Anxious Times: Big Pharma Clouds What It Means to be Sick

Monday Magazine | February 1, 2008
Tense? Anxious? Worried what tomorrow might bring?

So are 3,400 children in Greater Victoria, according to ominous literature distributed to media outlets across the city last week. The press release, headlined “Anxiety disorders in teens risk factor for suicide,” promotes a free January 24 seminar “to help parents learn how to manage anxiety disorders in their children and ultimately reduce the suicide risk in adolescence and young adulthood.”

The seminar is spearheaded by AnxietyBC, a non-profit group of “consumers, family members and professionals” founded in 1999. Seminar organizers cite a recent study from researchers in New Zealand who found anxiety disorders may be a risk factor in suicide and management of anxiety may be important in reducing that risk. Organizers say 10 percent of young people under the age of 19 are afflicted with one of at least seven different anxiety disorders and 80 percent of those cases go undiagnosed and untreated.

Perhaps it makes sense in an age of war, terrorism, bullying, high school shootings, materialism and the pursuit of superficial beauty that our children’s developing minds are wracked with woe about the state of their world. Then again, perhaps there’s more to the story.

A disorder for every concern

Anxiety disorders are among those contentious medical conditions—like bipolar disorder and the newly discovered restless leg syndrome—which, while grounded in empirical diagnoses in severe cases, have transcended rational thought to become one-size-fits-all conditions. Reading the list of possible symptoms, or self-administering a readily available online test, one soon finds that most of the North American population could qualify as anxiety patients at one time or another.

Experts like Dr. Melisa Robichaud, the UBC psychologist leading AnxietyBC’s upcoming seminar, say true anxiety disorders are diagnosed on the basis of frequency, duration, severity and impact on a person’s life.

But skeptics contend too wide a net is being cast, capturing those at the far fringes of the spectrum of newly discovered mental health epidemics—a phenomenon borne mostly of disease-mongering by large pharmaceutical companies in need of markets for their ever-expanding stable of products. This problem, says Victoria health policy analyst and consultant Janet Currie, undermines those with legitimate mental illnesses, while entrapping too many otherwise healthy people in a web of pharmacological dependence.

“The pharmaceutical companies would not be so foolish as to go out and say, ‘Buy drugs’,” says Currie. “Recent scrutiny has caused [companies] to support the work of groups who are genuinely well-meaning. How do drug companies market their products? They need legitimate organizations to say things like, ‘Anxiety is a serious condition.’”

This trawler approach also clouds the legitimacy of the myriad networks formed to help patients cope with the trauma of their disorders. AnxietyBC’s website, for example, says the group is funded by the province’s health authorities and other foundations. But in just three quick mouse clicks you can navigate from AnxietyBC to the web pages of some of the biggest pharmaceutical companies in the world.

AnxietyBC is an affiliate of AnxietyCanada, whose founding partners are GlaxoSmithKline, Wyeth, AstraZeneca and several other companies that have profited handsomely from the introduction and expanding diagnoses of new mood and personality disorders over the last three decades. They are among the largest manufacturers of antidepressant s on the market. GSK manufactures Paxil, Wyeth manufactured Ativan until 2003 (when it sold the rights to Biovail Corp. for $130 million plus yearly payments) and AstraZeneca makes Seroquel.

Phone calls to AnxietyBC’s Vancouver office to inquire about the nature of the group’s relationship with AnxietyCanada and the pharmaceutical companies were not returned by press time.

American author and speaker Barbara Coloroso, who has spent more than 30 years writing on parenting, teaching and positive schooling, doesn’t dispute that children today are anxious, but contends less time should be spent trying to “fix” them as patients (or customers, in the eyes of big pharma), and more time dedicated to improving the environments in which they grow up.

“Yes, anxiety is on the rise, but we’ve labelled it a medical malady and opted for drugs as a solution,” says Coloroso. “Kids today are over-organized, over-tested, and over-protected to the point they’re not allowed to take the kinds of safe risks that allow them to gain confidence and grow as people.” Coloroso acknowledges there are plenty of legitimate cases of anxiety disorders among children, but a climate of “bubble-wrapping” kids means they’ve been cut off from the challenges and opportunities that help them solve the problems that are part of everyday life.

“I think we need to take a serious look at the culture we’ve created for our kids,” she says.

Beware the monger hordes

Disease mongering is big business and few people in the province know that better than Victoria drug policy analyst Alan Cassels. His new book, The ABCs of Disease Mongering: An Epidemic in 26 Letters, takes a playful look at a phenomenon that has serious implications for our country’s medical system . . . and for the patients snared by the rhetoric of fear pervading the discourse on what it means to be “normal.”

Cassels’ book is told in children’s verse, a contrast to his last offering, Selling Sickness: How the World’s Biggest Pharmaceutical Companies Are Turning Us All Into Patients, which he feels was perhaps too earnest in its approach. The pen-and-ink drawings in ABCs portray agitated-looking characters knotted up by diseases they may, or may not, have. “Even I believe it’s best to sugarcoat things a little,” writes Cassels in the book’s introduction.

The Victoria researcher argues disease mongering is fueled by pharmaceutical companies continually developing new drugs, or redirecting and remarketing old ones capable of treating a seemingly endless array of diseases. These publicly traded companies are beholden to increasing shareholder value, and when there aren’t enough customers to generate a return on investment and keep shareholders happy, the companies begin flipping through the pages of the Diagnostic and Statistical Manual of Mental Disorders looking for obscure entries that the products of their laboratory work could be used to treat.

“There are other factors, too, like physicians who are pressed for time, consumers who are pressed for answers, and a society that is pressed to its limits in so many ways that it’s no wonder we find ourselves vulnerable and demanding cures of all sorts,” writes Cassels.

“In many ways, we’re all innocent kids being offered simple, consumable solutions to a whole range of real and pseudo diseases, the treatment of which by pharmacotherapy is sometimes as wasteful as it is wrong-headed,” he continues.

And as consumers it can be difficult to resist the lure of a good sales pitch.

It’s enough to make you anxious

“Xena’s taking Xanax, to help with her anxiety—

it comes up lots in company, and often in society.

But as much as she would like to feel that certain sweet relief,

the more she takes the more she finds, it gives her way more grief.

See, all those drugs like Xena’s pill—benzos, they are called—

can slowly lose their magic, until they’re all but stalled.

But Xena keeps on taking them, because, as we predicted,

she and all her aging friends seem totally addicted.”

—from The ABCs of Disease Mongering

The story of anxiety’s rise to public consciousness has been well documented in academia and the independent press. The tale is illustrative of how disease-mongering companies achieve their aims through well-run marketing campaigns.

In 2001, GlaxoSmithKline received approval from the American Food and Drug Administration to market Paxil, (a selective serotonin reuptake inhibitor, or SSRI), not as the antidepressant it was initially developed to be, but as a treatment for generalized anxiety disorder. Arriving late to the crowded antidepressant market, GSK needed a new niche for its product and found it in anxiety. The company called upon the marketing services of the firm Cohn & Wolfe to help get the word out.

What emerged was a triumph of modern public relations that inundated popular media with heartfelt tales of people who suffered from this epidemic of general anxiety disorder, which, according to GSK, Cohn & Wolfe, and a few sympathetic psychiatrists, was sweeping the nation.

Barry Brand, the product director for GSK who unveiled Paxil as a solution to the depredations of social anxiety disorder admitted in the journal Advertising Age, “Every marketers dream is to find an unidentified or unknown market and develop it. That’s what we were able to do with social anxiety disorder.”

General Anxiety Disorder was first added to the Diagnostic Statistical Manual of Mental Disorders—the bible of psychiatric work in the United States—in 1980, where it languished relatively unnoticed until 1998 when GSK (then SmithKline-Beecham) began looking at potential new indications for its SSRI pill, given that Prozac and Zoloft were already being widely consumed. GSK found what it needed under the umbrella of what had previously been characterized as social phobia. Meanwhile, Cohn & Wolfe was awarded the “Best P.R. program of 1999” award by the New York Chapter of the Public Relations Society of America for its Paxil promotion in 2000.

Those who work in the field treating anxiety know firsthand the effects of a legitimate case can be overwhelming for the patient, and potentially deadly for those at the extreme end of the conditions. UBC psychologist Melisa Robichaud says pharmaceutical intervention should be the last line of defence against anxiety disorders, especially for young patients.

“The strategies we talk about in the treatment of anxiety are Cognitive Behavioral Therapy,” she explains. “CBT is a psychological treatment, it is a non-pharmacologic treatment, and the research shows—and there is a lot of it, as CBT is empirically based and everything comes from research—it is the most effective way of dealing with anxiety.

“I am not a proponent of medication, but I can tell you there are people out there whose anxiety is so severe that it causes them distress to such an extent that it is difficult for them to carry on normal life, and they have taken medication and some people find it beneficial. Is it the first line of treatment? I don’t think so, not at all.”

Robichaud says the upcoming Victoria session will highlight techniques parents can use with their children in the home to minimize their anxious feelings. These include breathing techniques, relaxation techniques, and trying to concentrate on hopeful thoughts, rather than the catastrophic jumble that accompanies a serious anxiety disorder.

However, observers like health policy analyst and researcher Janet Currie argue that even inviting people into the discourse around disorders like social anxiety expose them to the possibility of unwarranted pharmacological intervention.

“Anxiety and depression are two conditions that are limitless in terms of those who could be diagnosed. Who isn’t depressed, worried or anxious at times?” says Currie. “It doesn’t really matter what [the organizers] talk about at the meeting—they’ve already done their jobs.”

Cassels argues that the limited resources of bodies like UBC’s Anxiety Disorders Clinic, where Robichaud works, means most people concerned with their own anxiety issues, or those of their child, will seek advice from their family practitioner, a potentially problematic situation given the amount of marketing directed at doctors by big pharma.

A recent study from York University’s Dr. Joel Lexchin showed big pharma in the U.S. spends an average $57.5 billion marketing its products each year—more than the firms spend on research and development. Using the 1/10 rule often applied to cross-border economics, that means Canada’s 65,000 doctors face a $5.7 billion barrage of marketing work from the pharmaceutical companies, either in the form of direct-to-office visits or through online meetings. Cassels says family physicians, being generalists in their professions, are rarely in a position to conduct independent research into a given drug’s effectiveness and are prone to taking the recommendations of the marketers’ sales pitch at face value.

“It’s very subtle, and certainly not all doctors are taken in by this. but they are targeted from medical school on,” says Cassels. “If you’ve got a product you can only sell by convincing a small group of people of the value of that product, you would intensely focus your marketing efforts on that small segment.

“The point is, if you own shares in a pharmaceutical company, you want those shares to go up and they will only go up if the marketing strategy works. So for the physician to say, ‘The marketing doesn’t work on me,’ is contradicted by the fact the companies keep selling more drugs and the value of the companies’ shares continue to increase,” says Cassels.

The systemic involvement of the pharmaceutical industry in our health systems does not stop at the doctor’s doorstep. The recent inclusion of Canada’s leading pharmaceutical lobbyist, Russell Williams, on B.C. health minister George Abbott’s new PharmaCare Task Force demonstrates the degree to which the drug business has transcended the medical profession and become a player in the formation of government health policy.

A strange phenomenon occurs at the confluence of dollars and diagnoses. Those who need the most help get lost in the system, those who sold their sickness get addicted, and those observing from the sidelines are left to wonder how the next sales pitch will strike. Really, it’s enough to make anyone anxious. M


An Alphabet Soup of Medicalization

Cassels’ ABCs informative and fun

The collision of legitimate medicine and disease mongering on the part of profit-hungry corporations is not occurring only in the realm of our mental health. There is a battle for our bodies too.

Before publication of The ABCs of Disease Mongering, Cassels presented a preliminary draft of his new work to a board room of B.C. Ministry of Health employees to solicit feedback. He says that while most comments he received were positive, one area of contention his audience identified concerned his position on influenza vaccinations. As the following verse illustrates, Cassels feels the annual flu vaccine campaign has gathered a momentum that far surpasses what the scientific literature on its effectiveness would support.

“What to do? What to do?

Winter’s here and so’s the flu!

Everyone across the land,

just like our friend Ferdinand,

will roll up their sleeves and get in line,

and pay for shots to keep them fine.

Nobody wants the chills and aches,

or the dreaded bird flu, so do what it takes.

The flu-mongers say, ‘It’ll be a bad year,

get your shot in the arm, so you won’t have to fear.’

Of course, there’s small proof the shot does the trick.

Despite all the hassle, you could still get sick.”

Cassels supports his rhymed recap on the subject with data contained in a review from the Cochrane Collaboration, a non-profit independent organization that reviews and synthesizes clinical trial data to arrive at a large-scale picture of the effectiveness of medical treatments. The Cochrane group study of the effectiveness of flu vaccinations was released on October 28, 2006. In it, researchers consolidated the findings of 38 clinical flu vaccination trials on 66,248 healthy people. The Cochrane Collaboration ultimately concluded “There is not enough evidence to decide whether routine vaccination to prevent influenza in healthy adults is effective.”

The Cochrane review went on to state that while the vaccine works against the virus 80 percent of the time, and worked against influenza-like illnesses 30 percent of the time, it made no dent in the number of people admitted to a hospital or experiencing complications.


Monday Magazine

Founded in 1975 to provide a critical voice in Victoria's political and cultural communities, Monday Magazine continues to shake British Columbia's conservative capital city with tell-it- like-it-is features and reviews. Targeting educated, active adults and Victoria's growing youth market, Monday...
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