elevated as possible indications of serious illnesses, and risks are sold as diseases. One result of these practices is that patients are prescribed medication they do not need, unnecessarily exposing them to possible side effects and squandering health system resources. She called for stricter government regulation of pharmaceutical advertising and more government funding for independent research. But the public too needs to actively seek out information.
Thomas Schramme from the University of Hamburg, who spoke on normative questions regarding fashionable diseases, lamented the impending broadening of the definition of disease. He made a case for distinguishing more clearly between absence of disease as the minimum criterion for health (negative health) and the paradigm of best-possible health (positive health). Sharper definitions are necessary to enable differentiation between truly pathological conditions and those that are medically normal. He also asked whether decisions about the collective financing of therapies should be based on conceptions of diseases.
In conclusion, Wolf-Michael Catenhusen, Vice-Chair of the German Ethics Council, moderated a roundtable discussion with Jörg Blech from Der Spiegel magazine, Lothar Weissbach from the Stiftung Männergesundheit (Men's Health Foundation), Boris Quednow from the University of Zurich, and Christiane Fischer from MEZIS (No Free Lunch Germany) on the consequences of the multiplication of newly-defined diseases. Basing therapy decisions solely on laboratory tests can, said Weissbach, lead to a situation in which formerly healthy individuals suddenly become patients in need of treatment. Unclear clinical results are inflated, leading to inflated diagnoses and inflated therapies. Quednow warned of psychiatric fads that can, for example in the case of burnout, lead to the unnecessary treatment of healthy people and increase the risk that those suffering from severe depression are misdiagnosed. Blech and Fischer pinpointed the pharmaceutical industry, together with medical professional interest groups and PR agencies, as responsible for these trends; they invent new illnesses and turn them into medical industry products. Rather than maximal treatment independent of the way in which a pattern of disease is manifested, Weissbach proposed that doctors sometimes practice the art of omission and advise against certain therapies – even when they receive no remuneration from insurance companies for this medical service.