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| BRYAN W. HUSTED,
Co-Director, Chair of Business Ethics |
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WHEN HEALTH AND PROFITS CLASH:CONFLICTS AT THE INTERSTICES OF BUSINESS AND MEDICINE
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One might think that the last two decades have seen an explosion of new diseases like restless leg syndrome and female sexual dysfunction. Other illnesses such as attention deficit hyperactivity disorder (ADHD), erectile dysfunction, and bipolar disorder have been redefined so that they are applied to an ever expanding population of people who are affected by these diseases. Fortunately, the pharmaceutical industry has come to the rescue with new drugs that promise relief and even lifestyle enhancement.
In reality, these conditions are often variations of normal human experience or better treated through non-medical interventions. The marketing of remedies for these disorders has been widely criticized as “disease mongering”. This phenomenon has been defined as “the effort by pharmaceutical companies (or others with similar financial interest) to enlarge the market for a treatment by convincing people that they are sick and need medical intervention”.
A recent issue of the journal Public Library of Science Medicine examines disease mongering and the role of the pharmaceutical industry in fostering this practice. A number of stakeholder groups have been involved in the expansion of these diseases and their
treatment as medical conditions. Teachers have been enlisted in the diagnosis of ADHD. The news media has helped to provide the public with information about these diseases. The medical profession itself has played a key role as the agent that prescribes medicines for relieving these conditions. The pharmaceutical companies are involved in public education campaigns about these diseases – often perceived as socially responsible business practices.
The economic consequences of these practices are potentially immense as people
seek treatment for conditions, which may not be susceptible to significant improvement from medication. Take erectile dysfunction as an example. Clearly, there are cases, such as diabetes and prostrate surgery, where the new medications are indicated. Yet erectile dysfunction can occur in most healthy men from time-to-time and it is the marketing of these products to such men that gives rise to accusations of disease mongering. As people seek treatment for these different conditions, private and public health insurers are being asked to pay. The attention of pharmaceutical companies is being distracted by the profits that are available in the treatment of these conditions, rather than focusing on the development of cures for diseases about which there is no debate concerning their consequences for personal and public health.
Clearly the attractiveness of relatively easy profits is very tempting in an industry where the development of new drugs may cost hundreds of millions of dollars and years of arduous research and testing. This situation gives rise to a classic ethical dilemma for business: the conflict between firm profits versus responsibilities to persons and groups both inside and outside the company. Similar dilemmas regarding health and profits faced business at the beginning of the twentieth century when marketing campaigns for soap in the United States emphasized the necessity of daily bathing as key to personal hygiene and cleanliness.
The causes of disease mongering are many. Clearly, consumerism is a prevailing ideology in the West, where a modified version of Descartes’ philosophical statement, “I buy,
therefore I am”, seems to characterize the lives of many people. Increased competition and the need to create profits also play a part in the explanation. The collaboration of physicians based on a variety of incentives for prescribing certain medications plays a role. Even teachers, desiring to control an unruly child, may find in a problem-free afternoon a subtle incentive for participating in the diagnosis and treatment of ADHD. Probably the main culprit is the lack of understanding of patients regarding their own medical care and their implicit trust in the people charged with overseeing that care. In some sense,
it is difficult to expect that patients will have the knowledge necessary to determine whether a treatment is valid or
playing upon their fears.
Taking advantage of others is inherently abhorrent as no one likes to be exploited – the golden rule. Even from a more utilitarian perspective, the pursuit of profit in this case may result in a lower overall benefit for society because of a misallocation of resources, which are directed toward the treatment of relatively unimportant maladies.
The solutions are many. Clearly, the medical, teaching, and news professions need to redouble efforts to avoid conflicts of interest. This tenet is basic to the
professional ethics of each
of these groups. Disease mongering needs to be acknowledged and critically examined by the pharmaceutical industry. Pharmaceutical stockholders, as they become aware of the problem, may even be willing to constrain profits in order to avoid excesses. Patients need to be educated and be actively involved in managing their own health care. Finally, it may be necessary for public policy to regulate the area, especially taking care to eliminate the most egregious practices such as incentives that cloud the medical judgment of health practitioners. Clearly, disease mongering is a complex problem, which needs collective attention now, or naive patients will continue to be subject to its practice.”
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