Disease mongering of low testosterone – two journal articles

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Two articles in the current Medical Journal of Australia point to disease-mongering of low testosterone.

David Handelsman, PhD, of the University of Sydney, reports that there has been at least a twofold increase in total expenditure on testosterone prescriptions in Australia over two decades.

Barbara Mintzes, PhD, of the University of British Columbia, and Agnes Vitry, PharmD, PhD, of the University of South Australia, publish a piece in the current Medical Journal of Australia, “Disease mongering and low testosterone in the tale of two regulatory failures.” (subscription required for full access)

They begin:

Currently, direct-to-consumer advertising of prescription-only medicines is legal in only two industrialised countries, the United States and New Zealand. However, in countries where direct-to-consumer advertising is not allowed, including Australia, Canada and countries in the European Union, pharmaceutical companies have found ways to sidestep this prohibition through intensive use of the internet, social media and print and broadcast media — for example, by running “help-seeking” or “disease awareness” campaigns. These unbranded promotional campaigns feature a condition treated by the manufacturer’s product, and often encourage viewers or readers to ask their doctor about a newly available treatment. However, there are many examples of drug company-funded disease-awareness campaigns that exaggerate disease risks and prevalence, and misrepresent treatment effectiveness. Aspects of ordinary life (such as menopause or unhappiness) are “medicalised”, and conditions that are often mild (such as irritable bowel syndrome and restless legs syndrome) are portrayed as serious illnesses. Disease-awareness campaigns can affect consultation and prescribing rates, with potential negative effects on public health if they encourage inaccurate health beliefs and incite consumers to request inappropriate treatments from health care providers.

And they conclude:

In Australia and Canada, the regulatory responses to low-testosterone campaigns highlight the need for changes to current approaches to enforcing the legislative ban on direct-to-consumer advertising. Like independent consumer and health professional organisations in Europe, Australia and Canada, we call for stricter limits on the role of drug companies in providing health information to the public because of the companies’ inherent conflicts of interest. Regulatory bodies should adopt and enforce the World Health Organization’s Ethical criteria for medicinal drug promotion, which states that:

“promotion” refers to all informational and persuasive
activities by manufacturers and distributors, the effect
of which is to induce the prescription, supply, purchase
and/or use of medicinal drugs.

In particular, unbranded product advertising, and the use of pseudo-branding or similar techniques, should be explicitly prohibited. Pharmaceutical companies should be discouraged from illegal direct-to-consumer advertising through meaningful penalties, rather than non-prohibitive sanctions such as the symbolic fines imposed in Australia.


Side note:  MSNBC today posted a story, “Men seek testosterone quick fix, with risks.”


Addendum on June 6:  William Heisel this week wrote, “Steer Clear of Disease-Mongering Quicksand.



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Michael Mirochna, MD

June 5, 2012 at 9:15 am

It would be awesome to limit these ridiculous campaigns. They are framed in such a slick way to convince people they have this problem and that “help” is available. Even if the “help” is available, if patients really knew the benefits (and if they were actually clinically meaningful, vs merely statistically) and if they had to pay for said device/medicine, there is no way in heck they’d ask for that medication.

Unfortunately, in this political climate, people are crying for less regulation. So I guess we have to let people have the right to be duped (and likely harmed). We certainly wouldn’t want to help people, then we’d be a nanny state. So instead we allow the PHARMA companies to make the rules and we all foot the bill when medicare spending goes up and our taxes or our premiums as well, in order to pay for things that don’t work, don’t help or hurt patients. Yuck.