Reporters at MedPage Today and the Milwaukee Journal Sentinel spent nine months looking into the issue known as medicalization. Medicalization is how drug companies and the doctors on their payrolls help turn what were until recently considered everyday health conditions into serious medical disorders. Here’s the story behind the story of “Lowering the Bar,” reported by John Fauber, Kristina Fiore and Matt Wynn.
Twenty years ago, terms such as adult ADHD, overactive bladder, binge-eating disorder and Low T were not a part of mainstream medicine. Today, they are. And all of them can be treated with dangerous and expensive drugs that often are not very effective.
For this project, John Fauber of the Journal Sentinel and MedPage Today reporters Kristina Fiore and Matt Wynn focused on eight of the conditions. As a group, they are purported to affect 180 million Americans, or 77 percent of adults.
The reporters found that drug companies not only helped create and define these conditions, they funded studies claiming that growing numbers of people were afflicted by them. At the same time, doctors who worked as drug company consultants and powerful medical societies that received millions in pharma funding chipped in by officially defining the conditions and creating treatment guidelines that recommended use of the companies’ drugs.
How a condition becomes an illness
Consider overactive bladder.
For decades, bladder problems were identified as incontinence or “detrusor instability.” The conditions were generally considered a consequence of people getting older.
Beginning in 1997, two urologists with pharmaceutical industry financial ties, spearheaded a movement to rename and redefine the condition, help write medical journal articles about it and boast of a new drug to treat it.
They also helped produce a survey claiming that 33 million Americans had the condition, a huge jump from the 11 million who had incontinence. Subsequent drug company-funded surveys would push that number to 42 million and then 46 million.
The reporters also uncovered a 2002 marketing slideshow by an executive of the company that made the first overactive bladder drug. The company also helped fund much of the overactive bladder effort.
The subtitle of the presentation: “Creating a disease.”
Today, the overactive bladder drug market exceeds $3 billion a year.
The project also showed cozy ties between drug company executives and regulators with the U.S. Food and Drug Administration.
In 1998, executives with Eli Lilly and the FDA met privately to discuss a condition known as premenstrual dysphoric disorder, a form of PMS that is said to be so strong it qualifies as a psychiatric disorder.
There has never been strong agreement that PMDD was a valid psychiatric condition, but in the years following the meeting, the FDA approved four drugs to treat it. One was Lilly’s drug, Prozac, which was rebranded by changing its colors to pink and purple and giving it the more feminine sounding name, Sarafem.
It would not be until 2013, that the American Psychiatric Association finally recognized PMDD as a psychiatric disorder.
Finding the damaging proof
One the biggest challenges for this project was finding data that showed the harm of medicalization. Maybe the best example of that is adult ADHD, which often is treated with dangerous amphetamines.
To gather that information, the reporters drew from several little-known government databases, even going to the local level to measure the growth of the problem.
A federal database showed that emergency room visits involving the drugs had nearly quadrupled over a seven-period; data from Florida showed its morgues had seen a 450 percent increase in deaths involving the drugs over six years. A federal survey showed recreational use of the drugs among those aged 26 and older had increased dramatically to 1.4 million people.
Part of the project also required downloading and analyzing a huge database maintained by the FDA. It showed that between 2013 and 2016 there have been more than 19,000 reports of complications from ADHD drugs.
The reporters used that same database to show tens of thousands of serious side effects and thousands of deaths from drugs used to treat many of the other conditions highlighted in their stories as well as to show how individuals were harmed by the treatments.