A call to challenge the “Selling of Sickness”BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f2809 (Published 14 May 2013) Cite this as: BMJ 2013;346:f2809
- Leonore Tiefer, convenor, New View Campaign1,
- Kim Witczak, co-founder, WoodyMatters2,
- Iona Heath, immediate past president3
- 1Department of Psychiatry, NYU School of Medicine, New York, NY 10009, USA
- 2Minneapolis, MN 55401, USA
- 3Royal College of General Practitioners, London, UK
The sense that medicine is out of control is generating a rising tide of concern that includes the BMJ’s Too Much Medicine campaign.1 Throughout history, unscrupulous people have preyed on our universal fears of suffering and death and made money by selling dubious remedies. The hope that the growing scientific foundation for medical practice would consign such activity to historical oblivion has proved to be a vain one. Indeed, contemporary enthusiasm for the commercialization and marketing of healthcare seems to offer ever wider opportunities to sell medical treatments. The results of medical research are often distorted or suppressed for commercial gain, and systems that attempt to control clinicians’ behaviour through payment by results drive overdiagnosis and overtreatment.2 3 Patients experience well documented harms as more and more often financial imperatives are allowed to trump clinical judgment.4 Harm is also caused by well meaning doctors trying to save lives by diagnosing serious conditions earlier,5 which inevitably drives up overdiagnosis and overtreatment. Well meaning doctors, patients, politicians, and journalists consistently overestimate the benefits and underestimate the harms of most medical treatments.
These problems have been increasingly aired and analysed on websites, in editorials, and in dozens of recent books by investigative journalists, crusading physicians, earnest advocates, and academic reformers.6 Proposed solutions include greater regulation of the medical and scientific communities to improve accountability and to expose conflicts of interest, greater transparency in publishing and education, much greater patient involvement in decision making, and higher standards of professional integrity. Yet the fundamental problems remain and the situation seems to get worse each year.
A comprehensive social health movement that combines the perspectives and resources of healthcare professionals, patient representatives, and consumer advocates in a partnership that aims to counter overdiagnosis and overtreatment is well overdue. A partnership model that affirms themes of mutual respect and collaboration can enable questions and concerns to be raised in different voices for different audiences; can foster wider dissemination of key messages to enlarge collective action; and can generate diverse strategies to promote public awareness and policy change.
A recent international conference (www.sellingsickness.com) held in Washington, DC, brought together many different stakeholders in healthcare, including professionals and consumer advocates, to discuss how to end disease mongering and how to challenge the undue commercial influences that distort so many aspects of healthcare research and practice. This self funded grassroots conference deliberately sought to model the possibility of a new social health movement with equal representation of professional and advocate perspectives and extended time for discussion.
A “Call to Action on Selling Sickness” was developed by a diverse group over a period of months, uploaded on to the Selling Sickness conference website for preview, and opened for signatures from the final day of the conference. Among its list of concerns were the problems of biased science, hidden data, inflated diagnostic categories, unnecessary screening and treatment, and the widespread neglect of social factors when treating illness. Its recommendations included a call for a new movement of alliances and actions to “ensure a firewall between commercial influences and medical guidelines.” The campaign aims to bring an end to direct-to-consumer advertising of diagnostics and drugs, ensure appropriate testing of new drugs and devices, put forward reform of the patent system, and promote responsible health journalism. Although there was no systematic effort to obtain signatures from the more than 240 conference attendees, 35 people signed the call for action by the end of the conference. They represented nonprofit organizations, university research groups, clinical enterprises, the Public Library of Science journals, and law offices to name a few, and came from Canada, the United Kingdom, Germany, Russia, the Netherlands, New Zealand, and the United States. The call to action on Selling Sickness is now online (www.sellingsickness.com/final-statement) and open for individual and organizational endorsement.
Using professional-advocate collaborations to tackle the problem of medical overtreatment is not a new idea. In a recent project, “Choosing Wisely,” designed by the American Board of Internal Medicine together with Consumer Reports,7 medical specialty organizations identify practices prone to overuse in their specialties and partner with Consumer Reports to disseminate consumer friendly educational materials. The list of participating specialty organizations continues to grow (www.choosingwisely.com). The alltrials.net movement has used social media to stimulate publicity and now has thousands of signatures on its petition for open access to all clinical trial data (www.alltrials.net/). The Selling Sickness call to action, promoted by an emerging advocate-professional partnership, will add strength to the new social movement for healthcare reform that may prove crucial to global health in the 21st century.
Cite this as: BMJ 2013;346:f2809
Competing interests: We have read and understood the BMJ Group policy on declaration of interests and declare the following interests: None.
Provenance and peer review: Commissioned; not externally peer reviewed.