Defining Disease

According to an editorial in the NYT, a recent proposed shift in defining hypertension was funded by — and perhaps pushed by — drug companies standing to increase sales via a larger number of patients being diagnosed with hypertension.  The editorial notes that the new definition (which looks at other risk factors in shifting people who would now be pre-hypertensive into the hypertensive category) has some merit and defenders, but focuses on the funding as a concern.

The Post has a closely-related piece about Restless Leg Syndrome, a bona fide but previously-little-known syndrome that has become much better-known via direct-to-consumer advertising via GSK (the first drugmaker to gain an RLS indication).  The basic issue, policy-wise:

The debate has focused attention on what some have dubbed “disease-mongering” — taking something that is within normal bounds and labeling it a disease needing pharmaceutical treatment.

“We’re increasingly turning normal people into patients,” said Lisa M. Schwartz of Dartmouth Medical School.

Shy people have “social phobia,” requiring psychotropic drugs. High-strung boys have attention deficit disorder and need amphetamines. Baby boomers with slightly elevated blood pressure have “pre-hypertension” and line up for beta blockers. A few nights of restlessness calls for sleeping pills.

“The ordinary experiences of life become a diagnosis, which makes healthy people feel like they’re sick,” Schwartz said.

On the issue of DTC advertising:

“The argument the pharmaceutical industry is always making is that this is patient education — that this is an under-diagnosed condition and ‘we’re just trying to raise awareness,’ ” said Michael Wilkes of the University of California at Davis. “If you’re talking about something like hepatitis C or measles, that might be true. But if you’re talking about toenail fungus or baldness or restless leg syndrome, I just don’t buy it.”

[Hypertension story via Greedy Trial Lawyer.  Disclosure: I perform litigation consulting for a couple of drug companies.]