The Journal of the American Geriatrics Society published an editorial, “Disease Mongering of Age-Associated Declines in Testosterone and Growth Hormone Levels.” It’s written by Dr. Thomas Perls, Professor of Medicine and Geriatrics, Boston Medical Center and Dr. David Handelsman of the University of Sydney.
Because we want to devote more attention to health care advertising and marketing issues, we think this topic is particularly relevant for our site.
A combination of direct-to-consumer product advertising (DTCPA) and lax consensus guidelines for testosterone prescribing have, over the past decade, led to 10- and 40-fold increases in testosterone prescriptions in the United States and Canada, respectively, with Internet pharmacies playing a major role in the latter’s increase. U.S. pharmaceutical sales of testosterone increased from $324 million in 2002 to $2 billion in 2012, and the number of testosterone doses prescribed climbed from 100 million in 2007 to half a billion in 2012, not including the additional contributions from compounding pharmacies, Internet, and direct-to-patient clinic sales. On September 17, 2014, the U.S. Food and Drug Administration (FDA) convened a meeting to address concerns that many men are receiving testosterone who should not and because of reports of adverse cardiovascular events in men using testosterone. We join others who characterize the mass marketing of testosterone coupled with the permissive prescribing of testosterone for common, nonspecific, aging-related symptoms as disease mongering of declines in testosterone with advancing age.Disease mongering is defined as “the selling of sickness that widens the boundaries of illness and grows the markets for those who sell and deliver treatments.” The prescribing of growth hormone for “antiaging” or “age management” is another example of disease mongering.
DTCPA is the mass marketing component of disease mongering of age-related declines in testosterone. With advertising directed primarily at baby boomers, age-related complaints such as “slowing down” and low libido are attributed to catchy medicalized sounding syndromes like “low T” and “andropause.” These syndromes are likened to menopause, which is a false and misleading analogy because middle-aged men do not experience any universal or sharp decline in serum testosterone. The pharmaceutical industry asserts that DTCPA is an important service to the public that helps people and their doctors become aware of treatable medical problems. However, when sophisticated mass marketing is directed toward people lacking the technical expertise to critically evaluate the deceptively simplified medical science claims that such advertising makes, there is ample opportunity for disease mongering. Because doctors are the prescription gatekeepers, these advertisements can effectively pit patients against their doctors, pressuring them for compliant prescribing on demand and distorting clinical judgment.
We applaud the FDA’s recent joint committee meeting and labeling changes to address what we and others view as disease mongering of age-related declines in testosterone for “age-related hypogonadism” or “antiaging.” We call upon Health Canada, the U.S. FDA, and the Federal Trade Commission to ban educational and product advertising of testosterone for these contrived “indications.” Without demonstrated underlying reproductive system pathology, a set of common complaints plus or minus a low serum testosterone cannot constitute “hypogonadism.” To discourage medically inappropriate prescribing of growth hormone, the FDA requires that a pathological basis for growth hormone deficiency be demonstrated to provide and dispense a prescription. To discourage disease mongering of testosterone, the FDA and Health Canada should similarly require demonstration of pathology to provide and fill a lawful prescription for testosterone.
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