Disease Mongering

Cathy Arnst

I recently wrote an article for BusinessWeek on disease mongering, a term coined by pharmaceutical industry critics to describe the practice of creating or exaggerating an illness in order to sell more drugs. Examples: restless leg syndrome, social anxiety disorder and premenstrual dystrophic disorder. But the examples I found most disturbing were those related to children, such as the diagnosis of bipolar disorder in kids as young as two. This is a disease whose symptoms don't usually show up until a patient is in their teens or early 20s--labelling a kid with bipolar at age two is controversial, to say the least.

Lots of doctors are bugged by the inflation of the ordinary discomforts of life into full blown diseases. An excellent blog by a pediatrician, Dr. Flea, homed in recently on what he sees as the over-use in emergency rooms of Zofran, an anti-nausea drug, for children who have been vomiting. For that matter, he's pretty unhappy about the overuse of emergency rooms for vomiting children.

Says Dr. Flea:

The background of this study is one that is familiar to readers of Flea: too many non-emergently ill children are being brought to emergency departments. Too many parents present to E.D.s expecting intravenous hydration for their children, and too many E.D. docs are obliging them. The purpose of the study, with the best of intentions, was to see if there were some safe, effective medicinal means of avoiding having to place an IV.

There is not one thing about this study that I like....When I was a resident, we needed to page the anesthesiologist covering the "pain service" if we wanted to order Zofran for our inpatients, including oncology patients! Now we're studying the use of this (still) very expensive drug to outpatients who don't really need it. In the study, after the drug or placebo was administered, the treating physician could decide whether to administer IV fluids, to patients in whom IV rehydration was not indicated!

Be sure to read all the comments to this post. There are lots of real life examples of parents who found themselves waiting around ERs for minor childhood problems beause they weren't sure what to do. And there are stories frm those who resisted going to the ER, gave their vomiting child some water, and the problem went away.

I think it's a natural reaction to panic a little when your child is sick. Dr. Flea's post was a good reminder that most illnesses go away on their own without any intervention, and especially in children. The first time my daughter got a bad cold I found myself rushing off to the pediatrician, only to be told (in much more diplomatic words), "Hey, kids get colds. Get used to it." Wise words in these over-anxious times.