Recently I was reintroduced to the concept of medicalisation. To be honest, after my first exposure to the topic in 2011, it never really left me. I was lucky to have a combination of an inspiring lecturer in Peter Kennedy, and being able to make a strong connection outwith the biomedical perspective of health and illness for the first time during my bachelor studies. Now nearly 3 years later I was in Copenhagen and I had the pleasure of having a lecture with the fervent Peter Gøtzsche. I have got to admit, I found it hard at first, to digest the passion which Gøtzsche clearly portrayed during his two hour talk, but it left quite a formidable impression. I am once again drawn elusively towards this controversial and sobering topic.
So what exactly is ‘medicalisation’ ? Well it simply can be interpreted as the medical classification of issues within society, which previously didn’t enter the medical gaze. This can therefore include a wide variety of medical elements from classification of diseases, health promotion, preventative screening, complementary alternative medicines, social norms, moral panics, the list goes on. However the classic example of this would be the classification of the medical disorder of depression.
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If you feeling down, upset and sad at life, you are most likely to be prescribed a cocktail of antidepressants, to address your ‘chemical imbalance’. Even though there are definitely some cases which require medical intervention, some medical professionals would argue that there is an overprescription of these medications throughout the Western world. Some would argue that an individual’s unhappiness in life is merely a natural part of our human lifespan. Life is a roller-coaster after all, with a series of ups and downs, challenges and hurdles, all to be overcome.
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Therefore why has there been a dramatic increase in pharmacological consumption over the last 20 years ? The biggest reason is the domineering influence of big pharmaceutical companies (Big Pharma). They research, develop, manufacture and distribute the drugs, equating to an towering global multi billon pound industry. Add to this, Big Pharma have representatives, who are metaphorically considered as salesman like individuals, who sell their drugs directly to general practitioners and health care systems globally.
This is fundamentally a bad relationship to have for a number of reasons. Science is built upon the foundation of research based knowledge. Within the medical sciences, this is characterised by the gold standard of Random Controlled Clinical Trials. However Big Pharma are accused of ‘selectively reporting’ clinical trail results, resulting in only 50% of results being published. As a result data which goes ‘missing’, instead of being published to the medical community, creates a dangerous monopoly centred primarily around Big Pharma. It also fundamentally goes against the principle of scientific research, in accepting whether a hypothesis is correct or incorrect. However Big Pharma misreport the false results, and mislead healthcare systems and professionals by only showing the positively portrayed results.
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The controversy continues when this lack of information provided by Big Pharma results in side effects or drug failure. There has been wide spread criticism of the Department of Health who purchased nearly 40 million units of Tamiflu, costing £424 million of British taxpayer’s money. This knee-jerk reaction against the ‘swine flue’ outbreak, was a result of evidence published in a meta analysis which was funded by Roche. Subsequently the drugs were not used due to uncertainty in their effectiveness. Europe’s millions of Tamiflu stockpiles are soon to reach their expiration date, resulting in further millions of pounds needed to be spent to replace medical stocks. As a result there have been questions raised by MPs to the role of the medical industry within governmental roles. It has been documented that many members of advisory boards within the UK government, are also active lobbyists for a number of wide organisations within the Big Pharma industry. Make of that, what you will …
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Unfortunately it doesn’t get much better for Big Pharma. Peter Gøtzsche argues that Big Pharma’s selective publishing has resulted in the unnecessary deaths of thousands of patients. He states that the anti arthritis drug, Roxecoxib, has resulted in 100,000 heart attacks as a result of an undocumented side effect. He continues by questioning Big Pharma’s role in another anti arthritis drug, in not disclosing data around celeoxib’s role in heart attacks and gastrointestinal disruption. Gøtzsche also notes the successful removal of the diabetes drug, Rosiglitazone, as it increased cardiovascular disease mortality, but only after many years being widely available on the global medical market.
This sort of negligence and dominance by Big Pharma, not only demonstrates a serious adverse effect on patient’s health, along with misleading patients, healthcare professionals, and health care systems; but also hampers the progression of the scientific community. There have been efforts by a number of international organisations, NGOs, ministries of health and journal publishers to force compulsory publishing of all emperical research data, but it is yet to be seen to effectively work on a large scale.
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Finally, this disregard of the scientific community is a fundamental breach of research ethics. The Declaration of Helsinki’s aim of ‘Medical research involving human subjects must [...] be based on a thorough knowledge of the scientific literature’ is clearly breached a number of times in some of the few examples given in this article.
To conclude the purpose of this article wasn’t to slam ‘Big Pharma’, as that is role of a number of public figures and activists, but to illustrate one of the negative aspects of a medicalised society. Making money in a capitalist globalised world is an entity which is habitually natural in an business environment. However when the lines between public and private become blurred, and result in negative health, ethical and financial implications, then there must be a movement of change. The topic of medicalisation and the role of Big Pharma is very fascinating and I thank individuals such as Peter Kennedy, Peter Gøtzsche, Ben Goldacre and other like minded health professionals for highlighting this unglamorous health issue. However I find once you are eyes are opened to this topic, it is quite difficult to keep them closed.
The ‘Spotlight Series‘ aims to focus on non glamorous diseases or challenges which don’t necessarily receive much of the limelight in Global Health. These are often health issues which are hard hitting, symptomatically bleak in nature or outcome but should receive much more focus due to the serious threat they pose globally.
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