Profitably Inventing New Diseases

A recent article in Medical Marketing and Media (May 2003), aimed at the marketing departments of the pharmaceutical industry, provides an extraordinary view of this industry of which the public, unfortunately, remains unaware. Vince Parry, the “Chief Branding Officer” for a company called “InChord,” tells his pharmaceutical company readers — and potential clients — how to increase sales by combining the “creation” of a disease with a drug to treat it.

There is no dispute that the pharmaceutical industry, first and foremost, is an industry needing and seeking ways to increase profits for its shareholders and that larger profits require a continuing increase in sales, a feat orchestrated by marketing departments. But in the past, simply letting the public know the uses for a drug too often failed to generate the robust growth in sales desired. The solution, as described by Parry, is something called “condition branding” in which a company defines a new condition (along with its worry-provoking symptoms) to convince physicians and patients that they must treat the condition and use one particular drug.

Parry begins with an early example: Warner-Lambert’s desire to expand its market for Listerine, which in the 1920s had multiple uses but lacked sales growth. Warner-Lambert’s strategy was to take a harmless concept, unpleasant breath, and change its name to “halitosis,” thereby creating “awareness — and anxiety — around a serious-sounding medical condition.” Halitosis, in ads, was made responsible for problems ranging from lack of career advancement to divorce, and within six years, sales increased from $100,000 to $4 million.

Today, healthcare marketers are much more imaginative: they take their pharmaceutical product and add in “external thought leaders [usually physicians who vouch for the drug’s worthiness], support groups and consumers.” Parry lists three principal strategies that can be used to create a new condition:

“Elevating the importance of an existing condition

Redefining an existing condition to reduce a stigma

Developing a new condition to build recognition for an unmet market need.”

An example of the second suggestion is Pfizer’s marketing strategy that turned Viagra into an acronym for erectile dysfunction.

Drug companies are now masters of suggestion number three — developing a new condition — spectacularly so in the field of mental health. Parry advises, “No therapeutic category is more accepting of condition branding than the field of anxiety and depression.” The manual used to describe mental disorders, the Diagnostic and Statistical Manual of Mental Disorders (DSM), is compiled by the American Psychiatric Association, an organization heavily funded by the pharmaceutical industry.

As a result of carving out more and more subcategories, DSM has increased dramatically in size from 106 categories (in 1952) to 357 (in 1994). Parry states that, “Not surprisingly, many of these newly coined conditions were brought to light through direct funding by pharmaceutical companies, in research, in publicity or both.”

Xanax. One example of such a newly created mental health need was Xanax for panic disorder, a condition first appearing in the third edition (DSM-III) in 1980. To create this need, the manufacturer, Upjohn, funded research, publications, and speaking tours. They also funded an unrestricted three-day “thought leader conference at NIMH [National Institutes of Mental Health],” a U.S. government agency. As a result, NIMH published a consensus on diagnostic criteria for panic disorder and Upjohn was able to get the first drug for this disorder approved from the Food and Drug Administration. Parry notes that since DSM-III first recognized the syndrome of panic disorder, its incidence has increased 1000-fold.

Sarafem. Lilly was a beneficiary of DSM-IV with its newly created “premenstrual dysphoric disorder” (PMDD). Unknown to many, except to industry insiders, was the fact that Lilly’s drug to treat PMDD, Sarafem, was identical to Prozac. However, since Prozac connoted mental disorder, Lilly changed the brand name (to Sarafem) and pill color (to lavender) and in their ads, built public awareness, “recasting diagnosis to conform to the new criteria.”

Zantac. In the digestive disease area, Zantac (made by GlaxoSmithKline; GSK) was originally used to treat ulcers, a limited market. By converting Zantac into a treatment for a disease, gastroesophageal reflux disease (GERD), GSK opened up a large market for a condition that could be treated chronically. GSK ads aimed to frighten the public with the potential for serious long-term consequences if GERD were left untreated. According to Parry, GSK went even further, creating the Glaxo Institute for Digestive Health for “education and awareness.” The institute sponsored research awards, involved powerful third-party advocates such as the American College of Gastroenterology, and established a public relations outfit ,“Heartburn Across America,” all of which succeeded in driving sales to $2 billion at the peak of its popularity.

Parry lists questions to help industry determine whether “branding is right for your product.” He concludes, “If you feel that your product could benefit from condition branding . . . remember the basic lessons learned over time: evaluate all the strategic options for what suits your product best, develop nomenclature, . . . and build consensus [convince the medical professionals] early on.”

What is never mentioned is that many drugs that people are induced to take as a result of this pressure are not only not needed but may cause adverse reactions that result in extra doctor’s visits or even hospitalizations and deaths. The public needs to become aware of the subterfuges employed by the pharmaceutical industry — to use Parry’s phrase, “a better brand of illness” — and keep these clearly in mind in order to avoid being misled and potentially harmed.