Bmj Usa: Editor's Choice

What's wrong with that?

BMJ 2003; 327 doi: (Published 19 November 2003) Cite this as: BMJ 2003;327:E115

This article originally appeared in BMJ USA

Five articles in this issue are taken from the April 13, 2002 theme issue of the BMJ, which was devoted to “medicalization.” That term refers to the practice of giving a medical name to what many might consider a “non-disease,” such as social phobia or male pattern baldness.

Whether these are “non-diseases” is somewhat contentious. Many contributors to the BMJ theme issue doubt that these conditions warrant the stature of disease, whereas victims of these conditions may feel otherwise. Something is clearly amiss when the normal troubles of life are labeled as pathological, but those in suffering often resent having their ailments dismissed as “non-diseases.”

The BMJ theme issue would have us believe that medicalization is something odious, but it is nothing more than the profession naming a problem it feels it should or can correct. Critics of medicalization doubt that the problems need correcting, at least by doctors. They have a point. Anxiety at parties can be distressing, but what's wrong with that? Must it be named “social phobia” and treated with drugs? Nihilism, however, is a safe haven for ignorance. Was James Parkinson wrong to “medicalize” the condition that bears his name when, in 1817, some might have considered a resting tremor an odd nuisance of aging (BMJ USA p 337)? Freemantle and Hill say that treating risk factors to benefit a few (eg, statins for low-risk individuals) is medicalization (BMJ USA p 310). But for two centuries legendary public health successes—from building sewers to smallpox vaccination and blood pressure control—have slashed mortality rates and eradicated disease by doing for many to benefit a few. If saving lives this way is medicalization, what's wrong with that?

But medicalization is not always so innocent, especially when it convinces people they are diseased when they experience the normal troubles of life and death (BMJ USA p 347). How many children are mislabeled with attention deficit hyperactivity disorder because they are simply boisterous? Thousands of women are told they have low bone density, creating the false impression that they have a disease, when what they actually have is a risk factor (BMJ USA p 339). Some women, fearing that their bones are brittle, abandon exercise to reduce their risks, not realizing how much this increases their risk of dying from cardiovascular disease.

The darker side of medicalization is that conditions that are hardly diseases are purposely repackaged as such, often with help from Madison Avenue, to sell drugs and other health care products. How cleverly industry shapes public opinion is detailed by Moynihan et al (BMJ USA p 339). In Disease Mongers, the late Lynn Payer explained that “trying to convince essentially well people that they are sick … is big business” (BMJ USA p 351). Should a business not promote its product? If drug makers use the same advertising tactics as any other manufacturer, what's wrong with that? But the money that consumers lose when advertisers lure them into buying blue jeans and cars is far less precious than the health at stake when the products are drugs and disease.

Rapid response, BMJ USA p 337,

Medicalization, limits to medicine, or never enough money to go around (Freemantle), BMJ USA p 310,

Between hope and acceptance (Clark), BMJ USA p 347,

Selling sickness (Moynihan) (twice), BMJ USA p 339,

Book review: Disease Mongers (Moynihan), BMJ USA p 351,

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