Selling Sickness to the Well
A new book looks at how pharmaceutical companies are using aggressive marketing campaigns to turn more people into patients.
By Jennifer Barrett
Aug. 2, 2005 - There are few Americans these days who aren't popping pills to treat a complaint, or to prevent one. From headache medicine to cholesterol-lowering drugs to sexual-dysfunction aids, there seems to be a remedy for every disorder out there and even some we didn't realize existed (until we saw the ad, that is). In their new book, Selling Sickness: How the Worlds Biggest Pharmaceutical Companies Are Turning Us All Into Patients (Nation Books), Ray Moynihan and Alan Cassels examine how the drug industry has transformed the way we think about physical and mental health and turned more and more of us each year into customers. NEWSWEEKs Jennifer Barrett spoke with Moynihan, a medical writer for the Milbank Memorial Fund in New York and a regular contributor to the British Medical Journal, about how and why drug makers have begun targeting people who aren't sick. Excerpts:
NEWSWEEK: You write that drug makers now aggressively target the healthy. Why?
Ray Moynihan: The book opens with a quote from a former Merck CEO that it was a shame he wasn't able to make Merck more like the chewing-gum maker, Wrigleys, because then he'd be able to "sell to everyone." I think that does drive the marketing machinery of the drug companies now. Drug companies target lots of sick people and make fabulous drugs that extend lives and ameliorate suffering. But the so-called preventives are where the big money are: like the bone-density drugs or the cholesterol [-lowering] drugs. Increasingly were seeing the marketing shift to those types of drugs. People talk about the "worried well." There are many ways in which the drug companies target those people.
You mean people who are well but worried about being sick? How are they targeted?
The use of celebrities is now a standard way in which drug companies don't just promote their drugs but try and change public awareness, public thinking and public perceptions about illness. In some cases the disease phrasing is legitimate and welcome. But when you have celebrities trying to change the way we think about sexual difficulties or stomach problems or symptoms of stages of life, these are insidious campaigns.
Why celebrities? I might take Serena Williams' advice on a brand of tennis racket but menstrual migraine medication?
[Laughs.] There's actually a whole mini industry of celebrity brokers who bring together celebrities and drug companies. I've interviewed one of the brokers who talked about the reason celebrities work so well in getting people to think about conditions and to go to their doctors.
Why do they work so well?
Because people trust celebrities. But they are not telling you often enough that they are on the [drug company's] payroll. Of course, if they did tell you as often as they should, your trust might diminish somewhat.
Aren't there enough sick people that the drug companies can target? Why try and convince others they're sick?
The marketing people and the sophisticated PR people who work for them are doing what shareholders demand of them. They're looking for ways to maximize markets. One way is to redefine more and more people as sick. There's an informal alliance between the drug companies and aspects of the medical profession and aspects of the patient advocacy world who all seem to have interests in defining more and more people as ill. We look at this condition by condition in the book, and what you see is a similar formula or process at work. Every time a panel of experts come together, they want to nudge the boundaries a little further out, whether its mental illness, cholesterol or high blood pressure.
How do you think this is affecting the American psyche?
Asclepius was the Greek god for healing and one of his children was Panacea. She is one we all worship no matter if were Jewish or Christian or Muslim. We all want a panacea, particularly if were vulnerable or sick. The trouble is that there are vast commercial and professional forces trying to exploit the vulnerability we have and exploit our desire for a panacea. I don't know what is happening to the American psyche. But I see a country bombarded with advertisements. Were seeing fear of disease, decay and death becoming a central part of life. Id like people to investigate the psychic impact of being told 10 times a day you might actually be sick.
You're from Australia, though you focus on the United States for this book. Is America unique?
The marketing strategies of pharmaceutical companies play out globally. However, the U.S. is the epicenter of the selling of sickness, of disease-mongering. Americans make up less than 5 percent of the worlds population but the U.S. makes up 50 percent of the drug market.
That doesn't mean the U.S. takes 50 percent of pills.
That's a relief.
But it does account for half of total spending on drugs. It's still extraordinary. And it's at the high end of pill taking.
Why is that?
The U.S. is different because it allows direct-to-consumer advertising [of prescription medications], which has taken off in a huge way in the past eight to 10 years. It's been around a long time, but there was a loosening of the regulations in the mid- to late '90s. New Zealand, too, is [unusual] in the world that way. In Australia and other countries, there is a strict ban on direct to consumer marketing. But so-called disease awareness programs, heavily funded by pharmaceutical companies, are not banned. So marketing strategies do play out in other places as well.
Have you heard from any drug companies since your book came out?
It's been out for a month in Australia, and there hasn't been anything out there to counter the journalism in my book. There's been a very strong silence. The worrying thing about that is that it makes me think that I might be right.
If so, what do you hope would come from the book?
I hope a few more people become a bit more skeptical about the claims being made to them about drugs and disease, about the labels that are being attached to them, and the conditions they're being told they have. Its time for all of us to be a bit more skeptical.
2005 Newsweek, Inc.