/ 14 October 2005

The wages of fear

It is extraordinary how many of the decisions we make are fuelled by fear. Persuading people to be afraid of something or other is one of the most effective of marketing tools. Every car advertisement these days has its inbuilt motorists-beware message. “In case you are not realistic enough to be scared of an accident, let us remind you that if our model B’s electronic brake distribution, anti-lock braking system, anti-skid technology, superior road-holding and suspension don’t help you to avoid rolling, sliding and slamming into a concrete truck, we have prepared for the worst. Model B has no less than six airbags, self-tightening seat-belts, a crumple-zone, side-impact- and roll-bars and a chrome steel passenger cage that will save you and your loved ones from being mangled like the idiots who bought their cars from our competitors.

“When you have a puncture out in the dark and lonely, don’t worry. Your run-flat tyres will allow you to drive blissfully away from that menacing platoon of the criminally intent coming out of the roadside shrubbery. Model B’s halogen peer-round-corners headlights will make sure that your drive to sanctuary is properly illuminated.”

Fear is a big sales point. Not only in cars. The entire insurance industry is predicated on fear of one kind or another. There is so much else that we buy, hire or invest in so as to appease our anxiety or trepidation. Often for very good reasons. The security business in South Africa is enjoying boom times, which is not surprising when housebreaking, and the gratuitous violence that goes with it, are so common. But it’s still good old fear that is being peddled when the security salesmen talk of proximity infra-red beams, 16-zone panels, movement detectors, panic buttons, armed response and all the rest of their terrifying panoply.

A book recently published in Canada adds a forbidding new dimension to our already glutted anxieties. Written by Alan Cassels, a drug policy researcher at the University of Victoria in British Columbia, and Roy Moynihan, a specialist journalist, it is called: Selling Sickness: How the World’s Biggest Pharmaceutical Companies are Turning us all into Patients.

The authors have much to say about what they call “drug company-funded disease creation”. Their contention is that the giant pharmaceutical companies are subversively promoting dedicated research intended to expand the boundaries that define what illness is. That way they get to sell even more drugs.

Nothing more than the typical physical complaints of life are now being represented as “diseases” by ostensibly independent researchers who just happen to be hugger- mugger with the big drug companies. Premenstrual tension is now being marketed as “premenstrual dysphoric disorder”. Coincidentally, there are brand new specific drugs available to counteract it.

It’s no longer good enough to be of a shy or placid nature. Instead, you are now suffering from a psychiatric pathology called affective social anxiety disorder, controllable only by you signing up to lifelong dependence on lithium therapy. Remember Ritalin? There’s no need to continue to feel envious of your toddler’s need for personality-containment capsules. There’s now a mint-condition mental affliction on offer called Adult Attention Deficit Disorder.

Some say the drug companies first invent a drug and then pay a bunch of tame doctors to invent a disease it will cure.

The book tells of how drug companies fund medical conventions all over the world. Ostensibly, these conventions are held to promote communication and discussion about medical advances. In many cases, they are used primarily to introduce new drugs to the medical profession. The authors of Selling Sickness found there were undisclosed ties to drug companies among eight out of nine experts who formulated new cholesterol guidelines for the United States. These so lowered the ceiling for healthy cholesterol levels that some 40-million Americans were placed in the cholesterol danger-zone. Needless to say, the drugs to combat this artificial level are right out there on the pharmacist’s shelves. The drug companies just wanted to sell a lot more of them. Get the public slobbering with its terror of exploding arteries and statin sales will run riot.

Interviewed in Newsweek magazine, co-author Ray Moynihan said that the drug companies are always on the look-out for ways to maximise their markets. “One way is to redefine more and more people as sick. There’s an informal relationship between the drug companies and aspects of the medical profession … every time a panel of experts come together, they want to nudge the boundaries a little further.”

The other author of Selling Sickness, Alan Cassels, sums it up. “From their domination of guideline committees, their involvement in physician ‘education’ and their marketing of fear to consumers, the pharmaceutical industry is using its immense power to drive more and more of us towards another prescription.”

There’s a dictum, patiently lambasted into the minds of every drug company employee. Anyone joining Merck or Roche or Boehringer-Ingelheim has to recite or write out the basic mission statement a hundred times every week or they don’t get paid: “With the greater population of the developed world already heavily addicted to drugs, who’s to say a few more will hurt?”