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Editor's Choice

Who should define disease?

BMJ 2011; 342 doi: (Published 11 May 2011) Cite this as: BMJ 2011;342:d2974

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Experience is the universal mother of sciences.

Dear Fiona,

The medical establishment began thousands of years ago with
altruistic motives of 'curing rarely, comforting mostly, but consoling
always". Rather, it all began basically to allay anxiety, relieve pain
and suffering of mankind. Lately, medical establishment seems to have
transformed itself into big business. The drug and technology people
seem to have invaded the medical profession in such a way that recent
studies published almost simultaneously in the leading British Journal
Lancet and the American New England Journal of Medicine show that medical
education is completely under the influence of drug and technology

As if that is not enough, lately reports are pouring in from
different sources showing how drug companies get medical scientists to
invent new diseases to sell their wares. This was going on in the past in
a more dignified but quiet style. Lately it has all come out in the open.
The ugliest one is the example of a new disease, "Female Impotence".3 Dr.
David Graham shows how even the FDA can easily be fooled by the Pharma
lobby. (Google)

One could always confuse people with complicated statistics, anyway.
To achieve this end they attempt to medicalise human life at every stage
and create newer problems to sell their drugs. Researchers with close ties
to drug companies try to define and classify medical disorders at company
sponsored meetings. Practising doctors do not realize the attempts by
these drug giants to establish "normative data" for a range of
physiological measurements, like normal blood pressure, sugar, cholesterol
and sexual response etc. These levels keep changing almost by the day
depending upon the need for drug sales. Serum cholseterol level which were
at 150-250 mg % during my student days have come down below 200 mg lately.
I have not been able to find a good scientific reason for this fall except
that the cholesterol lowering drug market would have gone up by a few
billion dollars. Similar is the story with blood pressure levels and sugar

To give the reader the enormity of this problem a few such meetings
are cited here. A large gathering of "clinicians", "researchers", and drug
company representatives met for two days at the Cape Cod Hotel to "discuss
the future directions for research and clinical trials in the area of
female sexual dysfunctions against the backdrop of widespread lack of
agreement about its definition." 4,5

Since then many epidemiological studies have been "generated" to show
that anywhere between 49-80% of all women suffer from one of the above
mentioned sexual dysfunctions and the company claims that they could all
be helped by regular use of sildenafil. This is the similar story with the
definition of hypertension, hypercholesteraemia, hyperglycaemia and many

Earlier a similar campaign was mounted to sell expensive hormones
(HRT) to post menopausal women. It was made out that regular HRT use
after menopause would not only make life enjoyable, it would, at the same
time, prevent dangerous diseases of elderly women like bone loss and
fractures, heart attacks, cancers and what have you. The brainwashing of
doctors was such that the poor souls did not and could not think beyond
the artificial boundaries of the bio-medical model of man in this dynamic
universe, where Nature has a reason for everything but human reason cannot
comprehend all of it. If hormones were good for women after menopause,
why did Nature stop the secretion of such good a thing after menopause.
Now comes the revelation that long term use of HRT after menopause is

A glaring lacuna in the medical wisdom that affects the lives of
millions of hapless humans is in the arena of doctors trying to predict
the unpredictable future of apparently healthy people with the limited
knowledge of the phenotypical (body) features that the present bio-medical
model permits them to assess.8 Routine check up would dangerously damage
human health if doctors intervene with drugs or surgery to alter the
initial state of the partial knowledge obtained from screening, avers a
recent editorial in the leading British Medical Journal.9

I have written many times in the past on these problems but who cares
unless it comes from the Horse's pen (mouth).

"I don't give them hell, I just tell the truth and they think it is

Harry S. Truman.

yours ever,



1) Editorial. Drug company influence on medical education in USA.
Lancet 2000; 356: 781.

2) Marcia Angell. Is academic medicine for sale? N.Engl.J. Med 2000; 342:

3) Moynihan R. The making of a disease: female sexual dysfunction. BMJ
2003; 326: 45-47.

4) Special supplement. Int. J Impotence Res. 1998; 10: S1-S142.

5) Basson R, Berman J, Burnett A, et. al. Urology 2000; 163: 888-893.

6) Beral V, Banks G, Reeves G. Evidence from randomised trials on the long
term effects of hormone replacement therapy. Lancet 2002; 360 942-944.

7) Loeb T, editor. Cecil's Textbook of Medicine. 2002. Page 1202.

8) Firth WJ. Chaos-Predicting the unpredictable. BMJ 1991; 303: 1565-1568.

9) Stewart-Brown S and Farmer A. Screening could seriously damage your
health. BMJ 1997; 314 : 53

Competing interests: No competing interests

13 May 2011
BM Hegde
Editor in Chief, Journal of the Science of Healing Outcomes
Mangalore-575 004, India.