PLoS has pharma pegged wrong

In scathing articles earlier this month, the online medical journal Public Library of Science (PLoS), www.plos.org, decried pharmaceutical industry public education campaigns as disease mongering that "turns healthy people into patients [and] wastes precious resources."

In scathing articles earlier this month, the online medical journal Public Library of Science (PLoS), www.plos.org, decried pharmaceutical industry public education campaigns as disease mongering that "turns healthy people into patients [and] wastes precious resources."

Company-sponsored disease education, the journal claims, has turned "minor problems" - it cites irritable bowel syndrome (IBS) as an example - into serious illnesses; has exaggerated the prevalence of some diseases, such as attention-deficit hyperactivity disorder (ADHD); and has turned risk factors, such as osteoporosis, into diseases themselves.

The PLoS special won coverage in USA Today, the Chicago Tribune, and The Times of London. That respected media outlets would reprint these claims as truths is disappointing. The accusations make great copy, but the criticism is just plain wrong... and more important, it is dangerous.

Of course, drug companies need to sell products, expand markets, and win market share. But the pharma industry is unique in its ability to translate science into medicines that help millions, educate the public about disease conditions, and encourage patient- healthcare professional dialogue.

Opinion disguised as facts only turns patients and caregivers away from valuable resources and toward cynics with little to offer.

For a patient suffering from IBS, the excruciating pain associated with it is anything but minor. To suggest that companies aren't serving a public need by helping identify the thousands of undiagnosed patients is reckless and insensitive.

To suggest that companies exaggerate the benefits of treating ADHD or pediatric bipolar disorder is an affront to thousands of parents whose children have these conditions. I have spoken to many such parents who tell me they welcome more - not less - information from pharma companies.

PLoS complains that companies invent disorders. Sure, companies sometimes try to simplify names to make them more understandable (or, in the case of erectile dysfunction, more acceptable), but new disease categories rarely arise de novo from marketing staffs. Redefinitions must be grounded in sound medical research; if not, they won't gain traction with the medical community or the public.

The articles assume we've already identified every disease, but throughout history, doctors have redefined disorders and recategorized them based on new evidence and treatment plans. Medicine's history is one of evolving definitions and nomenclature.

High-serum cholesterol is not, by itself, a disease, and drug companies don't suggest that it is. However, it is a very serious risk factor for heart disease and stroke, and we know from many well-designed clinical studies that coronary events can be reduced 27% to 40% when medications are given to at-risk patients. Is it "disease mongering" to communicate these benefits to patients? Hardly.

In Illness as a Metaphor, Susan Sontag wrote: "Illness is the night-side of life, a more onerous citizenship. Everyone who is born holds dual citizenship, in a kingdom of the well and in the kingdom of the sick. Although we all prefer to use only the good passport, sooner or later each of us is obligated, at least for a spell, to identify ourselves as citizens of that other place."

To navigate this "other place," we need all the help we can get, including that of drug companies.

Michael Durand is senior counselor, healthcare, at Porter Novelli.

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