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Lynn Payer's Disease-Mongers is passionate, provocative, and
prescient. The book's thesis is simple, compelling, and for many people utterly
counter-intuitive: doctors, drug companies, and device manufacturers are engaged
in "broadening the definitions of diseases" in order to increase demand
for their products and services. Since the book was first published in 1992, the
evidence has mounted that Payer's disturbing view of the medical establishment
is all too accurate.
Payer quickly establishes her argument that the boundaries of disease are fluid,
and that there are too many vested interests trying to push those boundaries
as wide as possible. In tough, accessible prose she details the way that doctors,
drug companies, test makers, medical writers, hospitals, courts, and insurance
companies are all caught up in a frenzy of disease-mongering: "Trying to
convince essentially well people that they are sick, or slightly sick people
that they are very illis big business."
Payer also explores the many tactics of the disease-mongers, including turning
normal life into a disease (for example, menopause), exaggerating the suffering
attached to mild problems (for example, premenstrual syndrome), and using extreme,
unrepresentative examples of severe symptoms when depicting a common condition
(for example, bone-thinning). Payer's criticisms of the media are particularly
biting, arguing that it often forms part of an "unholy alliance" with
industry and the medical profession, to make a condition look as widespread
and serious as possible.
But the book is in fact much bigger than a critique of disease-mongering. It
also introduces a lay audience to the move to an evidence-based approach in
medicine, and ends with constructive suggestions for reshaping the US healthcare
system.
Disease-Mongers is not a well known book, partly because of
its own flaws. Although Payer synthesises highly complex scientific evidence
and makes it comprehensible to a wide lay audience, she has not crafted a racy
non-fiction narrative.
The best things about this book are its three central claims which are illustrated
by plenty of examples, and backed by good evidence from the world's leading
medical journals --
- Firstly, more and more of the processes and ailments of life are being seen
as medical problems.
- Second, self interested forces seek to make those medical conditions look
as widespread and serious as possible.
- Thirdly, the therapies for these problems are oversold: their benefits are
played up, their harms are played down.
To write the book off as gratuitously anti-doctor or anti-drug would be a gross
error. The great power of Payer's thesis is this: resources wasted on
expensive and needless tests or therapies for the healthy are resources that
could have been available to ameliorate or prevent the suffering of the genuinely
ill. Yes, deciding where to draw the line between what is healthy and
what is legitimately treatable pathology is not always easy. But as Payer has
helped us to understand, to continue to allow those with vested interests to
have such a strong influence over those decisions is plainly unhealthy.
Ray Moynihan, journalist.
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