Disease Mongering

(This 836th Buffalo Sunday News column was first published on April 1, 2007.)

I thank my lucky stars I went to school when I did.

My achievement was always reasonably good but I was identified as a discipline problem. I know this for two reasons. First, I held the school record, having been kept after school every day through my sixth grade year, many of those afternoons in the principal's office. Second, I returned to that school system as a math teacher after attending college and serving in the armed forces. When my former teachers identified me, they universally expressed their amazement that I had "made anything" of myself.

I am convinced that, if I was in school today, I would be identified as a child with ADHD: Attention Deficit Hyperactivity Disorder. While the identification may well be a correct one, the response might not. I would probably be drugged with psychostimulants, calmed down of course but almost assuredly dumbed down as well.

In telling my story I am not arguing against treatment of extreme so-called "acting out" students; rather, I am deeply concerned about what has come to be called disease mongering: applying medications well beyond the use for which they were designed.

Because of my own school experiences, I read up on ADHD and was amazed to find one psychologist who claimed that one out of five children needed treatment. His estimate it seems to me is wildly beyond reality. Take what he says to heart and we would end up with a collection of zombies in our schools.

It is easy to blame teachers for this. "If only I could get rid of little Gerry," they would say, but when Gerry is gone, Fred would be next. Then Monica, then.... And they would end up tutors -- or alone.

But I don't blame teachers. I blame our modern society. We're applying to disease the same kind of nonsense we apply to pet rocks and dollar-a-bottle water. If an advertisement tells us to do something, we line up.

Here is an example of how disease mongering works. The pharmaceutical company Pfizer spent a great deal of money developing the drug Viagra as a response to organic erectile disfunction often related to diabetes or prostate surgery. Tests indicated that the drug was a reasonably (50-60%) effective and quite safe response to these serious problems.

But Phizer is also a business. If they could expand the market for Viagra, they could make much more money. And so Viagra is now sold, with the usual ad-man's exaggerated claims, as a kind of social stimulant.

Just so the ADHD drugs, in that case with psychologists and teachers serving as unwitting shills to expand the market.

There are, of course, serious illnesses in our community, but most of us don't suffer from those diseases. If we listen to the radio and watch television, however, we are counseled to think seriously about these problems. And it is not a great leap to personal identification.

The entire April 2006 issue of the on-line journal, PLoS Medicine, was devoted to this issue with far more detail offered than I have given here. That issue is posted at: collections.plos.org/plosmedicine/diseasemongering-2006.php.

Another of the journal examples is bipolar disorder, the syndrome that was formerly called manic-depressive illness. Essayist David Healy of Cardiff University tells how one drug is sold: The television advertisement "begins with a vibrant woman dancing late into the night. A background voice says 'Your doctor probably never sees you when you feel like this.' The ad cuts to a shrunken and glum figure, and the voiceover now says, 'This is who your doctor usually sees.' No drugs are mentioned but viewers are encouraged to log onto" a website where the drug Zyprexa is recommended. Healy goes on to suggest that this ad can be taken as "a genuine attempt to alert people" or as disease mongering. His point is that the drug marketers don't care, so long as their product sells.

The authors of the essay series agree that we need doctors trained to head off misapplied panaceas and government intervention to control ad abuses. While those may be appropriate, I believe that we all need to discipline ourselves. The world is full of temptations, but each of us has to begin making more reasonable choices. The alternative: a nation of April fools.