Laboratories define new pathologies in search of more market options:
Raloxifene (Evista, Lilly Laboratory) at 75% reduces the risk of fractures in women after menopause. The ropinirol (Requip, Glaxo) relieve restless legs syndrome, which affects 20% of the population, and methylphenidate (Ritalin, Novartis) attenuates hyperactivity, that 8% of children suffer. Proliferates female sexual dysfunction, bipolar disorder grows, increases osteopenia.Tudo the above is true. But not the whole truth, because the statistics are diverted, although technically correct, see the problem of artificial perspective. And are the key emerging debate about the "trafficking of illness (disease mongering). It is a loaded term, and intentionally. It was promoted by Australian journalist Ray Moynihan, who now works at the School of Medicine and Public Health, University of Newcastle (Australia). And he wants to denounce "the sale of diseases by expanding the boundaries of pathology in order to open up markets for those who sell and administer treatments" (PLoS Medicine, May 2008). Although the term "disease mongering" has been appropriated by psychiatry movement and the cult of Scientology, the debate is serious and has reached the technical literature. And also those responsible for public health. The Health Council of Madrid, for example, demanded last year that firms Lilly and Procter & Gamble slow down the promotion of their products (Actonel and Evista) to prevent fractures. "In Europe the drug companies are already marketing their drugs to prevent fractures in women with osteopenia [slight deficit of bone mass] and other conditions which, according to his calculations, affecting almost half of women after menopause, "said Dr. Pablo Alonso, the department of clinical epidemiology and public health hospital Sant Pau.Alonso is the principal author of a study of disease mongering and osteopenia published this year by the British Medical Journal. His conclusion is that "exaggerated the risks of osteopenia and undervalued the side effects of pharmaceuticals." He refers to four active ingredients: raloxifene, alendronate, risedronate and ranelate estrôncio.Esses products have proven their effectiveness for preventing fractures in women with osteoporosis. The question is whether to extend them to more common osteopenia. The industry relies on it for four scientific papers published in recent years, such as that opened this article: "Raloxifene reduces fractures by 75% for osteopenia. It seems a strong argument. But the statistic is distorted. Mathematician John Allen Paulos explains this kind of diversion in his book "A mathematician reads the newspaper" is a polluting chemical plant nearby, and one study concluded that the risk of a rare type of cancer has doubled in the neighborhood. Naturally, everyone abandona.Mas should not, because this cancer is so rare (0.0003% say it affects the general population) that the doubling of their risk (up to 0.0006%) is negligible. For women with osteopenia, your fracture risk is so low that reducing it 75% is irrelevant: it would be necessary to medicate 270 women over three years to prevent one fracture, according to Alonso and his estimate is more than that colegas.Mas . Possible side effects of ranelate - causes diarrhea, and there are doubts about their cardiovascular and neurological consequences - are not mentioned at any time. Nor those of raloxifene, despite increasing the risk of stroke and heart attacks. Neither the sequelae of gastrointestinal alendronato.Para finish the work on the product of Lilly brings the signing of three employees of Lilly, the substance of the Merck not only was funded by Merck as three of its authors acknowledge conflicts of interest, the drug distributed in Spain by Procter & Gamble include two experts from Procter & Gamble, the product of the laboratory Servier bears the signature of three consultants from Servier, which also financed the study.The own definition of osteopenia is under the scrutiny of experts on trafficking in human diseases. The criterion is based on bone mineral density. If it is much smaller than normal (2.5 standard deviations below the mean), osteoporosis is diagnosed. If not much (between 1.0 and 2.5 standard deviations below the mean) is diagnosed osteopenia.Na reality, these criteria were published in 1994 by a small study group associated with the World Health Organization (WHO) and are not intended be a pattern of diagnosis - the authors consider their own "somewhat arbitrary" - But merely to help normalize the epidemiological studies. Alonso also stressed that the group had funding from WHO laboratory Rorer, Sandoz and SmithKline Beecham.A vagueness of diagnostic criteria is a common theme in the debate on trafficking diseases. The researchers Steven Woloshin and Lisa Schwartz of Dartmouth University, said that the incidence of restless legs syndrome "has been exaggerated to open markets for new drugs." The evidence presented at 1st international congress dedicated to the trafficking of diseases, held two years ago in Newcastle, Austrália.Na same meeting the psychiatrist at the University of New York documented Leonor Tiefer the role of the pharmaceutical industry "in the creation of a new condition called female sexual dysfunction." And another psychiatrist, David Haley, of Cardiff University, criticized "the increasing promotion of bipolar disorder and drugs to treat it." The discussion becomes more delicate when it affects some types of cancer. For example, the English government approved a year ago to market the vaccine against human papillomavirus to prevent cervical cancer, the autonomous communities and proposed its inclusion in the calendar of vaccinations from the National Health Service (NHS). Germany, UK, Belgium, France and Denmark had already taken similar measures. The vice president of the English government, Maria Teresa Fernandez de la Vega, explained that cervical cancer is the second most common tumor among women and causes 280 000 deaths worldwide each year. In Spain emerge every year 2100 new cases.The most experts supports this decision, but not all. The NHS 'not taken the most rational decision possible, "says a group of six researchers led by Carlos Alvarez-Dardet, professor of public health at the University of Alicante and director of the Journal of Epidemiology and Community Health." These experts estimate the cost minimum extent of 125 million euros per year (each vaccine it costs 465 euros). And calculate that "when you start to prevent the first cases of cancer within 30 years the NHS has spent 4 billion. Avoiding a single death will then cost 8 million euros." Each year die from this cancer in Spain 600 women, a rate of two deaths per 100 000 women aged risco.Com a drug of proven efficacy, the economic arguments may be secondary, but this is not the case of a vaccine against papilloma , according to these experts in public health. The cervical cancer usually takes decades to develop, and the earliest phase III clinical trial began four years ago. "The vaccine has been promoted as an effective tool in preventing cervical cancer, but that scientific evidence does not exist, "afirmam.Esse virus, however, because one of the most common sexually transmitted infections. They usually give two years before, but if they persist can evolve to cancer in 20 or 30 years. More than a hundred varieties of the virus, but authorized vaccines (Gardasil, from Merck, and Cervarix, GSK) to protect against the cause 70% of cancer cases cervical.Uma team of researchers led by Teresa Ruiz Cantero, the department of public health at the University of Alicante, studied the communication strategies of laboratories, focusing in medicines for menopause and dysfunction erétil.Também here a common strategy is to "broaden the range of information" through the "spread of the disease from severe to minimal symptoms. The drugs today are consumed by healthy populations off the initial indications." Segundo Ruiz Cantero, were sent messages like "more than half of men over 40 have erection problems," which are "a clear manipulation, biased and simplistic messages that increase the perception that the problem is very prevalent, almost epidemic ". These experts point out that WHO's objective is to make a rational use the drug, which is not achieved if the industry raise the prevalence or may not include all information in advertising of the drug. The WHO also certainly speaks of the "search for truth" in medicine. "Should it provide a concert of English universities to regulate the use of his name in marketing campaigns of pharmaceutical companies," says Ruiz Cantero. "And to impose transparency on the funding of university research." Patients' associations should also disclose which companies financiam.A Internet could help, but is full of drug information disseminated by their respective manufacturers. Ruiz Cantero believes that the Ministry Health should lead to information on the Internet. "Just the other institutional sites would have to periodically update their information." The study's findings were published by the Institute of woman director of the International Federation of Pharmaceutical Manufacturers, Harvey Bale, defended last year at a meeting of consumers a hundred countries, the industry's ability to promote their products ethically. But only after admitting some "examples of exaggerated giveaway." The British pharmaceutical employer issued a leaflet to reporters in which he admits the number of diseases is growing, but argues that the sector companies are not responsible for its definition. Glaxo, in turn, denies that the promotion of your medicine for restless legs syndrome is a case of trafficking of diseases. "Part of the problem is that the industry spends on promotion about 25% of its sales figure of almost twice that of research, "says Moynihan. Marketing strategies, according to this specialist include ads on television about "remedies for lifestyle, public awareness campaigns about new diseases and the" financing of patient and doctors. " EL PAÍS
Javier Sampedro
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