DRUG BUST by Alan Cassels

There’s a new mania and I’ve got it. At least, I think I’ve got it.
I seem to have all the symptoms for someone whose mania is seeing diseases everywhere. It’s like “all illness, all the time.”
I’ve got “disease mongering mania.” Call it DMM for short.
All around me I hear voices chanting the mantra, “You’re sick, don’t suffer in silence, see your doctor, get treatment. You’re sick, don’t suffer in…” etc.
These same voices seem to be coming from all kinds of unique places: television and magazine ads, the wife of a former prime minister, even from the pages of a medical journal as two psychiatrists battle it out.
Ironically, my current form of DMM seems to be largely emanating from the makers of powerful drugs for schizophrenia – a coincidence, that? – and they all seem to be saying the same thing: It may not be depression; it could be bipolar disorder.”
That’s the tag line hanging off one new ad campaign launched by a major pharmaceutical company, which is pushing a powerful anti-psychotic drug.
The three-page ad starts out on one page featuring a dark and grainy picture of an obviously depressed woman and the bold subtitle: “Sometimes there is another side to depression.”
Turn the page and you find two pages of snapshots of her in her manic phase: talking too fast, sleeping less, spending out of control and flying off the handle, among other sins.
Not to be too snarky, but these traits could apply to lots of women on the planet – many women I know and especially my sisters. The tagline there reads: It could be bipolar disorder.”
The ad steers you toward www.isitreallydepression.com/. The website offers a “mood questionnaire,” which is, and I’m not making this up: “Easy, quick and confidential…” and it can also “… help you recognize behaviours (past or present) that may suggest bipolar disorder.” Sheesh, I wish I were making that up.
Now what the heck is going on? Is depression reincarnated as the latest disease du jour – bipolar disorder?
Let me clear the air right now and say that genuine bipolar disorder can be truly debilitating and devastating for people who swing between extreme episodes of deep depression and euphoric mania.
There is no doubt in my mind that people with genuine bipolar need help: both psychological counseling and sometimes, medications.
But what is it with this garden variety bipolar being described by the marketers? Is it even ethical to describe the condition in terms so common that it’ll draw in whole swaths of people who experience nothing more than normal ups and downs?
To see how bipolar is being sold to your doctor, check out www.recognizebipolar.com/. There, you’ll learn: “At any time, 49 percent of people with bipolar disorder are undiagnosed.”
The goal of this type of doctor-targeted ad is to make docs feel guilty. If you watch US television programs, you may also see an advertisement asking people to log onto www.bipolarawareness.com/, which takes them to the Bipolar Help Center, backed by Lilly, makers of another anti-psychotic drug. This stuff is everywhere.
The problem is not just that the disease is being packaged for us at every turn with these “awareness raising” activities, but that the target drugs behind the bipolar marketing are – and I don’t use these words flippantly – powerful, anti-psychotic treatments, capable of causing horrendous, sometimes irreversible, adverse effects in some people. These truly are drugs for truly sick people.
From the academic press comes some evidence of bipolar-mongering. Dr. David Healy, a Wales-based psychiatrist, recently wrote an essay entitled The Latest Mania: Selling Bipolar Disorder, which was published on the free, web-based Public Library of Science. (Google PLoS and Healy and you’ll find it).
His analysis sparked a stunning rebuke from Dr. Ghaemi, who alleged that Dr. Healy must be suffering from DMM, and seeing made-up diseases everywhere.
The debate between the two academics spilled onto the pages of popular media, including the Guardian Unlimited in the UK. An April 28 headline read: “Glaxo Denies Pushing ‘Lifestyle’ Treatments.”
The story featured GlaxoSmithKline, the biggest drug company in Europe, saying it most categorically was not “… turning healthy people into patients by ‘disease mongering’ and pushing ‘lifestyle’ treatments for little-known ailments.”
At the heart of the debate is the prevalence question. On one side, people like Dr. Ghaemi say there is a ton of empirical evidence showing that bipolar disorder has been highly under-diagnosed, (i.e.: lots of people running around who need treatment), while Healy maintains that bipolar is being vastly over-diagnosed. So much so that it is being “sold” as a disease to many people who may not even have it.
While the truth is multilayered, what we do know for sure is that “under-diagnosed” is the view favoured by the companies that hope to profit from our mania.
Just recently, Margaret Trudeau, ex-wife of the late Pierre Elliot Trudeau, Canada’s former prime minister, jumped into the fray. At the recent launch of a fundraising event at an Ottawa hospital, she admitted to struggling with depression and bipolar disorder for much of her life.
At the press conference, Dr. Pierre Blier, chairman of mood disorders research at the University of Ottawa’s Institute of Mental Health Research, provided a resonant soundbyte: “The pivotal stone for treating the illness is medication.”
Pharma’s shareholders no doubt rejoiced with the coup of capturing such a high-profile Canadian as Maggie to deliver the necessary traction in the slippery minds of attention deficit-disordered journalists.
Is it a problem when celebrity magnets are used to highlight a condition? Not really, but what bothers me is that even as we feel for the plight of Ms. Trudeau, and others like her, few of us can see the fingerprints of Pharma all over this mongering, as it busily colonizes the illnesses of celebrities to normalize the prescribing of Zyprexa, Seroquel and Risperdal to people a lot less sick than she is.
The mania around bipolar disorder has been stalking me for some time now. Wendy Armstrong, one of Canada’s leading consumer health activists with Alberta’s consumer association, told me a story about a stakeholder consultation on drug patent protection she had attended in 1998.
When someone at the meeting noted that the association needed to rethink how much patent power it was giving the drug companies, a high-profile and highly respected member of Alberta’s research community adamantly disagreed, saying, “Drug companies need expanded patent protection in order to come up with the next generation of anti-depressant drugs to deal with the worldwide pandemic of bipolar depression.”
Wendy said she burst out laughing, thinking the guy was joking, but abruptly stopped when she realized he was dead serious. Remember, that was 1998. Big Pharma has had this one on the books for a long time.
Wendy suggested to him that maybe a revolution might be more effective and a whole lot cheaper. She now looks back on the whole episode with aplomb.
“Sheesh, I mean between the obesity epidemic and the bipolar thing, it’s lucky we can walk to the bathroom and back without losing our self esteem.”
This is the one thing keeping me partly sane as I struggle with my disease mongering mania: that there are people out there like Wendy Armstrong and David Healy to keep me company.
And, please, dear reader, if you hear about or come across any “new” diseases that someone is trying to convince you that you are suffering from, please email me at alan@alancassels.com/.
We disease-mongering maniacs have to stick together. Because, after all, misery loves company.

Alan Cassels is co-author of Selling Sickness: How the World’s Biggest Pharmaceutical Companies Are Turning Us All Into Patients, and a drug policy researcher at the University of Victoria. He is also the founder of Media Doctor Canada (www.mediadoctor.ca), which evaluates reporting of medical treatments in Canada’s media.