A scientist’s view of disease-mongering
Karen Sepucha, PhD, One of our medical editors
Why this matters to patients
Dave deBronkart has seen disease-mongering in news stories and he calls it “foolishness.”
Why Does This Matter?
- Some people are trying to make all of us feel like there’s something wrong with us – even if there isn’t. That’s what we call disease-mongering. It’s dangerous because it scares people, it drives people to seek medical attention when they really don’t need it, and it costs all of us – emotionally, financially – and in a public policy perspective because it can distract us from the really important health care issues we should be addressing.
- Sometimes it is not intentional disease-mongering. News stories may exaggerate a condition. They may treat risk factors as diseases. For example, they may treat an elevated blood test result as a disease. They may convince us that we should be concerned about “a score” or a test result number when really what we should be concerned about are outcomes like illness or death.
- Disease-mongering also includes turning a normal state of health – or a normal variation of normal health – into a medical problem. For example, baldness, wrinkles, shyness, menopause and toenail fungus are NOT diseases.
- Identifying disease mongering is a matter of judgment. Sometimes it is obvious. Sometimes there’s a fine line about whether an article on irritable bowel disorder, erectile dysfunction, restless leg syndrome or osteoporosis (all of which can be serious for some sufferers) is misrepresenting the condition to the public.
- Beware of statistics that may inflate the seriousness of a condition. Beware of articles that exaggerate the human consequences of a condition – as with the example above that stated that millions of us are “suffering in silence” with toenail fungus. Suffering?
- Beware of interviews with “worst-case” patients – holding such patients up as examples as if their experiences were representative of all with this condition.
- Focus on what’s really important in your own health – not on what someone who is “selling sickness” may want to do to scare you into testing or treatment.
- Question prevalence estimates. Who says x number of people have restless leg syndrome? Social anxiety disorder? Scrutinize spurious statistics.
- Be wary of stories about pseudodisease – such as a “pre-disease” state that lowers the threshhold for what we call disease, opening new markets for people to be treated with drugs or vitamins or whatever. If you follow these issues over time, you’ve seen how numbers get changed, threshholds are lowered, so that overnight, millions more have diabetes, high cholesterol, high blood pressure and osteoporosis.
- Watch for stories that make women targets of disease-mongering– with premenstrual dysphoric disorder, vaginal atrophy, female sexual dysfunction, overactive bladder, menopause all framed as diseases that must be treated. (Actually, men get their share as well – being hammered about low testosterone, balding, etc.)
Thumbs Up Examples
The story did not engage in overt disease mongering. In fact, it concluded that having the test is “not a good idea if the number will be just one more thing to obsess over or feel guilty about.”
The story did not engage in disease mongering. In fact, it alluded to the fact that not all cancers are dangerous. This is a concept that is not often mentioned.
The story notes that heart disease is the leading cause of death in the U.S., but it also points out doubts about whether screening with CT scans for calcium buildup in heart arteries can reduce the toll.
Thumbs Down Examples
In one of the worst examples of disease-mongering we’ve ever seen, the paper let a plastic surgeon get away with saying, “The pain that women with large breasts can have has been compared to when someone gets metastasized cancer of the spine”
Classic case of disease mongering. Millions of us “suffering in silence” with toenail fungus? Gag me.
The story does not exaggerate the prevalence or mortality of colon cancer. However, the story crosses the line into disease mongering in its description of polyps, calling them a “monster… sprouting inside a patient’s large intestine like a mushroom”. More importantly, though, it falsely claims that most polyps develop into cancer in 10 years. This kind of misstatement does a disservice to the reader in obscuring the clinical reality with fear mongering.