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As we were sayin' ...

"Speakin' Of DRUGS and SCARES!  First It Was BUSH and FEAR ... Now
    It's Your DRUG Empire!"

"Medicalization has created its own side effect -- anxiety. (There's a
drug for that, too.)"

We think we have to be hyper-vigilant about disease to put it off as
long as possible."

"Popular medica books' "mission is to "alert you, warn you, maybe even
scare you into going to the doctor."

Patient advocacy groups such as the American Cancer Society have long
believed that the way to improve the nation's health is to increase
"awareness" of this or that disease, and the best way to increase
awareness is to frighten people into their doctors' offices.

"Condition branding" [is] one of the most brilliant and widely used
marketing techniques for selling drugs, forging  links between disease
and treatment in the minds of both patients and doctors." If drug
makers have a drug "but no condition, they will simply invent a
disease."

These are some of the ways your friendly and generous drug companies,
and the "disease community" as a whole, frighten and pressure
Americans to see a doctor, take a pill.  Or several.  Of each.

One patient advocate has some timely advice for the "worried well."
-----------------------------------------
"Let's Stop Running Scared"
By Shannon Brownlee
Sunday, March 30, 2008; B01

Felt a little short of breath the other day, walking up a hill. Uh-oh.
A nugget of worry lodged for a moment in my mind. At 50-something, I'm
in decent enough shape. I don't smoke. I walk several miles most days,
and I can still beat my 40-something friend at tennis. Not exactly a
candidate for a heart attack. But still. I've read all those stories
about women like me, the ones with no risk factors for cardiac disease
who were suddenly hit with an attack.

Maybe you've had the same worries -- wondered whether some sharp
little twinge was heartburn or a heart attack, whether that nasty
headache was caused by tension or a stroke. Almost everyone I know who
has hit middle age spends a certain amount of time fretting about this
or that ailment. My husband and friends and I used to talk about
politics, science, religion, kids. Now no dinner party is complete
without at least a few minutes' discussion of cholesterol levels, the
merits of walking vs. running, or whether or not snoring is a sign of
sleep apnea.

It's not as though we're actually sick. Oh sure, a couple of us have
high blood pressure, and a dear friend has a serious chronic disease.
We all know at least one person our age who has died of cancer or a
heart attack. As a medical reporter, I've met many people who suffer
terribly from life-threatening or debilitating conditions, and I know
that eventually nearly all of us will be hit with a serious illness.

But most of my friends and I, like most middle-aged Americans, are a
remarkably healthy lot. If I asked my friends how long they plan to
live, I'd bet they'd answer like the respondents to a recent UPI poll,
which found that a majority of Americans believe they'll live well
into their 80s and beyond -- even though the average U.S. life
expectancy is 77. It's not that we fear we're in imminent danger of
death, but that we think we have to be hyper-vigilant about disease to
put it off as long as possible.

That's what worries me. By constantly reminding us to be on the
lookout for illness, doctors and the media have made many Americans
feel more anxious. I'm not so sure their warnings have made us any
healthier, but they have decidedly eroded our sense of well-being. We
worry about every ache and pain; we fret that the least little sign of
sadness in a teenager is a symptom of clinical depression. But in
viewing so many aspects of ordinary human experience as treatable
diseases, we may have granted medicine more power than it deserves --
or is good for us.

I realize that's a contrarian view of medical progress. But think
about all the messages we constantly get from the medical world and
the media: Watch your weight. Know your cholesterol. Learn the warning
signs of stroke. Get more sleep, or you'll have car accidents. That
mole on your back? Could be melanoma. Feeling constipated? Might be
ovarian cancer. Take the test. Know your numbers. See your doctor.

In case you've missed the point, there are headlines like this one
that appeared in Forbes magazine: "Medical Symptoms You Shouldn't
Ignore." And a new book: "Body Signs: From Warning Signs to False
Alarms . . . How to Be Your Own Diagnostic Detective" -- a compendium
of symptoms ranging from dry skin to excessive hiccupping that could
signal serious conditions. The book's mission is to "alert you, warn
you, maybe even scare you into going to the doctor."

Scaring people, of course, being the operative idea here. Patient
advocacy groups such as the American Cancer Society have long believed
that the way to improve the nation's health is to increase "awareness"
of this or that disease, and the best way to increase awareness is to
frighten people into their doctors' offices. As early as 1936, the
American Cancer Society was using slogans like "No one is safe from
cancer" in an effort to get women to go in for a breast exam.

Today, patient-advocacy groups routinely sound the alarm about
whatever condition they're trying to eradicate, either by inflating
the number of people affected or by exaggerating the danger. The
National Sleep Foundation, for example, a group dedicated to
encouraging Americans to get more rest, recently released a poll
claiming that a whopping 75 percent of us are so sleep-deprived that
it's interfering with our sex lives. That's one heck of a lot of
sleepy, undersexed people, and it's pretty hard to believe, given that
the National Institutes of Health find that at most 21 percent of the
population has recurrent insomnia. A few years back, at least one
breast cancer patient advocacy group was claiming their disease as the
No. 1 killer of women. In reality, far more women die of heart
disease, followed by lung cancer.

Striking fear also serves pharmaceutical companies, which want you to
worry about diseases, because people who worry are more likely to go
to their doctors and ask for drugs than people who don't. It turns out
that much of what we -- and our doctors -- think we know about many
health problems has been shaped by drugmakers and their marketers.
Take "condition branding," one of the most brilliant and widely used
marketing techniques for selling drugs. Condition branders use
"information" about medical conditions to forge links between disease
and treatment in the minds of both patients and doctors. If they have
a drug but no condition, they will simply invent a disease. I've been
reporting this for years.

One of the best examples is "osteopenia," a diagnosis that millions of
women my age are given every year. Osteopenia is supposedly the
precursor to osteoporosis, the gradual loss of bone that happens to
most of us as we age. Advanced osteoporosis can make women vulnerable
to hip fracture, a serious event when you're old and frail because it
often heralds a series of complications, such as pneumonia, that can
ultimately lead to death. Millions of women are treated for
osteoporosis with drugs that can slow bone loss, thus reducing the
risk of hip fracture. Or so the logic goes.

The problem is, osteoporosis and osteopenia aren't really diseases.
Before the 1990s, doctors decided that you had osteoporosis if you
were elderly and you broke a bone. When the pharmaceutical company
Merck came up with its anti-bone-loss durg Fosamax, it wanted a
broader market than just elderly fracture patients. The solution? The
company helped fund a panel of medical experts to create diagnostic
criteria for osteoporosis so that a diagnosis could be made before the
patient actually broke a bone.

The panel's first step was to define "normal" bone density as that of
the average 30-year-old woman. Next, the experts chose as their cutoff
for osteoporosis a statistical point that was slightly below the bone
density of their normal 30-year-old -- a definition they admitted was
"somewhat arbitrary." Finally, they came up with a completely new
disease -- osteopenia -- for bone density that fell somewhere between
that normal 30-year-old and their arbitrary definition of
osteoporosis.

Voila -- 30 percent of post-menopausal women suddenly had a disease
that needed to be treated early in order to prevent a problem -- hip
fracture -- that wouldn't occur for many years, if ever. According to
the new guidelines, millions more women now had osteopenia, which
their doctors needed to watch like hawks so that their patients could
be treated once they progressed to osteoporosis. Merck then took the
added step of helping doctors buy DEXA scanners, X-ray machines needed
to scan your bones to get that all-important diagnosis.

Along with osteoporosis and osteopenia, we now have a whole raft of
pre-diseases that doctors want to screen us for -- and that drug
companies are only too happy to remedy. There's pre-high blood
pressure and pre-diabetes, which your doctor can supposedly diagnose
even when your blood sugar is perfectly normal. If you've been to the
dermatologist lately, maybe you had some "pre-cancerous" spots
removed. These may well have been actinic keratoses, which, despite
the scary name, almost never develop into an aggressive form of skin
cancer. Get them removed if they're unsightly, but there's no cause
for alarm if you don't. Then there's the mother of all pre-diseases,
high cholesterol -- which is a risk factor, for heaven's sake, not a
death sentence. Yet one creepy Pfizer ad for the anti-cholesterol drug
Lipitor that appeared a few years ago used a female corpse to exhort
women in their 50s to get their cholesterol checked. Know your
numbers. Ask your doctor. Be afraid -- be very afraid.

What's lost in all of this is the belief that we can cope with life,
or really, that we can live in the face of its abiding uncertainties.

In the 1983 movie "The Year of Living Dangerously," a character named
Billy Kwan explains the significance of the Indonesian sacred-shadow
puppet plays. Called the wayang, the plays are set on a screen that
represents heaven. The puppets' shadows are their souls. "The unseen
is all around us," says Kwan, "the right in constant struggle with the
left, the forces of light and darkness in endless balance. . . . In
the West, we want answers for everything, but in the wayang, no such
final conclusions exist."

In our desperate desire for protection against the ambiguous and
unseen nature of disease, we have allowed our physicians and the drug
industry to medicalize everything from heartburn to heartache. We want
answers, even when there are none. We look to medicine to bring relief
from the terrible unknowns of aging and its inevitable losses, even
when the answers have been manufactured to sell a drug. And we are now
so thoroughly convinced of medicine's power that anyone who doubts the
wisdom of medicalization risks being labeled a "therapeutic nihilist,"
one who rejects medicine in its entirety. But you can't spend most of
your career reporting on medicine, as I have, and fail to marvel at
its many wonders -- or to feel compassion for those who are truly ill.

At the same time, I can't escape the sense that we are paying a heavy
price when we broaden the definition of disease to encompass so much
of life. For one thing, there's no such thing as a free lunch when it
comes to medical treatment. Every drug you can name, from aspirin to
Zocor, has side effects -- some potentially more serious than the
diseases they are supposed to prevent. Fosamax, for instance, can
cause necrosis (death) of the jawbone. What's more, there aren't any
valid scientific studies to show that treating osteoporosis early will
prevent fractures down the road. The drug can also trigger serious
heartburn, for which you can take an antacid such as Nexium, but that
makes you more susceptible to pneumonia.

The other price we pay, of course, is that medicalization has created
its own side effect -- anxiety. (There's a drug for that, too.)

Thanks anyway, but I think I'd rather not spend the rest of my life
obsessing over what might kill me. When I fall ill, I'll seek
treatment. I will get my blood pressure checked, because there is
clear evidence that keeping it under control will reduce my chances of
a stroke or heart attack (though even that is no guarantee). I'll
probably get the occasional mammogram, although their value has been
much overstated.

I have no plans to monitor my cholesterol, undoubtedly to my doctor's
consternation. Why bother? I'm already watching my weight, exercising
regularly and eating a healthful diet, and I don't want to take
medications that offer little if any protection against heart attacks
for people whose only risk factor is elevated cholesterol. If I fail
to get eight hours of shut-eye, oh well. There's always tonight to
catch up. My bones will just have to crumble quietly on their own,
because I have no intention of taking a drug whose benefits are
uncertain and whose risks are all too real.

As for anxiety? I think I'll take care of that by tuning out the
medical scare talk.

brown...@newamerica.net

(Shannon Brownlee is the author, most recently, of "Overtreated: Why
Too Much Medicine Is Making Us Sicker and Poorer.")

http://www.washingtonpost.com/wp-dyn/content/article/2008/03/28/AR2008032802972.html

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