Intended for healthcare professionals

Feature Medicalisation

A new deal on disease definition

BMJ 2011; 342 doi: (Published 03 May 2011) Cite this as: BMJ 2011;342:d2548
  1. Ray Moynihan, author, journalist, and conjoint lecturer
  1. 1University of Newcastle, Australia
  1. Ray.Moynihan{at}

How do we replace the old panels of conflicted experts? Ray Moynihan investigates

As this still-fresh century rolls forth, medicine’s imperial project looks on the whole to be in remarkably good health, despite the odd failed campaign. With our new found fondness for preventing disease and premature death we’re redefining more and more of the healthy as sick, and then prescribing our new patients lifelong pharmaceutical solutions to reduce their risks. One recent analysis suggests that the definitions of common conditions have broadened so much that virtually the entire older adult population is now classified as having at least one chronic disease.1

Yet a growing scrutiny of the seemingly well meaning march of medicalisation suggests we may sometimes be pushing boundaries too wide, and setting treatment thresholds so low, that people with mild problems or modest risks are exposed to the harms and costs of treatment with little or no benefit.2 It has also become clear that many of the people on the panels that are widening the patient pool have direct financial ties to the companies benefiting from that expansion. Concerns are mounting that doctors are collectively overdiagnosing millions of what were until very recently considered healthy people, and leading voices are asking whether it is time society at large took a more direct role in deciding who really warrants a medical label.3 Some are now calling for a major renovation of the way in which we define disease.

Conflicted panels widen diseases, lower treatment thresholds

Among the 12 members of the panel that created the controversial diagnostic category “pre-hypertension” in 2003, 11 received money from drug companies, and half of those people declared extensive ties to more than 10 companies each.4 Critics have rejected “pre-hypertension” as a dangerous pseudo-syndrome that could increase drug company markets,5 while others point out that …

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